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Practice To Become Expert
Part 2: Deliberate Practice
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Last week, in Part 1, Practice to Become Perfect, I spoke to you about my son, Lazarus, who thinks it is necessary to have natural talent to be a successful ballet dancer. As it turns out, talent is only a very small part of the expertise equation, and practice is more important. However, a very specific type of practice is necessary to become an expert.
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“Talent is only a very small part of the expertise equation, and practice is more important”
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That specific type of practice is called deliberate practice.
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Let’s talk today about what deliberate practice is, how to practice something deliberately, and what the research says about the effectiveness of this method.
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Deliberate Practice
So, what is deliberate practice?
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This is a very specific form of practice in which how one practices is more important than how much one practices. The first step in designing a deliberate practice plan is to break down the skill into its key components. Then, practice each component until mastery occurs. This method requires a focus on skills beyond the current level of ability, rather than repeating those skills already mastered. Additionally, immediate and specific feedback is necessary to improve. Having an expert coach to provide that immediate feedback is necessary.1
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Deliberate Practice as Applied to Podiatry
This concept can be applied to any learned skill. However, since we are medically oriented here, let’s talk about how we might teach a podiatric skill. For example, I am teaching a student how to debride foot ulcers. First, we would break down this skill into its components (identification of an ulcer to be debrided, the appropriate instruments to obtain, the appropriate motions to make with the scalpel, etc.). Next, the student would debride an ulcer while I watch. While the student performs the skill, I would provide immediate feedback. We might then discuss the student’s strengths and weaknesses in regard to that skill. The students would then practice repeatedly on more wounds while I continue to provide feedback. Once the student has mastered this task, we would move onto the next one. If we were to expand this to all of the skills necessary to become a podiatrist, then the student would improve over time. As the student acquires experience and obtains superior results, they then grow to become an expert.
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Becoming an expert requires approximately 10 years2 or approximately 10,000 hours. This idea has been popularized in Malcolm Gladwell’s book,Outliers: The Story of Success. These numbers though have been extrapolated from research on chess players, and more research will be necessary to determine if this truly pertains to medical professionals.
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What does the research show about the effectiveness of deliberate practice? Let’s start with something from the nonmedical world. Platz and colleagues performed a meta-analysis on this method in musical achievement. After a systematic review, the authors found 13 studies that fit their criteria. They performed calculations for an effect size of deliberate practice in musicians and found an effect size of 0.61, which corresponded to a large effect. These researchers found that task-relevant practice correlated strongly with the attainment of musical achievement.3
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It makes sense that deliberate practice would be effective to make musical expertise, and it seems logical that this method would also translate into the medical and clinical sciences. Interestingly, a recent review article looking at innate skill versus practice in the creation of surgical experts found that “surgical expertise is reached through practice”.4
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The Deliberate Practice Method Works in Medical Education
Researchers at the Faculty of Health, Medicine and Life Sciences at Maastricht University studied medical students in the first three years of training (875 students participated). They adapted a questionnaire on the use of deliberate practice and then performed a structured clinical examination to see if habits consistent with deliberate practice improved student outcomes. They found that students who did better on their clinical examinations demonstrated higher levels of planning, concentration, repetition and revision (all necessary components of deliberate practice).5
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“Studies in medical education applications show that deliberate practice involving higher levels of planning, concentration, repetition and revision resulted in better performance on clinical exams”
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Patient Simulations are Needed
Now, from a residency trainer’s standpoint, there are problems with this method, and the most obvious one is that we don’t have 10 years to train our physicians. This is where the role of simulation-based training is important. If we want to advance our trainees more rapidly over their three-year residencies, then we need to begin incorporating simulation into their programs. For example, a new podiatry resident could perform 100 first metatarsal osteotomies before they start doing them on patients. This would be a very low stakes method to improve their skills while providing focused feedback. Clearly, this is something we need to focus on in the future.
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For those of you interested in more detail about this topic, I suggest an interesting book by Geoff Colvin titled Talent Is Overrated. This book provides a more detailed look at the practice-is-more-important-than-talent argument and discusses how to incorporate deliberate practice into our lives. Practice, in this case, really does make perfect.
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