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

Suggestions
• 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)

Suggestions
• Assist students to identify their strengths
• Provides students with opportunities to identify and correct mistakes in a safe environment
• Significant Event Audit http://www.projects.ex.ac.uk/sigevent/
• One Minute Preceptor http://www.practicalprof.ab.ca/teaching_nuts_bolts/one_minute_preceptor.html

3. Repeat tasks to improve

Suggestions
• 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
People who found this article useful might also enjoy Teaching your students problem solving and Teaching about cognitive error

Leave a Reply

Your email address will not be published. Required fields are marked *