Issue 83

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Aug 6, 2019

Practice Perfect 666
Deliberate Practice: How It Can Help You Learn Better

  Jarrod Shapiro, DPM, FACFAS, FACPM, FFPM, RCPS Glasg

PRACTICE PERFECT   August 6, 2019

Did you know there’s a correct way to learn? It’s not about what kind of learning style you prefer or how talented you are. As it turns out, there is a best way people learn, and psychologists who study education and expertise have discovered it through years of research. The best way to learn anything is called deliberate practice. Without giving it a lot of fanfare, here are the most important aspects of deliberate practice. For those interested, I highly recommend the book Peak: Secrets From The New Science of Expertise, by Anders Ericsson and Robert Pool. By way of introduction, Anders Ericsson is perhaps the most expert person in the world on studying experts. He’s worked with athletes, musicians, and physicians, among many others and studied what made experts achieve their respective pinnacles of success…and it all boils down to deliberate practice.

To learn most effectively, use the technique known as Deliberate Practice

Without further ado, here’s a quick, high-yield summary of the major characteristics of Deliberate Practice.

  1. Develops skills that other people have already figured out. A regimen is designed and overseen by a teacher or coach familiar with the abilities of expert performers.
  2. The focus is on well-defined specific goals, improving some aspect of the target performance. This focus is on a specific aspect of a skill.
  3. Requires full attention and conscious actions.
  4. Practice is outside one’s comfort zone and just beyond the trainee’s abilities. This requires a maximal effort so it is generally not enjoyable.
  5. Involves feedback and modification of efforts.
  6. Depends on effective mental representations, which are detailed pictures of what a specific skill looks like when performed by an expert.
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Let’s talk about one example to help elucidate the aspects of deliberate practice: training a resident to do a specific surgical procedure of the foot and ankle: a bunionectomy.

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First, we would need a list of very specific actions that an expert foot and ankle surgeon performs when doing this procedure (skin incision, dissection, capsular incision, bone cut, fixation, and closure). Each of these steps is broken down further into specific skills. For example, the incision may be composed of proper incision placement, scalpel position 90 degrees to skin, appropriate controlled depth incision, etc).

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Next, the resident would perform the skin incision multiple times, each time receiving direct, focused, and specific feedback by the teaching attending with an emphasis on what was done incorrectly.

During this process, the resident would have viewed and studied either videos or live demonstrations of an expert level surgeon doing the skin incision. This creates a mental representation of what the correct procedure looks like. As the resident performs these repetitions with constant feedback, he compares his incisional approach with that of the expert, focuses on where his method is deficient, and builds an increasingly detailed mental representation of how to make an incision.

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These steps are repeated for each aspect of the procedure, until the resident is able to execute the entire procedure in a living person. It may be apparent that this type of training would be best on in vitro simulations of various types with the resident only performing the procedure on a live patient after having reached a certain prearranged threshold.

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Deliberate practice may be used in any field to learn any skill. It clearly requires organization, excellent coaching, and resources to allow simulation (depending on the skill in question). To understand and learn more about the details of this method read Ericsson’s book, and let the learning commence.


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