NEAL CONAN, host: Surgeon and writer Atul Gawande watched Rafael Nadal play tennis on TV, saw a cutaway shot of the great player's tennis coach and came, he writes, to an obvious conclusion. If Rafael Nadal has a coach, how come lawyers and teachers and journalists don't? Specifically, how come surgeons don't?
In an article for next week's New Yorker, Atul Gawande argues that coaches can help anybody at any level, even those who think they've perfected their craft.
He's a staff writer for the New Yorker magazine. His new piece is titled "Personal Best." He's also a professor of surgery at Harvard Medical School. And nice to have you with us today.
ATUL GAWANDE: It's great to be here.
CONAN: And I assume you had some coaching as you wrote this piece.
GAWANDE: Yes. It's ironic that, in writing, you have an editor who pushes and prods, even when you reach high levels, but I was really struck by the fact that I've been a surgeon now for eight years and no one's ever come in and watched me operate, let alone tried to help me think hard about how I get better results.
CONAN: As you wrote in the piece, that's the result of an education system that supposedly teaches you to master your craft and gives you a degree and says, you're on your own.
GAWANDE: Yeah. There's the teaching model versus the coaching model. The coaching model is what you think of with athletes and singers who have someone who coaches them all the way through their career, even if they're one of the best in the world. But violinists, surgeons, at least in our theory of how we're supposed to do it, we don't.
You go to medical school. You go to Juilliard. You graduate, you get your degree. You get in your 10,000 hours of practice and then some cream are supposed to rise to the top. But I was really struck by how different these models are and tried to understand it, both by looking at data and sometimes by just calling people up.
I had a fascinating discussion with Itzhak Perlman, the great violinist, and I said, why don't violinists have coaches, but singers do? And he said, I don't know, but I think it's a mistake. He said he's had a coach his entire career. In his case, his wife whom he'd married had been at Juilliard with him and spent much of her career in the audience acting as his outside ears and providing him minute, fine-detailed direction over the course of his career about how he could be what he is now today.
CONAN: You also went to study, I guess is probably the right word, coaches at a high school and I thought that was really interesting. Again, teaching is not necessarily a profession that you think of and think of coaches, too.
GAWANDE: That's right. Teachers just graduate. They get their diploma and we know now that, in teaching the most important thing for the outcomes of students that the school has control over is the quality of the teaching. One of the striking studies - a bunch of them now have shown that when you have teachers go through workshops, learn some new skills about teaching math or teaching English, less than 20 percent are using those skills six months later.
But if you have a coach follow them into the classroom, even just once a month, watch them try that out, they get to over 75 percent likelihood that they use those skills. And so now, there's more than 100 school districts where they've put in - coaches in the classroom come once every couple of weeks, watches the teacher teach and then gives them detailed feedback. They work on an agenda that the teacher helps set for, you know, do they work on their problems handling the student behavior or planning the class or dealing with time management or very sophisticated challenges for teachers who are actually already great at what they do, but want to get even better.
CONAN: We're talking with Dr. Atul Gawande, the author of an upcoming piece in the New Yorker magazine called "Personal Best." You're listening to TALK OF THE NATION from NPR News.
And a coach, interestingly, at the professional level, anyway - we're not talking about a high school basketball coach or a college coach, necessarily - but coaches later in life, one of the really interesting things is they work for the client. They can be fired.
GAWANDE: Yeah. One of the big differences between - I mean there's multiple differences between the coach and the teacher in quite the same way. I mean, the coach is someone whose job is to be on your side of the fence. They're there for trying to help you achieve your maximum potential and help you figure out how to get there along the way.
And it's a funny relationship because, in individual sports, you know, the professional ice skater or tennis player, they hire and fire the coach. The coach is bossy, but they're not the boss.
And it's an interesting relationship that tends to be something that professional athletes - it's interesting that not every single one - but at the very top level of the game, the vast number of athletes find they can't get there on their own.
CONAN: I was fascinated to read an anecdote you told about John Wooden, the great basketball coach at UCLA, who put the emphasis so much on detail that he began the first practice every year by teaching his players how to put on their socks.
GAWANDE: Yeah, it was great. You know, one of the things that I did was I wanted to know what good coaching looked like and one of the people, obviously, people point to is John Wooden, and what he had as his creed was that details create success. And so when he would have his players practice putting on socks, he would show them what he wanted and that meant rolling the socks carefully up the foot around the heel, up all the way up the calf and then going back and smoothing all the wrinkles out.
And he had two reasons for this. Number one is that wrinkles cause blisters and blisters cost games. But the second reason was to understand how minutely fine-detailed the kinds of things they have to be good at are for them to win a season.
And this is a man who won 10 NCAA championships. It's unprecedented.
CONAN: In the article, you describe how you got a coach of your own, a surgeon you had studied with earlier in your career, and how he helped you improve your technique and improve your time, but also, there was a moment where some - one operation in particular did not go the way you had planned it and you began to resent the fact that he was watching.
GAWANDE: Yeah. So I had Dr. Bob Osteen, a man who won multiple teaching awards when I was training. He had since retired and I reached the midpoint of my surgical career. One of the great things is getting to write for the New Yorker, I have an excuse for trying kind of loony things.
And so I said, hey, let's try this idea. What if you came to the operating room and watched me operate? I'm eight years into my practice. And what I noticed is that, for the first five years, I was better every year than the last. But in the last couple of years, my complication rates have really not risen any further and I worried that I'd peaked and would only get worse from here.
And I had him come to the operating room. Now, he was watching an operation I've done over 1,000 times, removing a thyroid cancer. It was the first time he came in and I really wondered whether there was much that he could see. He didn't do a lot of these operations himself.
But when we sat down afterwards, in 20 minutes, he went through, you know, dense material on his notepad about how things like - he noticed that my elbow sometimes went up high in the air and that's a signal that I'm standing in the wrong position because you can't be precise if your arms are looking awkward and that means that they're feeling awkward. He noticed that I operate under magnifying glasses in order to see fine nerves and things like that, but that led me to not notice what was going on around me, including the fact that the light got knocked out of the wound and I was only getting half light off of reflected surfaces.
So for about once a month or so, we've been getting together for a while now and he's actually improved my complication rates. The really striking thing, though, is that it forced me into a situation where, you know, he was there at times when the operation goes wrong.
One case where I had misjudged. I tried to remove a large tumor laparoscopically with small incisions and a camera, and it was a misjudgment. It really was probably too big for me to be able to get out that way.
CONAN: And long story short, you wonder if coaching is going to be available to everybody because - well, some people don't want it.
GAWANDE: No. I was the first one to say, you know, do I want this guy in here still? Yes. The hard part is to imagine a world - we are taking on huge ranges of complex tasks in society. Having people, ordinary people operate on you, having people teach your eighth grader concepts that Euclid would have had a hard time with.
And having someone in that setting who's on the side of the individual, keeps their secret failures to themselves, we will benefit from it, but we have to be ready for it.
CONAN: The piece is called "Personal Best" in next week's New Yorker. Atul Gawande is the author and this is TALK OF THE NATION from NPR News.
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