Deliberate Practice: How to Develop Expertise

We all want to be great at something. Developing true expertise at a skill requires "deliberate practice". Psychologist K. Anders Ericsson, currently at Florida State University, has been a pioneer and at the forefront of research on expertise. His research has overlapped into medical education with at least 15 publications in PubMed specific to medicine.

Take your first bite into the apple of Ericsson's research by reading his 2007 article in the Harvard Business Review:

Ericsson, K., Prietula, M. J., & Cokely, E. T. (2007). The Making of an Expert. Harvard Business Review, 85(7/8), 114-121.

How can you not be drawn in to read this article when you see the following opening sentence?

"New research shows that outstanding performance is the product of years of deliberate practice and coaching, not of any innate talent or skill."

It's rather refreshing to know that we have the potential to be experts at something even if we weren't "just born with it". All one needs is about ten years, or roughly 10,000 hours, to practice a skill deliberately, a mentor or coach to provide feedback, and more time to practice, refine, and tune your skills.

You can a get good overview of his ideas of how deliberate practice develops expertise in medicine by reading his 2008 article:

Ericsson, K A. (2008). Deliberate practice and acquisition of expert performance: a general overview. Academic emergency medicine, 15(11), 988-94.

One of his pivotal articles on deliberate practice was written in 1993 while he was at the University of Colorado at Boulder. This paper would be well worth the read if you are interested in this topic because it has been cited over 2167 times according to Google Scholar!

Ericsson KA, Krampe RT, Teschromer C. (1993) The role of deliberate practice in the acquisition of expert performance. Psychological review, 100(3), 363-406.

Take heart that if you love something enough to want to excel in it, you hopefully by now have already clocked in or nearing your 10,000 hours of deliberate practice. Fire up the stopwatch and off you go!

NOTE:
Still can't get enough about this topic of deliberate practice? Read Malcolm Gladwell's book Outliers about the story of success.

Medical Education Subject Guide: Your Go-To Resource

Need ideas of where to read up on the latest medical education research? Have a brilliant manuscript describing your curricular innovations but not sure where to publish? Need to find multimedia resources for medical education? Looking for curricular objectives to help guide your medical education project?

Look no further than the Medical Education Subject Guide available on the UCSF Library's website. The direct URL to this guide is at http://guides.library.ucsf.edu/meded.

OR you can navigate from the Library's website from the Classes, Consulting, & Help dropdown menu by selecting the Subject Guides listing. The Medical Education guide is listed alphabetically on the complete guides page.

Below is a snapshot of the Medical Education Subject Guide

(1) Browse the yellow tabs to explore the Library's resources available to assist in your medical education research needs.

(2) Read the latest published medical education research by UCSF medical educators.

(3) Download PDF tipsheets summarizing literature searching tips for how to search PubMed and other key databases geared to medical education.

(4) Contact me via chat, email, or phone from the right margin of the guide.

Please feel free to send me any suggestions you have for content you'd like to see on this subject guide. Bookmark this site today! http://guides.library.ucsf.edu/meded

Using Mind Mapping as a Teaching Tool

How many of you remember the grade school exercise of diagramming sentences? How many of you can claim that you enjoyed the exercises? Very few of you out there, I would guess.

To this day, if you were to ask me how I know that the subject comes before the predicate followed by the complement, I would have no good answer for you. However, I am able to write and read a sentence and know that it is written in proper English grammar. My fifth grade teacher would be beaming with pride that I am able to intuitively retain the grammar she taught me decades ago.

So what does this all have to do with mind mapping? Wait a second...what IS mind mapping. It is a way to visualize a concept by drawing out the relationships between several ideas. Here is a bare bones example of how I used mind mapping to brainstorm what my breakfast menu could look like.

Click on images below to see larger views
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On a more complex level, you can use mind mapping as a study and teaching tool. Below is a mind map created by allergist and immunologist Dr. Dimov and colleagues at the University of Chicago and LSU to diagram the concept of adhesion molecules.

To find out more about how to use mind mapping as a teaching tool, you should read this article written by a fourth-year medical student in the UK:

Edwards, S, & Cooper, N. (2010). Mind mapping as a teaching resource. The clinical teacher, 7(4), 236-9.

ABSTRACT

BACKGROUND: Modern mind mapping has been around since the mid-1970s, having been developed in its current form by Tony Buzan. It works by taking information from several sources and displaying this information as key words in a bright, colourful manner. Mind maps have been described as an effective study technique when applied to written material.

CONTEXT: This paper looks at how to use mind mapping as a teaching resource, and was written as a result of the recent undergraduate 'Doctors as Teachers' conference at The Peninsula Medical School. INNOVATION: Mind mapping is a technique not often used or considered by many teachers. This paper looks at how a busy clinical teacher can apply this technique in a practical, useable way. This allows topics to be more interesting to students and makes both learning and teaching more enjoyable.

IMPLICATIONS: Mind mapping has many potential applications to clinical education, and can be adapted to many situations. It can be used as a teaching resource, as an aid to preparing and reviewing lectures, and the technique allows notes to be written and reviewed quickly, and most importantly enables information to be easily updated. Mind mapping can be used in many situations including problem-based learning, small-group teaching, in a one-to-one context, as an examination tool and for personal revision.

By training yourself to mind map the material you need to learn or teach, your brain will begin to integrate the information into a more second nature understanding. In this way mind mapping is like diagramming sentences, but a whole lot more enjoyable.

Be sure to check out my previous blog post about free and easy to use mind mapping tools. There are several sophisticated mind mapping software that you can purchase as well. Go forth and map!

Facebook and Doctor-Patient Relations

As of January 2011, Facebook has over 600 million active users. This breaks down to an average of at least 1 in 12 people in the world have a Facebook account. With these odds, it's inevitable that the paths of patients and doctors should eventually intersect on Facebook.

A real dilemma has arisen: Patients have found their physicians on Facebook and have requested to be friends with them.

Because of the personal information that can be found on Facebook, it seems intuitive that a doctor should not accept a friend request from a patient. But with no hard and fast guidelines, what is a doctor to do? Facebook reveals too much of what is personal and private that a physician, and a patient, would not particularly want to know about the other.

In the past two years, there have been a few opinion pieces published in medical journals addressing the issue of whether or not doctors should accept patients' friend requests:

• Grover, M. (2010). Defining the patient-physician relationship in the era of facebook. Academic medicine, 85(8), 1262-.


• Jain, S H. (2009). Practicing medicine in the age of Facebook. The New England journal of medicine, 361(7), 649-51.


• Lacson, S M, Bradley, C, & Arkfeld, D G. (2009). Facebook medicine. Journal of rheumatology, 36(1), 211-.

As of November 2010, the Australian Medical Association and their related Australian and New Zealand associations are in the forefront of setting guidelines for physician use of social networking sites such as Facebook.

[View the guidlelines at http://ama.com.au/socialmedia].

This initiative was in response to the fact that some physicians have posted negative comments and even the names of some of their patients on Facebook. This clearly crosses the boundaries of professionalism. These opinion pieces and guidelines should set the stage for active discussion in the medical profession and medical schools of how physicians should or should not interact within the world of social media. Feel free to put in your two cents in the comments section below.

The American Medical Association actually does have a short statement on their website about professionalism and social media. Check it out at http://www.ama-assn.org/ama/pub/meeting/professionalism-social-media.shtml

Personal Learning Environments: the new era of education

Technology has taken learning to an entirely new level in the 21st century. No longer do students learn by just receiving information from instructors in the classroom or lecture environment. Tools such as blogs, wikis, podcasts, YouTube, MySpace, Facebook, Twitter, text messaging, and smart mobile devices fold in multiple layers of alternative delivery of knowledge and communication.

Students no longer just write papers or take tests to show what they've learned. They create websites, blogs, and videos to capture and showcase their learning. I, for one, am very excited to see this wave of creativity surge in education. These new tools empower learners to develop a hybrid approach to exploring and defining their own learning styles.

What I've just described is the personal learning environment (PLE).

Watch & listen to this presentation by Graham Attwell, an "educational technologist, researcher and blogger based in Pontypridd in Wales and Bremen in Germany. "

Personal Learning Environments: The future of education?

View more PDF documents from GrahamAttwell.

Read more about PLEs:

- Attwell's compendium paper to the presentation above

- 7 things you should know about PLEs

Watch this great video that clearly paints the picture of our future, if not already present, medical students.

Understanding the Millennials

My parents are Boomers, I'm a Gen-X'er, and my students are Millennials. If you teach Millennials, you will definitely agree that they carry a vibe very different from the previous two generations.

This presentation, "The Generations Game" is very worth going through. It will take you less than ten minutes to read it.

• If you're a teacher - you can get a solid grasp of where your Millennials are coming from.
• If you ARE a millennial - take a look and see what data has been acquired and interpreted about who you are as a generational group.

The presentation is co-authored by two educators in the United Kingdom - Steve Mellor, the Head of Youth and Kids Research at Harris Interactive Europe, and Cathy O'Donnell.

Millenials

View more presentations from Steve Mellor.

(click on the projection screen icon above to view the presentation in full screen mode)

Learning about how our students think will open the doors to how we can keep our students engaged as we develop our plans and innovations to keep medical education on the cutting edge. Knowing our audience is in the best interest of educators and students alike.

BEME Collaboration

Oh, how I wish, how I wonder if there were such an ideal resource where I could find best practices for medical education research...

What's this now you speak of - BEME? What's that?

BEME stands for the Best Evidence Medical Education and is pronounced "bee-mee".

The BEME Collaboration is based in the United Kingdom. They describe themselves as:

"a group of individuals or institutions who are committed to the promotion of Best Evidence Medical Education through:

• 
  the dissemination of information which allows medical teachers, institutions and all concerned with medical education to make decisions on the basis of the best evidence available
  
• 
  the production of appropriate systematic reviews of medical education which reflect the best evidence available and meet the needs of the user, and


• 
  the creation of a culture of best evidence medical education amongst individual teachers, institutions and national bodies.

Specific features I like about BEME (find these in the left blue menu options):

Published Reviews: provide systematic reviews of medical education topics ranging from assessment to faculty development

(ie, BEME Guide No 10 - A systematic review of the literature on the effectiveness of self-assessment in clincal education)

Reviews in Progress: view many of the drafts of current reviews being completed

(ie, A systematic review of the literature on the effects of portfolios on student learning in undergraduate medical education)

Of course, be sure to explore the other sections. The "starting a review" section is a very helpful guide if you are preparing to write a systematic review.

You will have a greater appreciation for the concept of evidence-based education research after you've perused the wealth of information in BEME.

Medical Students' and Residents' Use of Facebook

Okay, so I finally caved in and set up a Facebook account in June. To date, I have inched up to a mere 74 friends. One of my Facebook friends, a cousin in college, has 759 friends! That is a testament as to how social networking tools have made their way into the daily lives, the daily minutes, of how students keep in touch.

With the explosive popularity of Facebook use among students, it is no surprise that issues concerning the appropriateness of what students choose to disclose on their personal profiles and photos that they post are starting to arise as these students graduate and enter the professional world.

The authors of the article below are from the College of Medicine and the College of Education at the University of Florida. As students who use Facebook, and as educators who teach these students, this article is a must read as it touches upon the implications of professionalism and how it is affected by the online personas that people create using social networking tools.

Ferdig, RE, Dawson, K, Black EW, et al.
Medical students' and residents' use of online social networking tools: Implications for teaching professionalism in medical education.
First Monday, Vol 13, No.9, Sept 2008.

ABSTRACT:
This study sought to determine if and how 501 medical students and 312 residents are using Facebook at a large university in the southeastern United States. Results reveal that medical students and residents are using Facebook and about two–thirds of users maintain public profiles. While there is variation in the types of information provide within profiles, many medical students seem unaware of or unconcerned with the possible ramifications of sharing personal information in publicly available online profiles even though such information could impact their professional lives. Thus, this study provides data based evidence that online tools such as social networking sites should become a part of the dialogue related to preparing future physicians to meet the Accreditation Council on Graduate Medical Education (ACGME) professionalism competency.

Podcasting Lectures: Friend or Foe

Podcasting of lectures has been the most common use of broadcasting and archiving educational content using media files. "Enhanced podcasts" are growing in popularity because listeners can also view the lecture content, such as PowerPoint slides, while listening to the lecture.

As more students listen to podcasts of their lectures, will this make them less likely to attend lectures? Is this an issue that professors should worry about as they decide to podcast their lectures? Or are we starting to sound like our predecessors who worried if radio would replace the book, if TV would replace the radio, or if CDs would replace LPs?

Below is a presentation by educators at the University of Bath in the U.K. Slide16 through the end of the presentation cover reasons why enhanced podcasts can enhance learning.

Using Podcasting in Teaching and Learning

View SlideShare presentation or Upload your own. (tags: eatbath-present08 podcasting)

There is no denying that some students will be even less motivated to attend lectures because they can view them online. But the benefits outweigh the risks.

As of Aug 2008, there are 52 articles, dating back to December 2005, that mention podcasts.

Here's the most recent article specifically targeting podcasts for undergraduate medical students:

Pilarski, PP, Alan Johnstone, D, Pettepher, CC, et al. (2008). From music to macromolecules: using rich media/podcast lecture recordings to enhance the preclinical educational experience. Medical teacher, 30(6), 630-2.

I also blogged early this year about an article that looked at how podcasting lectures influenced student in-person attendance. Time will tell us what becomes of all this podcasting. But there's no doubt that podcasting will evolve to find its place in education.

Have We Over PowerPointed Medical Students?

Has lecturing with PowerPoint (ppt) made medical students lazy learners? Is there no longer any reason for students to read their textbooks? Is teaching with ppt a disservice to students?

This transcript of a thought-provoking talk given by Dr. Frederick S. Southwick of the University of Florida College of Medicine, may give us some answers to these questions He is the 2007 recipient of the Theodore E. Woodward Award honoring physicians who have made major contributions to medical education research:

Southwick, FS. (2007). Theodore E. Woodward Award: spare me the PowerPoint and bring back the medical textbook. Transactions of the American Clinical and Climatological Association, 118, 115-22.

ABSTRACT
A tutorial for 4th year medical students revealed absent long-term retention of microbiology and infectious disease facts taught during the 2nd year. Students were suffering from the Ziegarnik effect, the loss of memory after completion of a task. PowerPoint lectures and PowerPoint notes combined with multiple-choice questions may have encouraged this outcome; this teaching format was also associated with minimal use of the course textbook. During the subsequent year, active learning techniques, Just-in-Time Teaching (JiTT) and Peer Instruction (PI) were used, and instructors specifically taught from the textbook. Essays and short answer questions were combined with multiple-choice questions to encourage understanding and recall. Performance on the National Board Shelf exam improved from the 59(th) percentile (2002-2004) to the 83(rd) percentile (2005), and textbook use increased from 1.6% to 79%. This experience demonstrates that strategies incorporating active learning and textbook use correlate with striking improvement in medical student performance.

The Power of Garlic

Recently while on vacation, my hand and arm got quite swollen and inflamed from two bug bites. A friend suggested a family folk remedy of placing crushed garlic under a bandage directly on the swollen areas to excise the toxins from the bites. Since icing it and taking antihistamines for a day wasn't doing much, I agreed to the suggestion. I blame my lack of judgment on the 97 degree Southwestern desert heat and the pain and heat from the swelling. Within the first half hour, I felt a burning sensation where the garlic was and assumed it must be working. However, after almost three hours, things didn't seem quite right when my hand became even more inflamed.

Well, long story short, I suffered minor second-degree "garlic burns" on the two sites where the compress were. Symptoms included blistering, heat, and redness. The doctors prescribed oral antibiotics for the possibly infected bites and a topical antibiotic (bactroban cream) for the cellulitis. When I finally got hold of a computer, I ran a quick PubMed search and found that there have only been a few cases of garlic burns reported in the medical literature. The first was reported in 1987.

What I learned from the literature about garlic:

* It has allergens and irritants - the strongest are diallyl disulfide and allicin that are volatile sulfur compounds and can cause irritant contact dermatitis ('garlic burns').

* It can interfere with proper coagulation. It 's suggested that patients should stop eating garlic/taking garlic tablets at least one week before their surgery.

* Garlic burns have occurred in cases where garlic was directly applied to the skin to try to treat asthma, skin lesions, and fever.

* If properly treated with prescription topical antibiotic cream three times a day and covered with sterile gauze, wounds should heal within four weeks or so.

* Three soldiers who apparently did know of the harsh effects of crushed garlic on skin caused self-inflicted wounds on their legs and arms in order to avoid military duty.


So what did I learn from this experience?

(1) Do NOT use or take alternative medical treatment, or any medical treatment for that matter, without knowing what its risks, side effects, and reactions can be.

(2) The body is an amazing machine to be able to heal itself. My skin has repaired itself in a little over a month's time.

So here is my public service announcement to everyone: GARLIC is to be ingested in moderation and NOT applied to the skin.

Know how to handle burn injuries.
Find out more about garlic and its health benefits and risks.

FYI - after the skin has healed, sunblock should be applied to it for at least a year since the new skin is more photosensitive.

References:
Borrelli, F, Capasso, R, & Izzo, AA. (2007). Garlic (Allium sativum L.): adverse effects and drug interactions in humans. Molecular nutrition & food research, 51(11), 1386-97. (PMID: 17918162)

Al-Qattan, MM. Garlic burns: Case reports with an emphasis on associated and underlying pathology. Burns (2008) (PMID: 18406535)

Problem-based Learning and Larger Student Groups (article)

Problem-based learning groups generally span a size of 5 to 8 students. But what happens when PBL "small" groups start to expand to not-so-small group sizes?

This article details a "clustered PBL" approach where students are divided into 16 groups of 20 - 21 students per group. Each group is subdivided into 7 subgroups that have "clusters" of 2 to 3 students each.

Kingsbury, Martyn P, and Joanne S Lymn. Problem-based learning and larger student groups: mutually exclusive or compatible concepts - a pilot study.
BMC medical education 8(2008):35-.

CONCLUSION:
This clustered PBL methodology can be successfully used with larger groups of students. The key to success lies with challenging and well situated clinically relevant cases together with enthusiastic facilitators. Facilitator enjoyment of the PBL process may be related to adequate training and previous PBL experience, rather than academic background. The smaller number of facilitators required using this clustered PBL approach allows for facilitators with 'a belief in the philosophy of PBL' to volunteer which would again impact on the success of the process.

PowerPoint Presentation Tips

Most of us being self-taught PowerPoint (PPT) users have become quite accustomed to our own PPT styles. Like your wardrobe, it's good to reassess and revamp your presentation style to stay fresh.

What is the main goal of any presentation you give? Engage your audience and make sure they leave knowing the main message of your topic.

Here are some useful tips on how to improve your PPT presentations, and thus, your presentation skills:

PowerPoint for Teachers- PowerPoint Presentations: Design, Content, & Delivery

Death by PowerPoint (and how to fight it)

You'll notice that both presentations have quite a few slides. But, you will see the difference in how the message of the presentation sticks with you. The slides engage and deliver the message.

For some additional tips on how to give effective presentations, check out the Business Week article, The 10 Worst Presentation Habits.

Impliment at least three of anything you learned in these resources above and you're guaranteed to have a happier audience that is bound to be wowed by your ideas!

What's Your Learning Style

Wondering how you best learn and process information?

Take this quick quiz and find out if you're a visual, auditory, or kinesthetic learner.

Today's college and grad students were born in the mid-1980's and early 1990's. They are referred to as "millennials" and "digital natives".

Boomers, Gen-Xers, & Millennials: Understanding the New Students
Oblinger, Diana. 2003. Educause, July/Aug, p 37 (8 pages).

Read about how educators can find ways to approach different learning styles in an evolving set of learners.

Audio and Video Podcasts of Lectures (article)

There is ever-increasing use of podcasts of lectures in higher education. Along with this comes concerns of whether this form of delivering education may decrease class attendance and if podcasts truly improve student learning.

The article below addresses these issues and sheds light for those of you who currently podcast or are thinking of podcasting your lectures.

Copley, J. (2007). Audio and Video Podcasts of Lectures for Campus-Based Students: Production and Evaluation of Student Use. Innovations in education and teaching international, 44(4), 387-399.

ABSTRACT
Podcasting has become a popular medium for accessing and assimilating information and podcasts are increasingly being used to deliver audio recordings of lectures to campus-based students. This paper describes a simple, cost-effective and file size-efficient method for producing video podcasts combining lecture slides and audio without a requirement for any specialist software. The results from a pilot scheme delivering supplementary lecture materials as audio and video podcasts are also presented, including data on download patterns and responses to a survey of students on podcast use. These results reveal students' enthusiasm for podcast recordings of lecture materials and their primary use by students in revision and preparation for assessments. Survey responses also suggest little likely impact on lecture attendance as a consequence of podcasting, but indicate that podcast recordings of lectures may not be effective in facilitating mobile learning.

Faculty 2.0 (article)

Wondering how to keep up with teaching the new generation of learners - those techno-savvy students who populate your classrooms?

Check out this article: Faculty 2.0. Hartman, JL. (2007.) EDUCAUSE review, 42(5), 62-76.

ABSTRACT
Much has been written recently about the Net Generation--the generation (roughly twelve to twenty-five years old) that makes up the majority of students attending U.S. colleges and universities--but relatively little attention has been given to the college and university faculty who teach them. Faculty roles and the processes of teaching and learning are undergoing rapid change. The three traditional roles of college and university faculty are teaching, research, and service, with the relative emphasis on each varying by institutional type and mission. Among the three roles that are undergoing change, teaching and research are being most significantly altered by technology. Although research and publication are undeniably important components of the professional lives of many faculty members--for some, they form "the" most important component--the authors are focusing here on the less-visible changes brought about by technology in the teaching and learning space and on how these changes are fundamentally reshaping the processes and tools associated with the institutional structures, extending to the roles and responsibilities of campus IT leaders and organizations.

Wikis, blogs, and podcasts

What's all this buzz about "Web 2.0"? This catch phrase is already becoming "so yesterday", but the main thing to know is that the next phase of communication tools on the web are now giving educators a chance to take advantage of their teaching potential. For example, this blog you're reading has been set up as a way for me to be able to teach you search tips even though we may never meet each other.

In case you have just come back from a trip to the moon, here are some quick definitions:

WIKI - a website that houses documents that can be shared and edited by those with password access

BLOG - a website that has archived postings that allow for readers to comment on the content

PODCAST - an archived online audio or video broadcast

Subscribing to a blog/podcast's RSS feed allows you to keep up with newly added material. There's also a quick way to subscribe to a blog/podcast in a Firefox browser.

A 2006 article details ways medical educators have been using these collaborative tools:

Boulos, MN, Maramba, I, & Wheeler, S. (2006). Wikis, blogs and podcasts: a new generation of Web-based tools for virtual collaborative clinical practice and education. BMC medical education, 6, 41-.

Stay tuned... I'll be posting links to interesting wikis, blogs, and podcasts relating to medical education. For starters, there is a Medical Education blog created by University of Saskatchewan faculty.

Be sure to check out the UCSF Library's webpage focusing on medical information blogs.