Chapter 5 - Principles of Deliberate Practice on the Job

Studies

• Older doctors knew less and did worse in terms of providing appropriate care than doctors with fewer years of experience
• The most effective interventions regarding professional education for physicians were those that had some interactive component, and they improved both the doctors’ performance and their patients’ outcomes
• The experienced surgeons’ greater knowledge and greater experience in traditional surgery didn’t give them an advantage in developing skills in laparoscopic surgery
• Patients of more technically adept surgeons were less likely to experience complications or mortality
• You were twice as likely to have your cancer come back 5 years later if you were operated on by an inexperienced surgeon than if you were operated on by an experienced one

Key Terms

• Top Gun approach: approach focused on practicing something over and over, away from your real job where mistakes have real consequences
• Adaptive thinking: immediately determine the best actions in response to an unexpected attack or another unforeseen event

General Information

• The Top Gun school program had many elements of deliberate practice
• The first step toward enhancing performance in an organization is realizing that improvement is possible only if participants abandon business-as-usual practices
• The belief that one’s abilities are limited by one’s genetically prescribed characteristics is false
• The belief that if you do something for long enough you’re bound to get better is false
• The belief that all it takes to improve is effort is false
• Unless you are using practice techniques specifically designed to improve particular skills, trying hard will not get you very far
• Learning while real work gets done means that normal business activities can be turned into opportunities for purposeful or deliberate practice
• Some radiologists are more accurate than others in distinguishing between benign and malignant lesions
• Training with immediate feedback is an incredibly powerful way to improve performance
• Traditional approach has been to provide information about the right way to proceed and then rely on the student to apply that knowledge
• Deliberate practice focuses solely on performance and how to improve it
• Neither doctors nor nurses gain expertise from experience alone
• There are no benefits to continuing medical education for practicing physicians
• Attending lectures and minicourses offers little or no feedback or a chance to try something new, make mistakes, correct them and gradually develop a new skill
• The best approach is to develop new skills-based training programs that supplement or completely replace the knowledge-based approaches that are the norm now in many places
• You need to find some patient outcome that can definitely be linked to the behaviour of a doctor to find his/her level of expertise
• Feedback is the reason that surgeons get better as they gain experience
• The ability to recognize unexpected situations, quickly consider responses, and decide on the best one is important
• The main way surgeons detect problems is by noticing that something about the surgery does not match the way they had visualized the surgery in their preoperative plan
• Over time, experienced surgeons have developed effective mental representations that they use in planning the surgery, performing it, and monitoring its progress so that they can detect when something is wrong and adapt accordingly
• The major factor underlying the abilities of the world’s best doctors is the quality of their mental representations