Only portion of what is taught in medical school will be relevant to the particular career in medicine that the student enters as a physician. As a consequence, the physician must continue to learn the rest of his life if he is to be effective, safe, and relevant. Almost all of the learning a physician will need to accomplish in his forty or more years of professional work, after his formal medical education, will be his own responsibility.
The logical second task for the physician, therefore, is to continuously evaluate his own abilities, determine when new skills and knowledge are needed, and effectively use available resources to meet these identified needs. This can be stated as follows: The physician should be able to continuously define and satisfy his particular educational needs in order to keep his skills and information contemporary with his chosen field and to care properly for the medical problems he encounters.[...]
It is important for teachers to realize that the evaluation and management of health problems, whether you call it medical problem solving or the clinical reasoning process, is the physician's science.
- Problem-Based Learning: An Approach to Medical Education By Howard S. Barrows, MD, Robyn M. Tamblyn, BScN
Regarding the distinction between work, regular practice, and deliberate practice:
When you’ve reached a certain level, you can ‘design’ your own learning activities as well. Shank explains that over time people need to be able to self-monitor their skills, find the mistakes, and adjust (i.e., they must self-regulate their learning). Many articles on workplace learning claim that professionals or knowledge workers are well able to do this. Well, you might be an expert in your field but that doesn’t necessarily make you an expert learner nor an expert in designing your own learning experiences. Shank’s warning makes sense. If you expect people to self-monitor too quickly, before they are able, they are lost.
This is also a reminder that, although you do learn while doing your job and working with others, it’s not the same as practise. It’s work. Shank points out that one of the reasons that ‘normal’ work doesn’t necessarily make us better is that the prerequisites such as specific goals and meaningful expert feedback are not there. Shank says:“Rather than improve, we simply do what we usually do. We aren’t inclined to move out of our comfort zone during these times, for fear of making mistakes and looking stupid. In fact, we are likely on “autopilot” because we can’t take the time to slow down and “practise.”
This is exactly the point, and there’s more. It’s not just about making mistakes. Deliberate practice also means that you (yourself or with help from others) manage to ‘catch’ the mistakes that you make and which impede your achieving perfection/expertise and then find a way to eliminate them. If you don’t do that, you’re “just practising”. Regular practice can be extremely important sometimes. For example, if you need to master a certain procedure or be able to do something faster; that is, to become very proficient at something. However, through this type of practice you don’t achieve (a next level of) expertise or excellence!
- DELIBERATE PRACTICE: WHAT IT IS AND WHAT IT ISN’T by Mirjam Neelen & P.A. Kirschner
Is deliberate practice applicable to the practice of medicine?
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1. You should attempt to re-express your target’s position so clearly, vividly, and fairly that your target says, “Thanks, I wish I’d thought of putting it that way.
2. You should list any points of agreement (especially if they are not matters of general or widespread agreement).
3. You should mention anything you have learned from your target.
4. Only then are you permitted to say so much as a word of rebuttal or criticism.
Daniel Dennett, Intuition pumps and other tools for thinking.
Valid criticism is doing you a favor. - Carl Sagan