Deliberate Practice in Medical Simulation

You have likely heard the phrase . Iterative phrases, such as , and , may also be familiar. The nature versus nurture debate is also germane to this discussion relative to natural talent/ability versus what can be learned/acquired. In medical education, traditional methods of heavy didactics followed by short clerkships and electives emphasize knowledge acquisition over skills, as evidenced by the adage . This approach implies virtually instantaneous mastery of new procedures and clinical skills with minimal if any, practice or instruction. Methods of skill acquisition, professional development, and expert performance have long been studied and debated. K. Anders Ericcson introduced a descriptor for his perspective of how expertise, expert performance, and experts develop: (DP) is “when individuals engage in practice activities (which are, at least initially, designed by teachers and coaches) with full concentration on improving some specific aspect of performance.” In addition to observable behaviors and technical skills, expert performers can verbalize their cognitive processes and mental imagery of the events. Ericcson and Smith empirically studied reproducible superior performance to investigate the underlying methods and mechanisms. Ericsson and colleagues described five foundational elements necessary for instructors and learners to accomplish deliberate practice: (1) motivate the learners; (2) provide clearly defined learning objectives for specific tasks; (3) define precise, measurable metrics of performance; (4) engage in focused, repetitive practice of skills; and (5) deliver real-time, constructive, actionable feedback.  This method, employed in an iterative, active cycle to provide ample opportunities for gradual refinements of learner performance, has been shown to yield significant improvements in performance. Deliberate practice has been studied in typists, professional violinists, master chess players, and various athletic sports, including baseball, darts, tennis, and gymnastics. Ericsson et al. studied the deliberate practice in expert musicians, which led to the theory that 10,000 hours of practice are needed to achieve expert performance. In recent years, deliberate practice has been applied to the practice of medicine and medical education, fields of nursing, and many allied health professions from pre-clinical studies through post-graduate training and even into continuing education for practitioners.