Deliberate Practice

At the Cabin Fever conference in Alberta, I promised to write about teaching students to deliberately practice the art and skill of medicine. Why, because doctors who depend on experience without reflection:
 frequently construct a serviceable conceptual framework based on algorithms, then practice to achieve a level of performance sufficient to most needs -C. Desforges (2005)
 sub-optimal processes may achieve successful outcomes and when they do succeed, they may be reinforced -R. Rhodes (2005)
 rate evidence as good or bad based on how well it supports assumptions
 stick to beliefs even in the face of overwhelming contradictory evidence -Guest et al (2001)
Whereas physicians who used deliberate practice techniques had:
 a greater body of knowledge about their domain of expertise than other individuals
 highly adapted representations that aid in planning, prediction and evaluation (10,000-100,000 patterns)
 accurate memory for new information and patterns in their domain
 continuing high levels of performance after the age when less accomplished performers begin to decline. – K. A. Ericsson et all (1993)
Guest et al concluded that teaching deliberate practice means providing learners with opportunities to:

1. Address problems in medicine at the upper level of their ability

• Take an educational history
• Plan appropriate challenging patients at least once a week
• Suggest an independent learning project of interest to the student

2. Develop a livelong habit of self monitoring (seek out blind spots)

• Assist students to identify their strengths
• Provides students with opportunities to identify and correct mistakes in a safe environment
• Significant Event Audit
• One Minute Preceptor

3. Repeat tasks to improve

• Guide through multiple cases
• Skills and knowledge increase with repetition to the point where you are unconsciously competent (automatic)
• Key is timely feedback to prevent mistakes that might result in becoming unconsciously incompetent
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