Training Implications of Deliberate Practice John Pelley, PhD Texas Tech University HSC School of Medicine www.ttuhsc.edu/SOM/success

What Is Involved In Training? Instruction: Provides information on goals and objectives of a procedure Demonstration (teacher): Provides information on achieving objectives Application (learner): Provides information on limitations Deliberate Practice: Provides practice focused on limitation in skill

Deliberate Practice Characteristics Discovered in human performance research Evaluated factors that contribute to expert skill Not correlated with IQ! …with work experience Always correlated with Deliberate Practice Applied to limitation in skill; seeking superior skill Not aimed at minimum standards Self-actualization is the standard Expert skill = Performance x Professionalism If either is zero, it’s all zero Professionalism – unrelenting desire for DP skill

Deliberate Practice Characteristics Can be repeated a lot Feedback continuously available Most effective with experienced teacher Not work, not play – focused effort; demanding Need to avoid automated behavior Not much fun; motivation critical Mentally highly demanding; tiring 10 years, 10,000 hours – Gladwell, “Outliers”

Questions/Comments?

Mindset Comparison Fixed Mindset Growth Mindset Success based on innate ability Failure is dreaded, feared. Least likely to succeed Success based on hard work and learning Failure is a challenge to adapt. Most likely to succeed

Growth Mindset Through Deliberate Practice Designed specifically to improve performance Myth: “Practice makes perfect.” Reality: “Perfect practice makes perfect.” Reality: “Deliberate practice is perfect practice.” Deliberate Practice: Practice correcting weaknesses. Deliberate practice requires self-awareness … and self-acceptance. No fear! (K. Anders Erickson, “Deliberate Practice and the Acquisition and Maintenance of Expert Performance in Medicine and Related Domains.” Academic Medicine, 2004;79:October Suppl.70-S81.)

Counteracting Automaticity Cognitive learning followed by experience in application (“associative”)

Is Learning A Skill? Learning style as a preference Learning style as a component of experiential learning Experiential learning as critical thinking Experiential learning as whole brain learning Whole brain learning as multiple skill application Question/case analysis is complete whole brain learning

Sense-Integrate-Act Some Motor Skills Sensory Skills Thinking Skills Thinking and memory skills are what we evaluate on written tests. We think that if students remember information that they can think with it. Motor and sensory are also learned skills. Active testing eventually becomes an exam, usually MCQ. The results of the exam become concrete experience. Memory Skills Zull, 2002, The Art of Changing the Brain

Speaking and Hearing Roles

Clinical Skill = Learning Skill Any part of the brain can grow more intelligent Sensory (history and physical, other data) Recognition (meaning of patient data) Creativity (differential diagnosis) Analysis (diagnosis, taking certification exams) Motor function (physical exam, medical procedures) Emotion (communication, values for you and others)

Importance of Continued Training Working with known diagnostic or procedural outcomes