“The more I practice the luckier I get” is a statement that has been variously attributed to the golfers Gary Player, Arnold Palmer, and Bill Casper. In medicine, the traditional method of getting ‘lucky’ has been based upon working long hours in order to gain sufficient exposure to become an expert. The problem with this approach is that it can be very inefficient and can lead to less than optimum patient outcomes.
High performing athletes and musicians do not rely on exposure in order to ‘get lucky.’ Rather, they focus on particular areas of their performance which they wish to improve. To illustrate, Ericsson et al (1993) studied three groups of expert musicians who had attained differing levels of skill. All spent an equal amount of time on music-related activities. However, the two better groups spent more time in solitary practice (four hours a day). This deliberate practice allowed them to concentrate on the specific areas of focus.
“The crucial factor leading to continued improvement and attainment of expert performance is the engagement in special practice activities that allow performers to improve specific aspects of their performance with problem solving and through repetitions with feedback” (Ericsson, 2005, p 237).
In order to improve performance Ericsson et al (1993) recommends that:
- Instruction: Learners are instructed to improve some aspect of performance for a well-defined task.
- Feedback: Learners received detailed and immediate feedback on performance.
- Repetition: The learner has the opportunity to improve their performance gradually by performing the same or a similar task repeatedly.
- Limited Time: Training sessions limited to one hour.
Following these recommendations is difficult in an actual clinical environment. However, they can readily be addressed in simulated learning. Using an online simulated educational programme such as Medical Exam Tutor provides a method for engaging in deliberate practice that is consistent with Ericsson’s four recommendations. The learner can focus on an area that they wish to improve, they are given detailed (and immediate) feedback on their performance, they can complete similar cases, and they can limit the training time to as long or short as they wish.
It is no longer acceptable to ‘practice’ on patients to the extent that has historically been the case. Also, recent limitations in the number of hours that doctors can work means that we cannot rely on exposure to ensure that trainees become experts. However, combining simulation with deliberate practice is a technique that helps trainees become expert without exposing patients to unnecessary risks.
This improves both the luck of the doctors, and the patients they treat!