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Is your practice ‘deliberate’?

As a former pianist and ‘wanna a be’ competitive sports person, I found myself ruminating over this week’s readings and speculating that a higher level of performance could have been mine if ONLY I’d known about and focused on ‘deliberate’ practice way back then. Although….. the fact that I’m still reading and studying would suggest (according to Ericsson, in Dolcy et al 2011) that I’m perhaps in the class of continuous learners – those who never seem satisfied, but want to perfect their performance and those who always try to improve on their current level and reach ‘expertise’ (p. 6). (That made me feel only slightly better – since being a rock or sports star could have been quite fulfilling)….

As I read more on this theory, it once again seems like common sense; the recommendations seem so practical. It’s potentially a strategy to assist us in escalating our transfer of learning in the workplace from the 9% that I spoke of last week. It could create opportunities for relevant and repetitive practice and supervisor support which research suggests will improve training transfer.

I stopped and re-read this passage of Ericsson’s a few times:

The primary task of most professionals is to complete job-related tasks on time…. most professionals reach an acceptable level of performance during the initial phase of their career and then stay at this level without serious attempts to develop beyond the proficient execution of routine tasks. Only some individuals surpass this level and succeed in their continuous efforts to develop themselves as they become recognized as outstanding professionals in their domain. (p.6)

It seems so harsh….. that most professionals reach a stable, average level of performance, and then they maintain this ‘pedestrian’ level for the rest of their careers (Ericsson 2006, p. 685). I have colleagues who are doing a great job – but who are still doing the exact same job that I left 23 years ago…. they are proficiently caring for those with cardiac disease. I’d be lucky to have them care for me if I was ill. They certainly have put in the required time to achieve mastery (approx. 10 years).

BUT, there is the possibility that they have gotten too comfortable in their roles, that their performance is now  ‘automated’ and they’ve lost some conscious control over their execution. These are the people we likely refer to as ‘experts’, but according to Ericsson’s work – there is limited research to suggest that these professionals perform at a higher level than their colleagues; that they show a reliable superiority over novices…. simply with added experience. In fact there are some studies that have shown that performance decreases in accuracy and consistency with the length of professional experience after the end of formal training (p. 688)

Ericsson (2004) encourages us to rethink how we consider ‘expertise’ and to seek out individuals who consistently exhibit superior performance, whether they are socially recognized as experts or not (p. 71). That years of service does not automatically equal ‘expertise’.

In his work with the medical profession, Ericsson (2011) found that to maintain professional expertise, physicians need to incorporate new developments in their field  – that they need to continue to practice deliberately. He recognized, especially in healthcare professions, that learning at work is less than optimal. In a study of 60 physicians in the Netherlands:
The results showed that learning in medical practice was very much embedded in clinical work. Most relevant learning activities were directly related to patient care rather than motivated by competence improvement goals. Advice and feedback were sought when necessary to provide this care. Performance standards were tied to patients’ conditions. The patients encountered and the discussions with colleagues about patients were valued most for professional development, while teaching and updating activities were also valued in this respect. In conclusion, physicians’ learning is largely guided by practical experience rather than deliberately sought. (p. 81)

So, is Ericsson trying to tell us that the thing that we are the most proud of – providing high levels of patient care – could be holding us back from doing exactly that? Do we need to take a step back from what we do automatically and start asking the ‘why’ question again? Rather than spending all of our time focusing on the condition in front of us, and reactively reflecting and problem solving, perhaps we should be discussing our performance standards? How did we get to this point? What if we had tried X instead of Y for this case? Was this the optimal outcome we could have achieved? What did you see that I might have missed? Let’s go to a safe setting and rehearse alternative treatments and outcomes. As Ericsson suggests: “doctors, who bear a great responsibility for patients’ wellbeing, do not extensively engage in the type of deliberate practice that professionals in more competitive domains would do to stay at the top of their games” (p. 93).

So how do we practice ‘deliberately’ ? Well, I don’t think that healthcare is unique in this regard. I believe that there is a lot that we can learn from the competitive domains such as sport, music and chess. There is a lot of great advice already available on blogs and web sites like ‘The Most Valuable Lesson I Learned from Playing the Violin’.  As Noa suggests, we need to deliberately monitor our performance – both in real-time and on video. We need to stop to analyze what went wrong and how we can produce different results next time…..

Ericsson (in Dolcy et al 2011) suggests there are 7 principles for developing expertise:
  1. Informative & immediate feedback is fundamental in order to refine knowledge and skills;
  2. Measuring & analysing current performance is cornerstone to improving it;
  3. Practice activities need to be specifically designed to improve performance aspects that need improvement;
  4. Practice activities need to be repetitive but also allow for reflection on outcomes and processes;
  5. The motivation to improve performance is a prerequisite to achieving expertise;
  6. Time & effort need to be invested; and
  7. Teachers and coaches play a crucial role in guiding individual development.

Interesting to me is that much of the advice is very similar to what I read and wrote about last week when I spoke of eliminating scrap learning. The two concepts seem to go hand in hand. The key difference being that perhaps developing expertise is not as dependent on cognitive/physicial abilities (unless you are 5’2″ and wanting to play pro basketball) and more related to a continuous aspiration to learn and improve.

For once, I could hardly wait to get to the end and tell you where I can play a role in deliberate practice…. our brand new simulation centre is just the place to: practice, reflect, video tape, review, increase the complexity, repeat…. you get the picture. It was created exactly for this – I just didn’t have the terminology that I now have to describe it.

The centre has already become a busy environment – mainly with those new to our professions who are at the early stages of expertise and who are trying to develop/refine their motor skills. The challenging part will be to shift our more experienced culture….. the team who is focused on patient centred care and reactive problem solving. We need to motivate these teams to think differently about what we do and who we call ‘the expert’. For my part it will start by encouraging them to visit our centre and we’ll need to make that first visit memorable…. that’s the opportunity ahead of us.

So, what might you do to ensure that you practice ‘deliberately’ and maintain your focus, rather than just going through the motions? Thoughts? Comments? Advice?


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