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Habits of Experts in Pain Science

January 21, 2020 • Pain Science • Becky Vogsland

Everyone’s an expert…or are they? I guess that depends on a myriad of factors. There are courses, books, blogs, scholarly papers and podcasts about expertise across industries. One thing that unites the vast sea of experts is that becoming an expert was a process. The process of becoming an expert has been described in a stepwise approach 1,2,3 and specifically in the practice of physical therapy by Jenson and colleagues 4.

Given the existence of a progression toward expertise, it is safe to reason that these individuals would have accumulated knowledge and developed wisdom along the way. Experts often share their wisdom by teaching courses, writing books, mentoring others, and/or other scholarly work. Health care audiences are eager to absorb wisdom from experts so that they can apply this information in the care of their patients. Experts who share their knowledge and develop a following are often referred to colloquially as “gurus.” A quick look at the term seems to fit. The word is Sanskrit for “teacher” but has deeper contextual meanings that invoke concepts of values, knowledge sharing and leading by example5,6.

Physical Therapists have long been involved in the discussions of expertise and expert practice; moreover, they have championed the development of expertise in the area of pain science. We diligently follow these experts on social media, read their publications and flock to their speaking engagements. We love to hear them “talk the talk,” but have we ever considered if they “walk the walk?” To start exploring this concept, a group of EIM pain science faculty and pain science fellows-in-training reached out to experts in the world of physical therapy and pain science to ask them about their habits and/or daily routines. The request was general and unstructured, and the responses were provided in either bulleted phrases or narrative form. The opportunity to have a glimpse into the lives of experts in the field was special, and the information we received was enlightening. The problem for me was how to share all of this cool stuff with you!

Let’s start with the “Who” (See Box 1). All of the information herein has been de-identified from the individual respondents and aggregated. The list of experts is not intended to be exclusive, but rather a convenience sample of professionals with whom we were able to connect. I am very pleased to share that the first thing our experts had in common was that they were all gracious with their time and support of this project. In all, responses were collected from 6 women and 12 men representing 5 countries. Not surprising, most were primarily in Academia, but many still maintained some measure of clinical presence. It is easier to share your knowledge and publish when in an environment where that is part of the expectation of one’s assignment. This is not to say that there are not “gurus” among us who are primarily clinical. I know that they exist, as I’ve been very fortunate to meet a few.

Now let’s get to the “What.” See Figure 1 for a visual representation of the responses from our cohort of experts. The size of the words in the word cloud represent their frequency in the responses. Some filler words have been removed from the word count for clarity. The sentiment that is conveyed is one without absolutes; the words “think,” “try” and “usually” stand out. There’s also a representation of the different realms of life; “work” and “home” are featured. We’ve all heard the buzz-phrase “work-life-balance.” A concept, that if taken to mean a perfect sinusoidal wave of professional and personal effort, time, reward and fulfillment, sets most up for disappointment. I have yet to meet this “balanced” professional, but I keep my eyes open. Rather, I think this concept is fluid. There are seasons of both personal and professional life and there are one’s core values. I believe that if one can align core values with the demands of the present while keeping an eye to the future, that is a way to achieve balance. This still sounds very difficult and something I can only strive toward. I was quite pleased to see that none of the expert responses focused on “balance” in the sense of equality, but there was definitely an intentional dedication of time for valued activities.

So, what are the habits of the experts we involved in our project? All but one explicitly mentioned some form of exercise or physical activity that was intentional and planned (17/18). This made my heart soar as they are “walking the walk”. I would wager, that if I went back and asked the 18th expert specifically about exercise that they would tell me that this is an important part of their life. These experts are exemplars in life (guru quality) regarding physical activity. Experts also had dedicated time for professional reading (14/18) to stay up on the dynamic world of pain science, physical therapy practice, and health care. Other professional habits included time for research (11/18), writing (12/18), teaching (11/18), organization (9/18), managing email (9/18), coffee (8/18), and often noted getting off to a running start in the morning (7/18).

Several experts mentioned compartmentalizing work and home life, but others noted that this was conditional based on the demands at the time but that they valued flexibility. Most everyone mentioned leisure pursuits (14/18) though these varied and included a combination of recreational reading, sports/physical activities, the arts, and cooking. I found it interesting that these pursuits also seem to add to the knowledge base of these experts and give them context for translation of their expertise. Finally, some of our experts discussed a dedicated time for reflection to include thinking about their work, the work of others, and the future, while for others this seemed implied.

The experts also had an awareness of how their environment impacts their function. This was discussed explicitly by 11 respondents and indirectly by way of recognizing his/her team (6/18), family time (10/18), social time (6/18), and time with pets (5/18). About a third of the respondents specifically noted the importance of their sleep and nutrition. I wonder if this would increase if I asked more specifically about these items, or would that introduce bias from “talking the talk?” Even gurus have weaknesses.

I’ve saved the best for last. The overwhelming consistency among all of the experts was a clear passion for what they do and how they do it. This came through whether in bullets or narrative form. Concepts of values, humor, and humility were explicitly mentioned. The passion conveyed in the responses was palpable. Finally, another unanimous trait present in our gurus was a dedication to excellence. This was rarely mentioned outright but the intention by which these individuals go about their continued pursuit of knowledge and understanding and how that manifests in their work makes this unmistakable. There is also a clear desire to make things better for people with pain and to empower professionals to be a guru for their patients.

This project started a conversation about professionals who can “walk the walk” as well as “talk the talk.” May we all be so inclined. So, on your pathway to becoming an expert, here are a few takeaways to consider:

  • Move your body – Exercise, explore, recreate. Do this in a great environment and with family, friends and pets.
  • Keep learning – Read. If that’s not your favorite mode, there are many others out there.
  • Find time for leisure/relaxation – This can look different for everyone. Follow your values.
  • Consider your surroundings – The environment includes the people and physical space around you. Be intentional.
  • Get organized – Find a scheme that meets your needs. This will allow you to focus on the task at hand.
  • Be passionate – Follow pursuits that fit your values and continually strive to be better. Find the “why.” Why am I working so hard? Why am I dedicating this time?

I leave you with a request and a challenge. Please don’t settle for mediocrity. Your talent and caring are boundless and while the suffering out there is great, you have the potential to make a positive impact. I challenge you to think about what habits or elements you could start this week to help move your needle on the scale toward expert practice. Walking the walk begins with the first step. Happy Trails!


Figure 1  Created with www.wordclouds.com

1. Dreyfus S, Dreyfus H. A five stage model of the mental activities involved in directed skill acquisition. California University Berkeley Operations Research Center [monograph on the Internet]; 1980. Available from: http://www.dtic.mil/dtic/index.html [downloaded 01 November 2019]
2. Benner P. From novice to expert: excellence and power in clinical nursing practice. California: Addison-Wesley, 1984.
3. Tynjala P. Towards expert knowledge? A comparison between a constructivist and a traditional learning environment in the university. Int J Educ Res 1999; 31: 357–442.
4. Jensen, GM, Resnik, LJ & Haddad, AM 2019, ‘Expertise and clinical reasoning’, in J Higgs, GM Jensen, S Loftus & N Christensen (eds), Clinical reasoning in the health professions, 4th edn, Elsevier, Edinburgh, pp. 67–76. ISBN: 9780702062247
5. Stefan Pertz (2013), The Guru in Me – Critical Perspectives on Management, GRIN Verlag, ISBN 978-3638749251, pages 2-3
6. Joel Mlecko (1982), The Guru in Hindu Tradition Numen, Volume 29, Fasc. 1, pages 33-61

Becky Vogsland

Becky is a physical therapist with 12 years of experience. She has spent much of her career within the Department of Veterans Affairs (VA) health care system, where she has been part of several initiatives for treating pain. Current Roles: Assistant Director, Comprehensive Pain Center, Minneapolis VA Health Care System Nominating Committee, Pain Special Interest...

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