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.

"What Angry Birds Can Tell Us About Educating the Next Generation of Physicians"

In September 2011, Catherine Reinis Lucey, MD, will be joining the UCSF campus as our new Vice Dean of Education in the School of Medicine. Dr. Dave Irby is her predecessor in this position. Dr. Lucey brings with her expertise from the work she has done as the interim dean and vice dean for education at the Ohio State University (OSU) College of Medicine and associate vice president for health sciences education for the OSU Office of Health Sciences.

Click on image to view video

I recently happened upon a presentation that Dr. Lucey gave as part of AcademiX, an education series sponsored by Apple highlighting mobile technologies in higher education.

She bases her ideas of using mobile technologies in medical education on the example of the popularity of the mobile app Angry Birds. She discusses how to engage medical students through interactive learning on a mobile device.

Below is my summary of her key presentation points:

* In the age of "technology assisted learning", we learn best when at point of need (ie, when treating a patient)

* Utopia of medical education: Create the expert physician

* Deliberate Practice - concept for developing expertise (by K. Anders Ericsson), basis for "Outliers" (book by Malcolm Gladwell)

* Developing expert performance requires:
(1) increasing complex challenges
(2) immediate feedback and coaching
(3) time to practice, fail, practice, improve

* The science and power of motivation:
Having a cycle of challenge -- Allowing time for correction -- Time for reinforcement -- A time rechallenge

* Example: Computer games
(1) engaged user challenged to master skills in each level
(2) the device becomes the coach by allowing/denying passage/progress to next level based on skills learned

Examples of ideas generated at Ohio State University School of Medicine -

(1) "Angry" Mammograms app
-radiology training for reading mammograms
-provides levels of complexity & nuances
- tiered in difficulty
- develops pattern recognition

(2) "Angry" Heart sounds
- auditory learning
- reinforce through repetition, like listening to pop music over and over to learn the melody and lyrics

Goal - to embed mobile devices into medical curriculum to increase efficiency in learning in the process of creating the expert physician.

* Presentation video at http://tinyurl.com/3qvjznt
* Presentation slides at http://tinyurl.com/3ptfuon
* Dr. Lucey's bio at http://tinyurl.com/3oktlaa

Check out previous postings from my blog that relate to gaming apps for medical education topics - http://mededlit.blogspot.com/search/label/games

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

The Future of Medicine TED Talk

If you haven't gotten a taste of a TED Talk lately, here's one to inspire us towards the vision of how doctors are and will be treating patients with the exponential growth in technologies now available.

Watch oncologist, Dr. Daniel Kraft, a physician scientist, give his April 2011 TED Talk, on "Medicine's future? There's an app for that"

Tips for Teaching Millennials

If you are reading this blog post, chances are you are (a) teaching millennials (b) a parent of a millennial (c) a millennial. Whichever category you fall into, as an educator, we all want our students to look as eager as this child does in class.

Below are tips condensed from their original sources. Visit the links to the original sources to see the very helpful full details related to each tip listed below.

"7 Techniques for Teaching Generation Y Students"
(see full article at http://tinyurl.com/3srwrpx)

Characteristic #1: They are technosavvy.

Recommendation: Don't talk down to them...In other words, you are a guide, a coach; you are not the Computer God in the classroom anymore.

Characteristic #2: They have short attention spans.

Recommendation: Keep it short and sweet... Use relevant examples or you will lose them.

Characteristic #3: They filter data out quickly.

Recommendation: Make your topic introductions sizzle...Introduce your topics so compellingly that your GenY students cannot help but be interested.

Characteristic #4: They multitask very well.

Recommendation: Don't get offended at other activities... Doesn't necessarily mean that you've lost their attention.

Characteristic #5: They consume information quickly.

Recommendation: Keep up the pace... As long as you are presenting the material clearly, you can almost never go too quickly for your GenY students.

Characteristic #6: Information must apply directly to them or you will lose them.

Recommendation: Customize the presentation directly to students' needs...Ask students, "What is it that you are hoping to learn today?"

Characteristic (Challenge)#7: Teaching Generation Y and Mixed Groups

Recommendation: Use body language and other clues to balance mixed groups...Simply ask the group, "How is this pace for you?" Or, "Would you like to practice this concept?"


"Generation Y - The Millennial Generation"

from Generational Learning Styles by Julie Coates. Published by LERN Books, a division of Learning Resources Network (LERN), 2007.
(see full details at http://tinyurl.com/dkbmwt)

1. Develop opportunities for experiential learning.
2. Encourage the development of learning communities.
   
3. Provide lots of structure.
   
4. Provide lots of feedback.
   
5. Use technology.
   
6. Make it fun.
   
7. Incorporate games.
8. Be relevant.
   
9. Utilize their talents.
   
10. Present the big picture.
    
11. Allow for creativity and be creative.
    
12. Offer multiple options for performance.
    
13. Be visual. This group is the most visual of all learning cohorts.
    
14. Be organized.
15. Be smart.
    
16. Be fair.
    
17. Recognize the need for social interaction.
    
18. Remember, talk is essential.
    
19. Structure a learning environment that demands respect and positive reinforcement.
    
20. Tie learning to actions.
    
21. Think positively.
    
22. Be clear and precise.
    
23. Allow focus time.
    
24. Talk is critical.
    
25. Enhance procedural memory with movement.
    
26. Make learning relevant.
    

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