Mitchell Sally A., Boyer Tanna J.
Kansas City University
Indiana University School of Medicine
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.
你可能听过这样的表述。一些反复出现的短语，比如……，你或许也很熟悉。天性与教养的争论也与本次关于天赋/能力与后天所学/所获的讨论密切相关。在医学教育中，传统方法是先进行大量的理论讲授，然后是短暂的临床实习和选修课程，这种方法强调知识获取而非技能培养，正如那句谚语所体现的。这种方法意味着几乎能瞬间掌握新的操作和临床技能，即便有练习或指导，也是极少的。技能获取、专业发展和专家表现的方法长期以来一直受到研究和争论。K. 安德斯·埃里克森提出了一个描述词，用于阐述他对专业技能、专家表现和专家发展方式的看法：刻意练习（DP）是“当个体全身心投入到练习活动中（这些活动至少在最初是由教师和教练设计的），以专注提高表现的某些特定方面”。除了可观察到的行为和技术技能外，专家级从业者还能阐述他们对事件的认知过程和心理意象。埃里克森和史密斯通过实证研究可重复的卓越表现，以探究其背后的方法和机制。埃里克森及其同事描述了教师和学习者进行刻意练习所需的五个基本要素：（1）激励学习者；（2）为特定任务提供明确界定的学习目标；（3）定义精确、可衡量的表现指标；（4）专注于技能的重复练习；（5）提供实时、建设性、可操作的反馈。这种方法以迭代、积极的循环方式运用，为学习者表现的逐步提升提供充足机会，已被证明能显著提高表现。刻意练习已在打字员、专业小提琴手、国际象棋大师以及包括棒球、飞镖、网球和体操在内的各种体育运动中得到研究。埃里克森等人研究了专业音乐家的刻意练习，由此得出需要一万小时的练习才能达到专家水平的理论。近年来，刻意练习已应用于医学实践和医学教育、护理领域以及许多从临床前研究到研究生培训乃至从业者继续教育的相关健康专业。
