Necessity is the mother of invention: video recording firsthand perspectives of critical medical procedures to make simulated training more effective.

The traditional apprenticeship model for training doctors requires ample opportunities in the clinic for trainees to learn core procedures under the supervision of skilled doctors. In this issue, Kyser and colleagues document that the learning opportunities for residents to master certain core procedures, such as forceps and vacuum deliveries, are insufficient in many teaching hospitals. To address this serious problem, this author argues that learning techniques (i.e., deliberate practice and simulator use) from other domains of expertise, such as chess, music, and sports, must be adapted for use in medicine. For example, medical procedures should be videotaped and indexed for access over the Internet. Trainees then could view recordings of rare emergency procedures and complications and practice their decision-making skills. Evidence suggests that training outside the constraints of the clinic could be more effective in improving performance because trainees are able to engage in deliberate practice and focus on their individual weaknesses in executing procedures and making decisions. For example, with video and simulator training, trainees have the opportunity to repeatedly perform only the parts of a procedure that they find challenging until they have attained a level of acceptable speed and control. More generally, training could be structured around the particular needs of individual learners and scheduled when the learners are rested and able to concentrate fully on learning. Training also should include opportunities for learners to practice repeatedly with different patient descriptions requiring the same or different, yet related, procedures to teach trainees effective discrimination and execution.