DisruptEDU

Today we are going to explore an ugly experience with an adorable name…the yips.

I tried REALLY hard to come up with a good analogy for this ugly/cute name thing. I mean, it was a down-a-rabbit hole kind of time-suck (probably why my publication rate is so stellar). The only thing that I could think of was a Sphynx cat. Such a cool name, yet not exactly what probably comes to mind if you don’t know what they look like. I personally find them kind of cute, but I can assure you, I’m in the minority here.

Okay, enough with the yak shaving. What are the yips?

The term is usually encountered in the context of sports – the victims are most often golfers, followed by baseball players (and if you’re a fan of a certain series about an American football coach hired to manage a British soccer football team, yup, them too). Why? Because the primary association is with the impact of the yips on fine motor tasks. Picture a golfer lined up to sink a putt that will earn them whatever they give out in golf for prizes (sorry, the only type of golf I’m familiar with involves a disc). The hole is RIGHT THERE. They’ve done this a MILLION times before. It should be SO EASY. Yet, as the putter makes contact, the golfer jerks like they’ve been electrocuted, and the ball zooms past the hole to the next zip code.

OUCH.

While the herky-jerky that leads to shanks, slices, and whiffs may be the most obvious sign that the yips are on the set, they have another trick up their sleeve: the choke. While some may speculate that these are not the same problem, they share a common cause.

What shifty little gremlin makes one lose control of a previously mastered skill? There is a neurological component – in short, the physiological arousal caused by high stress situations affects motor pathways, leading to the jerking/tremors. The prevailing theory is that this physiological experience leads to the psychological disorder of choking, caused by performance anxiety.   

Isn’t this a blog about disruptive behavior in healthcare education? Why the hell is she rattling on about golf???

Let me try to explain …

I know I talked about psychological safety in Blog #3: The Weight. I would like to think that most of us who work in healthcare and education (or both, if you are the luckiest of ducks) are familiar with the short-circuit that occurs in our brains when the physical shenanigans caused by stress are running the show. So, I ask you – do we experience overthinking, anxiety, and stress that can lead to the yips? Does performance anxiety hold back people other than athletes? For example, the high-performing overachievers that dominate health care and healthcare education? Yes, I’m looking at you, deal with it.

If you said “no,” please immediately stop reading this blog and put your most awesome, special self to work figuring out how to share your skills with the rest of us. NOW! You could make MILLIONS!

For those of us left nodding in agreement…now we may start to understand why we should care. It starts with a little something called the Polyvagal Theory. This is an interesting take on our old buddy stress, and how our Vagus nerve unconsciously “reads” emotional shifts in the people around us. As we are social creatures that desire relationships and connection, any threat activates our autonomic nervous system and survival reflexes.

There is research that shows that even witnessing disruptive behavior negatively impacted the psychomotor skills of dental students. Yikes (yips).

If you’ve had the heart-wrenching experience of watching a student completely fall apart during a clinical exam (I mean one of those oh, THAT’S-what-they-mean-by-watching-a train-wreck moments) you’ve observed the yips. Welcome to the choke show.  

One of the more interesting aspects of the yips is the introduction of the “beyond the moment” response. From an evolutionary standpoint, it makes sense that the moments you’re being chased by a dinosaur are not optimal for learning (except for maybe how NOT to be lunch for a T-Rex). What happens after that? Do we shake it off (Wow! I survived!) or incorporate it (I’m NEVER leaving this cave again)? As my dad has always been fond of saying, “I’ll give you three guesses, and the first two don’t count.”

Here lives impact #2. Beyond the primary effects of the 5 F’s – the fight, flight, freeze, fawn, and/or flop response – our brains start to ask what our experiences say about us, and where we fit among other people. When the “threat” is not a carnivorous predator but an evaluation with the possibility of failure, our brains kick-start the same survival response; potential failure is a threat to both our identities (what does this say about me?) and our connection to others. If I am SO FOCUSED on my role as a student (or a teacher), is my identity then not inextricably linked to my performance?

If so, we end up with this snazzy little equation:

How I perform = WHO I AM.

Uh, oh. THAT’S not optimal if we screw up.

I found an article (yes, just one, and trust me I looked for more) about the yips from the perspective of a medical provider. The author looked at the same issues: high pressure situations, perfectionism, and a sense of self-worth.

What can we do about it? If you’re a regular in these parts (THANK YOU SO MUCH), it probably makes sense that many of the interventions to reduce disruptive behavior are rooted in the affective domain. We can focus on improving communication, coping skills, and self-efficacy.  Yet, another important concept that can be learned from tackling the yips is to separate our sense of identity from our performance: Having a bad day does not make one a “bad student” or a “bad teacher;” making mistakes does not make us bad people; and failing at anything does not make us a failure as a person.

Easier said than done, right?

Every year, the last clinic seminar topic is a Q&A session on life after graduation. The students ask about what they should ask in interviews, expect from employers, and many other things that we wouldn’t think of telling them. But I tell them something that comes as a shock – I was fired from my first job as a hygienist.

True story.

There I was, a new grad, recruited right out of school into a beautiful office with all kinds of technology. Felt like I won the lottery. And two weeks shy of 3 months, the boss asked for a chat at the end of the day. Told me the office was a “major league” operation, and my performance was “still in the minors” (didn’t do a damn thing to improve my opinion of baseball, BTW). That I wasn’t working out, but I could still work the last two weeks while I was looking for something else (how generous, right?).

Shocked does not begin to describe it. I was embarrassed. Humiliated. I had been working since I was 13 (had to get a work permit and everything) and was never given so much as a warning. And this was my first role with the ink barely dry on my hygiene license. How was I going to tell my husband? My parents? Anyone? Had I made a mistake choosing this field? I graduated with honors – did this dentist see something everyone else missed? I was ready to leave the field in less time than it took me to get my degree. My state of mind was such that I actually started tearing up at the first interview I had after it happened. Not great optics for a candidate.

Any student or educator can find themselves questioning their skills and choices the same way when faced with a situation in which they are told (or just know) that they did not perform to expectations. The next time, the little gremlin is there. Watching them. Judging them. Quietly breathing down the backs of their necks until it decides to yell: “OH NO IT’S A T-REX! RUN, YOU IDIOT!”

How do we shake off that little sucker? While I have been APA-trained to within an inch of my life, there is a time and place for quotes, and the author of the The Procedural Yips says it best:

“Rather than focusing solely on correcting a deficit, what additional grace might we allow ourselves if we could discuss failure as an experience rather than a flaw?” 

The answer is that we don’t shake it off (sorry, Swifties). We beat that critter at its own game. Stare at it until it breaks eye contact.

When failure is viewed as a flaw, it leads to self-doubt and shame. Instead of asking, “What’s wrong with me?” we should ask “What can I learn from this experience?” This mindset allows space to reflect, adjust our approach, and try again. In addition to separating “how I perform” from “who I am,” this approach creates a psychologically safe environment; when challenges are shared instead of hidden, it strengthens social connections. These connections help build resilience because students – and faculty – learn that they are not alone in their struggles.

And then, maybe we can talk about something that went RIGHT that day – with that patient, or with that student. We aren’t going to ignore what could have gone better, but it’s highly unlikely that the experience was a complete dumpster fire; clinical performance is rarely all-or-nothing. Instead of the “don’t worry, you’ll do better next time” platitude (and oh you bet we WILL worry), a meaningful conversation about what was learned from both will negate equating mistakes with personal failure and promote a growth mindset.

The bottom line about the yips? They’re a setback. If we choose to let them define us, the gremlins win. If we choose to reframe failure as an experience, we acknowledge that we are human and have room to grow and learn.

~Jaymi

P.S. Things I learned from my first job as a hygienist: 1. Avoid offices where the dentist and hygienist are dating; 2. Pay attention to red flags, like no one ever inviting you to lunch; 3. Employers believe they can fire an employee for no reason within a 90-day period and they will not have to pay unemployment (not necessarily true, BTW, not that I tested that theory). During my second-to-last week (yes, I agreed to work the last two like the gaslit idiot that I was) I noticed there were patients booked under a different name – when I asked, I was told that the other hygienist’s friend was moving to the state and she was due to start the next month. One of the front desk staff finally caved like a sand castle at high tide and spilled the details. They wanted someone to build the schedule, and instead of paying a temp (much more expensive), they deliberately chose a new grad so they could pay less AND use their stupid baseball analogy just shy of the 3-month probationary period. They were told to keep quiet and not get attached. Well, at least I felt a LITTLE better knowing why I was never invited to lunch…but within 5 minutes of this little chat it became the only job I ever walked out of. BYEEEE. Please do not stay in touch.