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The roles of deliberate practice and innate ability in developing expertise: Evidence and implications
Abstract
Medical education research focuses extensively on experience and deliberate practice (DP) as key factors in the development of expert performance. The research on DP minimises the role of individual ability in expert performance. This claim ignores a large body of research supporting the importance of innate individual cognitive differences. We review the relationship between DP and an innate individual ability, working memory (WM) capacity, to illustrate how both DP and individual ability predict expert performance.
This narrative review examines the relationship between DP and WM in accounting for expert performance. Studies examining DP, WM and individual differences were identified through a targeted search.
Although all studies support extensive DP as a factor in explaining expertise, much research suggests individual cognitive differences, such as WM capacity, predict expert performance after controlling for DP. The extent to which this occurs may be influenced by the nature of the task under study and the cognitive processes used by experts. The importance of WM capacity is greater for tasks that are non-routine or functionally complex. Clinical reasoning displays evidence of this task-dependent importance of individual ability.
No single factor is both necessary and sufficient in explaining expertise, and individual abilities such as WM can be important. These individual abilities are likely to contribute to expert performance in clinical settings. Medical education research and practice should identify the individual differences in novices and experts that are important to clinical performance.
... Based on this training approach, McGaghie et al. (2006) found a strong association between hours of practice on highfidelity medical simulators and standardized learning outcomes. From another perspective, Kulasegaram et al. (2013) examined the relationships between expert performances, deliberate practice and an innate cognitive capacity: working memory. They showed that expert performances often are affected by a number of factors, including a range of innate and environmental factors and that reducing expert performances to a single factor is an unfounded proposition. ...
... They showed that expert performances often are affected by a number of factors, including a range of innate and environmental factors and that reducing expert performances to a single factor is an unfounded proposition. Furthermore, they suggested that individual differences such as working memory capacities would play a role in the development of expert performances (Kulasegaram et al., 2013). Similarly, Hambrick and Engle (2002) investigated the interplay between domain knowledge and working memory capacity and found that innate working memory capacity contributed to memory performance even at high levels of domain knowledge. ...
... This approach seems to hold inspirational value for surgical education; and we speculate that it would improve the targeted training of a broader range of skills including the surgical trainee's ability to interact with and learn from the immediate social and cultural environment than those identified in the current surgical literature. This approach would, furthermore, advocate for a circumscribed use of deliberate practice in surgery, and hence, be aware of the limitations of deliberate practice that the literature from Kulasegaram et al. (2013) have added to medical education. Accordingly, we may suggest that instead of investigating what innate "talents" (e.g. ...
Purpose
Education of the surgeon and development of surgical expertise have been debated for centuries. Today, research in surgical education applies terms and methods from other performance domains such as sport and music. However, there still seems to be a lack of consensus as to how talent may be brought into the discourse about surgical education. Especially, when it comes to identifying and developing trainees who in the future will perform better than the average surgeon.
Design/methodology/approach
This five-step scoping study aims to map existing literature about talent identification, talent development and development of expertise in the domains of surgery, sport and music in the period of 1985-2014.
Findings
A total of 242 studies, divided in the four domains of surgery (69 studies), sport (115 studies), music (34 studies) and cross-disciplinary studies (24 studies) published in the period 1985-2014 were included.
Originality/value
Informed by the performance domains of sports and music and their inclusion of a holistic, ecological approach to research, this study suggests that research in surgical education may benefit from broadening its view on talent by including psychosocial variables and environmental, demographic and structural influencers when considering how surgical talent may be identified and developed.
... Depending on the type of task, either variations in individual working memory or the provision of deliberate practice may dominate the effect on performance. 23 While some may argue that innate intelligence, memory, and other cognitive abilities have little impact on performance, Kulasegaram et al 23,24 show that innate learner differences, specifically working memory, can predict expert performance. 23,24 They define working memory as "an individual's ability to store, access, and manipulate recently acquired information for the purpose of task completion." ...
... Depending on the type of task, either variations in individual working memory or the provision of deliberate practice may dominate the effect on performance. 23 While some may argue that innate intelligence, memory, and other cognitive abilities have little impact on performance, Kulasegaram et al 23,24 show that innate learner differences, specifically working memory, can predict expert performance. 23,24 They define working memory as "an individual's ability to store, access, and manipulate recently acquired information for the purpose of task completion." ...
... 23 While some may argue that innate intelligence, memory, and other cognitive abilities have little impact on performance, Kulasegaram et al 23,24 show that innate learner differences, specifically working memory, can predict expert performance. 23,24 They define working memory as "an individual's ability to store, access, and manipulate recently acquired information for the purpose of task completion." Tasks that are routine do not require extensive working memory, whereas tasks that are unfamiliar and depart from routine problem solving require more working memory. ...
Background and objectives:
Simulation-based education strategies to teach regional anesthesia have been described, but their efficacy largely has been assumed. We designed this study to determine whether residents trained using the simulation-based strategy of deliberate practice show greater improvement of ultrasound-guided regional anesthesia (UGRA) skills than residents trained using self-guided practice in simulation.
Methods:
Anesthesiology residents new to UGRA were randomized to participate in either simulation-based deliberate practice (intervention) or self-guided practice (control). Participants were recorded and assessed while performing simulated peripheral nerve blocks at baseline, immediately after the experimental condition, and 3 months after enrollment. Subject performance was scored from video by 2 blinded reviewers using a composite tool. The amount of time each participant spent in deliberate or self-guided practice was recorded.
Results:
Twenty-eight participants completed the study. Both groups showed within-group improvement from baseline scores immediately after the curriculum and 3 months following study enrollment. There was no difference between groups in changed composite scores immediately after the curriculum (P = 0.461) and 3 months following study enrollment (P = 0.927) from baseline. The average time in minutes that subjects spent in simulation practice was 6.8 minutes for the control group compared with 48.5 minutes for the intervention group (P < 0.001).
Conclusions:
In this comparative effectiveness study, there was no difference in acquisition and retention of skills in UGRA for novice residents taught by either simulation-based deliberate practice or self-guided practice. Both methods increased skill from baseline; however, self-guided practice required less time and faculty resources.
... In addition, when information needs to be actively organized, contrasted, or combined rather than simply held in WM (as is often the case during learning), this number drops to between 2 and 4 van Merriënboer & Sweller, 2010;Young et al., 2014). Research into individual differences also suggests that WM capacity can vary substantially between individuals (Brunken et al., 2003), either due to innate characteristics or variations in cognitive processing efficiency (Baddeley, 2012;Kulasegaram et al., 2013). In turn, individuals' WM capacity correlates highly with performance on higher-order cognitive tasks, including reading comprehension, mathematics, and multi-tasking (Unsworth & Engle, 2007). ...
... This interpretation is supported by an extensive evidence base in educational psychology suggests that SRME is sensitive to relatively small differences in CL arising from different instructional designs (Ayres, 2006;Leppink et al., 2013;Paas et al., 2003b). Conversely, a number of studies have documented individual variance in working memory capacity (Brunken et al., 2002;Kulasegaram et al., 2013), which could impact the amount of 'spare' cognitive resources individual participants are able to invest in the secondary task, thereby increasing the variance in this measure. Alternatively, it is possible that our study was not sufficiently powered to detect significant group differences in SRT, given the smaller effect sizes associated with the task complexity manipulation compared to those associated with the change in SRT over the training period. ...
... However, variations in innate working memory capacity and the use of cognitive strategies can increase the amount of information individuals can process in working memory (Choi et al., 2014;Cowan, 2014;de Jong, 2010;Kulasegaram et al., 2013). Such variables could mediate or confound the relationship between CL, instructional design and learning, and thus warrant further investigation. ...
Dramatic changes to healthcare systems globally have led to increased use of simulation as a pedagogical tool in health professions education. An impressive evidence base has accrued in support of simulation-based education and training, leaving little doubt that ‘it works’. As a result, scholarship in the field is shifting toward clarifying the features of simulation instructional design that optimize learning outcomes. Many scholars advocate for the use of established instructional frameworks to advance this agenda.
In this dissertation, the author employed Cognitive Load Theory (CLT) and related instructional frameworks to investigate the relationship between task complexity, cognitive load (CL), and learning among novices engaged in simulation-based procedural skills training. Phase one of this research program established the sensitivity of two CL measures (subjective ratings of mental effort and secondary task performance) to predicted differences in load related to learners’ proficiency with a procedural skill and simulation training task complexity. As a result, these measures may be used to track changes in CL during simulation training and distinguish between the CL imposed by different instructional designs.
Phase two operationalized Elaboration Theory (ET) to identify the task-conditions that impact training complexity of a prototypical procedural skill (lumbar puncture). The results of this phase demonstrate the methodological and theoretical advantages of combining a structured instructional design framework with expert consensus (via the Delphi technique) when developing healthcare simulation curricula.
The final phase examined the competing effects of task complexity and context similarity on novices’ skills transfer. The results demonstrate that higher task complexity increases load during training, which may impede initial learning and subsequent transfer of skills ‘peripheral’ to the task (e.g. sterility). However, the findings also suggest that other variables (i.e. context or information processing specificity and learners strategies to manage load) may have important effects on these learning outcomes.
At a broader level, the systematic, multi-phased approach employed in this dissertation provides a framework to guide future research in simulation instructional design. Furthermore, the application of CLT in this work exposes strengths and shortcomings in the theory that educators and researchers should be aware of, and highlights avenues for future inquiry.
... Another study of deliberate practice by Kulasegaram, Grierson, & Norman, 2013, focused on the relationship between deliberate practice and innate ability, a topic that has long been a topic of debate in sonographic skills training based on previous research (Hathaway, 2007). The question that has been posed previously with innate ability focused on its required amount to be proficient in sonography. ...
... Also, the amount of practice time needed to achieve competency in sonography has been debated. Kulasegaram et al. (2013) conducted a review which focused on whether it was the amount of deliberate practice individuals engaged in or their innate ability that predicted performance. Kulasegaram et al.'s search found nine studies that tested the influence of deliberate practice or its related factors and working memory in predicting performance. ...
The purpose of this mixed methods study was to examine relationships between sonography students’ levels of self-regulation and self-efficacy and their performance in a 16-week introductory vascular sonography skills laboratory course. Measures for the study were designed to yield qualitative and quantitative data related to student goals, strategies, and course performance, and were generated by both students and faculty. Qualitative data from the study included student self-reports of self-regulatory strategies and instructor evaluations of student performance, while quantitative data were provided by instructor and student ratings of performance, student self-efficacy ratings, and student reports on their use of deliberate practice. Results showed that many students learning how to perform sonographic examinations encountered motivational challenges that appeared to be tied both to their self-efficacy and their ability to effectively use self-regulatory activities. The findings of the present study suggest possibilities for improving sonography’s curricular models and teaching strategies toward the goal of making sonography instruction more efficient and effective. Advisor: Roger H. Bruning
... Students also commented on wanting to have an opportunity to practice: "I think anything is better than paper...More active learning than everything on paper and then doing it with a partner" (see comments by Student 5 on the 4SQT; Textbox 2). The role of deliberate practice-one that is purposeful and meaningful-has also been linked with transitioning from novice to expert clinical reasoning [35]. ...
Background:
The VSTEP Examination Suite is a collection of evidence-based standardized assessments for persons after stroke. It was developed by an interdisciplinary team in collaboration with clinician users. It consists of 5 standardized assessments: 2 performance-based tests using the Kinect camera (Microsoft Corp) to collect kinematics (5-Time Sit-to-Stand and 4-Square Test); 2 additional performance-based tests (10-Meter Walk Test and 6-Minute Walk Test); and 1 patient-reported outcome measure, the Activities-Specific Balance Confidence Scale.
Objective:
This study aimed to describe the development of the VSTEP Examination Suite and its evaluation as an educational tool by physical therapy students and faculty to determine its usefulness and usability.
Methods:
A total of 6 students from a Doctor of Physical Therapy program in the United States and 6 faculty members who teach standardized assessments in different physical therapy programs from the United States and Israel were recruited by convenience sampling to participate in the study. They interacted with the system using a talk-aloud procedure either in pairs or individually. The transcripts of the sessions were coded deductively (by 3 investigators) with a priori categories of usability and usefulness, and comments were labeled as negative or positive. The frequencies of the deductive themes of usefulness and usability were tested for differences between faculty and students using a Wilcoxon rank sum test. A second round of inductive coding was performed by 3 investigators guided by theories of technology adoption, clinical reasoning, and education.
Results:
The faculty members' and students' positive useful comments ranged from 83% (10/12) to 100%. There were no significant differences in usefulness comments between students and faculty. Regarding usability, faculty and students had the lowest frequency of positive comments for the 10-Meter Walk Test (5/10, 50%). Students also reported a high frequency of negative comments on the 4-Square Test (9/21, 43%). Students had a statistically significantly higher number of negative usability comments compared with faculty (W=5.7; P=.02), specifically for the 5-Time Sit-to-Stand (W=5.3; P=.02). Themes emerged related to variable knowledge about the standardized tests, value as a teaching and learning tool, technology being consistent with clinical reasoning in addition to ensuring reliability, expert-to-novice clinical reasoning (students), and usability.
Conclusions:
The VSTEP Examination Suite was found to be useful by both faculty and students. Reasons for perceived usefulness had some overlap, but there were also differences based on role and experience. Usability testing revealed opportunities for technology refinement. The development of the technology by interdisciplinary teams and testing with multiple types of users may increase adoption.
... Without training to apply what they know, their information during composition is frequently inert. Utilizing intentional practise is fundamental to the development of expert performance across a vast array of physical and cognitive task domains [24][25][26]. Theoretically, such a practise could minimise the high working memory demands of planning, creating, and reviewing textual composition, freeing up limited capacity for managing and monitoring these operations. Instead of just automating a skill, careful practise enables its regulation to achieve greater performance. ...
A combination of writing skill training and revision feedback was evaluated to increase text quality in higher education. The goal of this study was to review the feedback and provide strategy training for enhancing academic writing. The methodology includes the interaction of cognitive and metacognitive support that is crucial for mastering difficult tasks such as academic writing, particularly in higher education. Writing ability and text quality were assessed using items and ratings. First, text structure knowledge application strategy improved academic writing skills; second, feedback related to writing experience improved text quality; undergraduates benefited from informative tutoring feedback, while postgraduates benefited from try-again feedback; and third, the combination of writing strategy and feedback did not improve text quality significantly. To improve writing performance, the demands on working memory must be decreased so that executive attention can be directed to controlling their interactions. In theory, this can be accomplished through focused practise that assists authors in developing executive control through regular writing opportunities and timely, appropriate feedback. Automated essay scoring software may be able to relieve instructors of their time-consuming grading duties, significantly boosting the amount of writing practise pupils receive.
... In other words, performance tests are merely snapshot indicators of time-bound learning progress rather than absolute indicators of giftedness or ability (Sternberg, 2001a). Therefore, to become experts (Sternberg, 2001b; see also Ericsson & Lehmann, 1996), learners need to engage in deliberate practice (Ackerman, 1988;Kulasegaram et al., 2013): that is, planfully designed activities that are responsive to the learner's progress, whilst the learner is encouraged to have intent on improvement (Ericsson, 2018). Academic expertise is developed through cumulative experience of such activities. ...
Cumulative experience is important for developing expertise through in-person learning, along with country setting and gender, but evidence is limited the role of these features in online learning. Yet, COVID-19 has catalysed the centrality of online learning, such that the efficacy of online learning is now highly relevant. Although the Pandemic triggered a surge of self-report and literature review research on stakeholder perceptions of online learning, less educational research has used big data to understand online learning. Therefore, the present research mined online learning data to identify features that are important for developing expertise in online learning. Data mining of 54,842,787 initial data points from one online learning platform was conducted by partnering theory with data in model development. Following examination of a theory-led machine learning model, a data-led approach was taken to reach a final model. The linear regression model was regularised with the Lasso penalty to enable data-driven feature selection. Twenty-six features were selected to form an extreme gradient boosting model that underwent hyper-parameter tuning. All cross-validation adopted the grid search approach. The final model was used to derive Shapley values for feature importance. As expected, cumulative experience, country differences, low-and-middle-income country status, and COVID-19 were important features for developing expertise through online learning. The data-led model development resulted in additional insights not examined in the initial, theory-led model: namely, the importance of meta-cognition and independent learner behaviour. Surprisingly, no male advantage was found in the potential for expertise development through online learning.
... Some faculty members believe that students behave very differently from those in the past; [2] therefore, they face challenges in trying to communicate with a generation they may not fully understand [2,10]. Most of the health sciences literature on the interface between generations and education is composed of theoretical and empirical articles, non-systematic, critical as well as noncomprehensive reviews [5,11,12] with the majority of papers having focused on Millennial learners [10,13,14]. The Millennials (official name: Generation Y) are also called the 'digital natives' [15], the 'instant messaging generation', and until now, have become the most highly educated generation in western history [10,[13][14][15]. ...
Introduction/Aims
We aimed at using drawings as a form of data collection to give voice to older and younger generations in regards to educational practices in undergraduate dentistry.
Materials and methods
First year dental students (younger generations) and faculty members (older generations) produced drawings depicting their perceptions of the current dental education learning environment. Qualitative analysis was conducted independently by two researchers using the drawings to produce codes, categories and themes.
Results
15 drawings were produced: 9/34 (26.4%) made by students and 6/20 (30%) made by faculty members. The generated themes indicated that students and faculties found that dental education is going through a challenging time, because of the restrictions caused by the COVID-19 pandemic; and that they were aware about the evident division between basic/preclinical and applied/clinical courses. Faculties showed hopeful signs that the situation may get better. Students‘ drawings evoked the following topics: digital connectedness, diversity, time goes by, and future aspirations in Dentistry.
Discussion
This study reinforced the validity of visual methods as an approach in research and showed different graphical features (features that might be intentionally or unintentionally represented in the drawings) that gave voice to participants. These voices could have been invisible in more traditional qualitative approaches, such as interviews or questionnaires.
Conclusions
Although the two groups of participants came from different generation cohorts, they had aligned perceptions regarding challenges in dental education, and mentioned the separation between preclinic and clinic. Drawings were unique, innovative, and an interesting tool to express perceptions regarding today’s learning environment. These insights can consequently help educators to personalize teaching approaches to better meet the needs of the students.
... Accordingly, this study asserts the fact that it is commitment and continuous effort that determine academic success during the learning process. Correspondingly, the fact that sustained deliberate practice is needed for academic success has started to receive attention in the field of language learning and teaching, since this concept is recognized to be connected a great deal with second language learning [37]. For example, both from training and instructional aspects, Kellogg and Writeford [38] explored the role of deliberate practice at the high school and college levels aiming at improving advanced writing skills. ...
Education for sustainable development has been regarded as a lifelong learning process and an integral part of quality education. To this end, this study aims to examine the implementation of online learning communities and deliberate practice in a blended learning context, to improve English as a foreign language (EFL) students’ learning performance and engagement. Specifically, in addition to the traditional offline courses, the online film clip watching and writing tasks were adopted to ascertain the role of deliberate practice and the dimensions of the community of inquiry (COI) framework were adopted to examine the perceived effectiveness and improved performance. A quantitative study was carried out, involving 67 undergraduate freshman English course students from one university at northeastern Taiwan. The findings of this study indicate that there is statistically significant correlation between the three dimensions of community of inquiry, perceived learning and learning engagement. Moreover, teaching and cognitive presence are more predictive of students’ perceived learning. Finally, this study also illustrates practical implications, to facilitate students’ learning for sustainable development competency in blended learning contexts.
... According to cognitive load theory, superfluous extraneous cognitive load leaves no capacity allocated for the germane cognitive load, which is responsible for the formation of mental schemes, which allows the actual learning process also known as cognitive overload. [60][61][62][63][64][65] Earlier studies have shown that complex learning environments can induce high levels of cognitive load. 66 Both screen-based simulation and VR-HMD cause intrinsic cognitive loads, but 1 study found an increased extraneous load in VR-HMD. ...
Summary statement:
Simulation-based training using virtual reality head-mounted displays (VR-HMD) is increasingly being used within the field of medical education. This article systematically reviews and appraises the quality of the literature on the use of VR-HMDs in medical education. A search in the databases PubMed/MEDLINE, Embase, ERIC, Scopus, Web of Science, Cochrane Library, and PsychINFO was carried out. Studies were screened according to predefined exclusion criteria, and quality was assessed using the Medical Education Research Study Quality Instrument. In total, 41 articles were included and thematically divided into 5 groups: anatomy, procedural skills, surgical procedures, communication skills, and clinical decision making. Participants highly appreciated using VR-HMD and rated it better than most other training methods. Virtual reality head-mounted display outperformed traditional methods of learning surgical procedures. Although VR-HMD showed promising results when learning anatomy, it was not considered better than other available study materials. No conclusive findings could be synthesized regarding the remaining 3 groups.
... Clinical expertise in medical practice is an important area of inquiry for medical education research and has direct implications for medical training and faculty development. Several areas of research have shed light on clinical expertise in medicine, such as the study of deliberate practice, adaptive expertise and clinical reasoning in medicine [1][2][3]. However, in order to contribute to a rich understanding of clinical expertise, further examination of excellent practice is required from varying perspectives. ...
Background
Humility has recently been conceptualized as a positive, multifaceted attribute in fields outside of medicine, such as psychology and philosophy. In medicine, there has been limited study into the nature of humility and its role in clinical practice. We sought to develop a deeper understanding of humility in medical practice through the lived-experiences of peer-nominated excellent clinicians.
Methods
We conducted a qualitative study with secondary analysis of transcripts from individual open ended, semi-structured interviews of 13 peer nominated physicians [7 (54%) female] at an academic centre. Using constant comparative analysis, the transcripts were analyzed for instances where humility was discussed as it related to clinical practice.
Results
Participants perceived humility to be an important driver for excellence in clinical practice. This was further explained using two overarching themes: an inward, intellectual perspective and an outward, social perspective. The physician’s inward perspective was their view of their abilities and limits, their self-confidence, and their intellectual openness and adaptability to the limitations and evolving nature of knowledge in medicine. Their outward perspective was an understanding and appreciation for the larger system in which they worked, an openness to others, and valuing patients’ experience. Through these perspectives, humility positively influenced clinical care, learning and curiosity, motivation in the care of others, and relationships with team members and patients.
Conclusions
Humility in medicine is a rich, multifaceted construct that was perceived to be a driver for excellence in medical practice by peer-nominated excellent clinicians. Humility was seen as an active force in formulating and calibrating a clinician’s perspective of self and of others, and as such, positively influencing clinical practice. These findings will help inform a discourse in medical education and faculty development about the important role of humility in medical practice.
... Participants felt this book club positively contributed to their professional development in several ways including the encouragement of deliberate practice, which has been identified in the literature as a key component in the development of expertise. [33][34][35] Fostering this practice early in training may compound results. Participants also noted the book club promoted self-reflection, which has been described as being essential for improvement. ...
Introduction:
Professional development is an important component of graduate medical education, but it is unclear how to best deliver this instruction. Book clubs have been used outside of medicine as a professional development tool. We sought to create and evaluate a virtual professional development book club for emergency medicine interns.
Methods:
We designed and implemented a virtual professional development book club during intern orientation. Afterward, participants completed an evaluative survey consisting of Likert and free-response items. Descriptive statistics were reported. We analyzed free-response data using a thematic approach.
Results:
Of 15 interns who participated in the book club, 12 (80%) completed the evaluative survey. Most (10/12; 83.3%) agreed or strongly agreed that the book club showed them the importance of professional development as a component of residency training and helped them reflect on their own professional (11/12; 91.7%) and personal development (11/12; 91.7%). Participants felt the book club contributed to bonding with their peers (9/12; 75%) and engagement with the residency program (9/12; 75%). Our qualitative analysis revealed five major themes regarding how the book club contributed to professional and personal development: alignment with developmental stage; deliberate practice; self-reflection; strategies to address challenges; and communication skills.
Conclusion:
A virtual book club was feasible to implement. Participants identified multiple ways the book club positively contributed to their professional development. These results may inform the development of other book clubs in graduate medical education.
... Many studies have indicated that deliberate practice and mastery learning approaches of procedural skills can ensure expert-level performance, particularly for routine procedures such as UGRA [21][22][23][24]. The trainees in the WG groups had more time to learn and practice in the one-to-one interactive simulationbased workshops than the trainees in the CG groups. ...
Background
Optimizing educational programs for obtaining and maintaining competency in ultrasound-guided regional anesthesia (UGRA) is needed for anesthesia residents. This study aimed to assess the effectiveness of simulation-based training programs on the UGRA skills of senior anesthesia residents.
Methods
This prospective assessor-blind randomized controlled trial was conducted in a tertiary hospital in November 2019. Twenty anesthesia residents who had been in a clinical rotation in anesthesiology for 3-5 years were randomly allocated to either the workshop group (WG) or the control group (CG) for pretechnical procedure training on UGRA. Following didactic lectures for both groups, simulation-based workshops were performed only for the WG. All participating trainees were assessed by written examination, ultrasound scanning and anatomy recognition in live human models and ultrasound-guided target injections in porcine meat models. The written examination score, sonographic proficiency scores, time taken to perform the injections and errors were recorded and analyzed.
Results
The simulation-based training program significantly reduced the time taken for target injections performed by trainees in the WG (183.9±44.8 seconds) compared with those in the CG (239.6±64.2 seconds): mean difference -55.8 (-107.7, -3.7), P=0.037. The error score was also significantly lower in the WG than in the CG. The sonographic proficiency scores of the thoracic paravertebral structures, brachial plexus and femoral nerve scanning were significantly higher for trainees in the WG than for those in the CG, as were the total scores for the four stations on live human models.
Conclusions
For senior anesthesia residents, the simulation-based training program can improve UGRA skills and might enhance clinical competence.
Trial Registration
Chinese clinical trial registry, ChiCTR-IPR-1900027585, Principal investigator: Hong Zhang, Date of registration: November 19, 2019 URL: http://www.chictr.org.cn/
... However, important though it may be, deliberate practice is not the only predictor of expert performance. Individual ability, such as working memory capacity, i.e. the ways to efficiently store and retrieve knowledge in memory, can be equally important [54]. ...
The practice of clinical medicine needs to be a very flexible discipline which can adapt promptly to continuously changing surrounding events. Despite the huge advances and progress made in recent decades, clinical reasoning to achieve an accurate diagnosis still seems to be the most appropriate and distinctive feature of clinical medicine. This is particularly evident in internal medicine where diagnostic boundaries are often blurred. Making a diagnosis is a multi-stage process which requires proper data collection, the formulation of an illness script and testing of the diagnostic hypothesis. To make sense of a number of variables, physicians may follow an analytical or an intuitive approach to clinical reasoning, depending on their personal experience and level of professionalism. Intuitive thinking is more typical of experienced physicians, but is not devoid of shortcomings. Particularly, the high risk of biases must be counteracted by de-biasing techniques, which require constant critical thinking. In this review, we discuss critically the current knowledge regarding diagnostic reasoning from an internal medicine perspective.
... Furthermore, distractions in the immersive environment add extraneous cognitive load. This possible increase in intrinsic and extraneous loads during training in immersive VR compared with conventional VR could result in cognitive overload, inhibiting learning, due to there being no cognitive capacities allocated to germane load [11][12][13][14][15]. Other studies have investigated cognitive load in less immersive surgical simulation training, but none have investigated cognitive load in immersive VR nor explored the consequences for performance. ...
Background
Virtual reality simulators combined with head-mounted displays enable highly immersive virtual reality (VR) for surgical skills training, potentially bridging the gap between the simulation environment and real-life operating room conditions. However, the increased complexity of the learning situation in immersive VR could potentially induce high cognitive load thereby inhibiting performance and learning. This study aims to compare cognitive load and performance in immersive VR and conventional VR simulation training.
Methods
A randomized controlled trial of residents (n = 31) performing laparoscopic salpingectomies with an ectopic pregnancy in either immersive VR or conventional VR simulation. Cognitive load was estimated by secondary-task reaction time at baseline, and during nonstressor and stressor phases of the procedure. Simulator metrics were used to evaluate performance.
Results
Cognitive load was increased by 66% and 58% during immersive VR and conventional VR simulation, respectively (p < 0.001), compared to baseline. A light stressor induced a further increase in cognitive load by 15.2% and a severe stressor by 43.1% in the immersive VR group compared to 23% (severe stressor) in the conventional VR group. Immersive VR also caused a significantly worse performance on most simulator metrics.
Conclusion
Immersive VR simulation training induces a higher cognitive load and results in a poorer performance than conventional VR simulation training in laparoscopy. High extraneous load and element interactivity in the immersive VR are suggested as mechanisms explaining this finding. However, immersive VR offers some potential advantages over conventional VR such as more real-life conditions but we only recommend introducing immersive VR in surgical skills training after initial training in conventional VR.
... Unfortunately, SBME is a resource intensive approach to medical training, requiring careful alignment of education and practice design principles with the intended outcomes. For example, there is growing evidence that deliberate practice and mastery learning approaches to training for procedural skills can ensure expert level performance, particularly for routine procedures [4][5][6][7]. Applying this structured approach, learners can transition as outlined in the "Dreyfus model" along a continuum of five stages: novice, advanced beginner, competent, proficient and expert [4]. Highly structured practice requires a substantial commitment of time and instructional resources [8]. ...
Background
Simulation-based medical education (SBME) is a cornerstone for procedural skill training in residency education. Multiple studies have concluded that SBME is highly effective, superior to traditional clinical education, and translates to improved patient outcomes. Additionally it is widely accepted that mastery learning, which comprises deliberate practice, is essential for expert level performance for routine skills; however, given that highly structured practice is more time and resource-intensive, it is important to assess its value for the acquisition of rarely performed technical skills. The bougie-assisted cricothyroidotomy (BAC), a rarely performed, lifesaving procedure, is an ideal skill for evaluating the utility of highly structured practice as it is relevant across many acute care specialties and rare – making it unlikely for learners to have had significant previous training or clinical experience. The purpose of this study is to compare a modified mastery learning approach with deliberate practice versus self-guided practice on technical skill performance using a bougie-assisted cricothyroidotomy model.
Methods
A multi-centre, randomized study will be conducted at four Canadian and one American residency programs with 160 residents assigned to either mastery learning and deliberate practice (ML + DP), or self-guided practice for BAC. Skill performance, using a global rating scale, will be assessed before, immediately after practice, and 6 months later. The two groups will be compared to assess whether the type of practice impacts performance and skill retention.
Discussion
Mastery learning coupled with deliberate practice provides systematic and focused feedback during skill acquisition. However, it is resource-intensive and its efficacy is not fully defined. This multi-centre study will provide generalizable data about the utility of highly structured practice for technical skill acquisition of a rare, lifesaving procedure within postgraduate medical education. Study findings will guide educators in the selection of an optimal training strategy, addressing both short and long term performance.
... This paper critically reviews the use of generation theory in the HPE literature. 18 Similarly to recent critical reviews, 19 literatures outside the health professions as a means to understand the potential consequences of using generation theory to inform our instruction and research practices. Our goal is to suggest ways in which our education approaches within HPE can be tailored to fit learners within and across generations rather than to assume a onesize-fits-all approach to stereotypes. ...
Context: The health professions education (HPE) literature abounds with recommendations for how educators should adapt practices to the needs of generations of learners, using these insights as a means to bridge inherent differences between learners and educators. Yet the evidence supporting these applications of generational theory in HPE have not been critically examined; if unsubstantiated, these approaches may perpetuate biases towards learners they are intended to support.
Methods: This paper critically reviews generational theory in the HPE literature, with particular focus on recent recommendations regarding ‘millennial’ learners. We used Google Scholar, MEDLINE, EBSCO, JSTOR, and PsycINFO to search for articles pertaining to the origins and uses of generational theory within and outside of the health professions. This synthesis is presented as a preliminary understanding of how ideas of generational theory arose and permeated the HPE literature, exploring potential downstream effects of generational theory on educational practices.
Results: Translation of generational theory into the HPE literature generally follows the types of recommendations that have been advanced other literatures, with broad generalizations about generational cohorts drawn from limited data. Outside of HPE, this application of generational theory has been criticized as a form of stereotyping that ignores the internal differences and diversity inherent in any large group of people. Accordingly, problematizing the needs of generations such as ‘millennial’ learners in the HPE literature may perpetuate narrow or privileged assumptions by teachers.
Conclusion: Generational archetypes such as ‘millennial learners’ are myths that perpetuate unfounded generalizations about cohorts, reinforce power differentials between age groups, and minimize the unique needs of individuals. To individualize and strengthen teaching practices in HPE, we recommend adopting ‘generational humility’ as a means to more purposefully explore the dynamic social, cultural, and historical influences that shape individuals within each generation of learners.
... Emerging from this, the field of talent identification, development, and selection (TIDS) has merited broad attention from the scientific community (Vaeyens et al., 2009). Regardless of following strict deliberate practice (Macnamara et al., 2014) or alternative approaches to expertise (Kulasegaram et al., 2013), TIDS programs aim at the early signalling of features suggesting potential for achieving expert performance levels (Leite et al., 2009). The reasoning is that early identification of talent may assist sport systems in providing them with greater support and training conditions from an early stage, hopefully translating into optimal performance later on (Pankhurst et al., 2013). ...
... However, there is a growing consensus on the utility of certain models and ideas that can guide our acquisition and maintenance of clinical expertise. [1][2][3][4][5][6][7][8] Understanding and applying these can, in turn, make us better clinician teachers and learners. ...
Understanding the process of expert clinical reasoning improves our ability to develop, practice, maintain, teach, and assess clinical diagnostic expertise. The dual process model describes a synergistic interplay of associative thinking and analytical reasoning. These complimentary processes facilitate the efficient abstraction of data from clinical presentations, the identification of key features, and the production of useful problem representations. These are compared unconsciously to prototypical cases stored in memory as illness scripts for a best match. A lack of a satisfactory match may stimulate a conscious, analytic analysis of discordance, ideally reducing bias and error and promoting further script development.An awareness of this process and the use of existing observation and assessment techniques can enable both the teaching and the assessment of clinical reasoning. Learners can also be taught to use these techniques to help develop self-assessment of clinical reasoning performance. Teaching and assessing clinical reasoning in others stimulates clinician teachers to reflect on their own clinical reasoning and practice, serving as an effective form of continuous professional learning.
... Then, initial levels and gains of knowledge characterize students' development of medical knowledge and are substantially related to later performances on national licensing examinations. This general developmental pattern is well in-line with current accounts of the development of expertise in medicine (Kulasegaram et al. 2013). ...
Background: Progress testing is a longitudinal assessment that aims at tracking students' development of knowledge. This approach is used in many medical schools internationally. Although progress tests are longitudinal in nature, and their focus and use of developmental aspects is a key advantage, individual students’ learning trajectories themselves play, to date, only a minor role in the use of the information obtained through progress testing.
Methods: We investigate in how far between-person differences in initial levels of performance and within-person rate of growth can be regarded as distinct components of students’ development and analyze the extent to which these two components are related to performances on national licensing examinations using a latent growth curve model.
Results: Both, higher initial levels of performances and steepness of growth are positively related to long-term outcomes as measured by performance on national licensing examinations. We interpret these findings as evidence for progress tests’ suitability to monitor students’ growth of knowledge across the course of medical training.
Conclusions: This study indicates that individual development as obtained by formative progress tests is related to performance in high-stakes assessments. Future studies may put more focus on the use of between-persons differences in growth of knowledge.
... Evidence from the literature shows DP has influenced the development of skill in various domains of practice [4][5][6][7]. The goal of DP is constant skill improvement, not just skill maintenance and has become a powerful tool in the nursing and medical professions [8]. ...
The concept of deliberate practice (DP) has been extensively applied to the development of skill and expert performance in many domains of professional practice. Although it has been widely reviewed in other health professions, there is a lack of evidence on its application in radiation therapy practice. This article aims to explore the concept of DP and how it can be applied to radiation therapy practice. The authors define DP, why it is essential, and how it can be implemented in radiation therapy. Evidence from the DP literature in the health professions was used to clarify the guiding principles for successful DP implementation within both the clinical and educational contexts. While the authors encourage radiation therapy practitioners to engage in DP approaches, every profession utilizing DP will develop strategies unique to the individual discipline. Hence, rather than imitating other professions, it is essential that radiation therapists engage evidence-based approaches that will generate empirical evidence to model radiation therapy-specific DP approaches.
... Emerging from this, the field of talent identification, development, and selection (TIDS) has merited broad attention from the scientific community (Vaeyens et al., 2009). Regardless of following strict deliberate practice (Macnamara et al., 2014) or alternative approaches to expertise (Kulasegaram et al., 2013), TIDS programs aim at the early signalling of features suggesting potential for achieving expert performance levels (Leite et al., 2009). The reasoning is that early identification of talent may assist sport systems in providing them with greater support and training conditions from an early stage, hopefully translating into optimal performance later on (Pankhurst et al., 2013). ...
The aim of the present study was to analyse the Japanese National Women’s Volleyball Team and to identify items differentiating it from other teams. All fifteen matches between the six National Teams (i.e., Japan, Brazil, China, Belgium, Turkey and Russia) competing at the Women’s Volleyball World Grand Prix Finals of 2014 were analyzed, in a total of 56 sets and 7,176 situations of ball possession. Data suggested the existence of differences between Japan’s and the other five teams’ gameplay, namely the likelihood of more gameplay with utilization of the float jump serve (20.42; ± 3.79%, very large magnitude) and attack tempo 2 (61.89; ± 29.67%, large magnitude), while exhibiting less gameplay with zero blockers opposing the attack (-42.06; ± 21.28%, large magnitude). Based on these findings, it was concluded that sports success could be achieved even when a core feature of mainstream performance models (e.g., height in volleyball) was lacking.
... While time spent practicing is not the only factor in the development of skills and expertise, students who spend more time deliberately practicing an activity, such as a digital game, are more likely to develop expertise in the activity, and vice versa (Kulasegaram, Grierson, & Norman, 2013). Through playing digital games, students can develop expertise both in the game content and in general problem-solving strategies. ...
Digital game play is a common pastime among college students and monopolizes a great deal of time for many students. Researchers have previously investigated relationships between subject-specific game play and academics, but this study fulfills a need for research focusing on entertainment game strategies and how they relate to strategies and success in other contexts. Utilizing a survey of 191 undergraduate students, the goal was to investigate students’ digital game play habits, strategies, and beliefs that predict gaming expertise, and to determine if these relate to academic success. Factor analysis revealed three latent variables that predict expertise: dedication, solo mastery, and strategic play. Multiple regression analysis was used to determine whether these three components could also predict academic outcome variables. Findings point to the absence of a relationship between these variables and academic GPA, but to the presence of a tentative relationship between confidence in game play and confidence in personal control over academic success.
... Often, expertise has been equated with repeated, deliberate practice (Ericsson 2015). However, evidence indicates that this concept is flawed because it does not take into account individual differences (Kulasegaram et al. 2013;Macnamara et al. 2014). The number of completed procedures is not necessarily a comprehensive measure of expertise. ...
... The ability to be explicitly reflective, either in-action or on-action, is thought to be a requirement for expertise development [13]. However, deliberate practice does not fully explain the difference between expert and non-expert performance [46]. From religious traditions to the descriptions of medical practice as an 'art, ' self-development often is described as a tacit, unconscious process that does not involve conscious reflection. ...
Background:
Reflection, a process of self-analysis to promote learning through better understanding of one's experiences, is often used to assess learners' metacognitive ability. However, writing reflective exercises, not submitted for assessment, may allow learners to explore their experiences and indicate learning and professional growth without explicitly connecting to intentional sense-making.
Aim:
To identify core components of learning about medicine or medical education from family medicine residents' written reflections.
Design and setting:
Family medicine residents' wrote reflections about their experiences throughout an academic year.
Method:
Qualitative thematic analysis to identify core components in 767 reflections written by 33 residents.
Results:
We identified four themes of learning: 'Elaborated reporting' and 'metacognitive monitoring' represent explicit, purposeful self-analysis that typically would be characterised as reflective learning about medicine. 'Simple reporting' and 'goal setting' signal an analysis of experience that indicates learning and professional growth but that is overlooked as a component of learning.
Conclusion:
Identified themes elucidate the explicit and implicit forms of written reflection as sense-making and learning. An expanded theoretical understanding of reflection as inclusive of conscious sense-making as well as implicit discovery better enables the art of physician self-development.
... Previous research has suggested that motivation plays a major role for the pace at which trainees attain proficiency in the simulated setting, 17,18 but differences in skills and aptitude may also play a significant role. 19 Our results support the position that learning aptitude rather than prolonged practice is responsible for initial clinical learning curves. ...
Objectives:
The aim of the study was to explore whether learning curves on a virtual-reality (VR) sonographic simulator can be used to predict subsequent learning curves on a physical mannequin and learning curves during clinical training.
Methods:
Twenty midwives completed a simulation-based training program in transvaginal sonography. The training was conducted on a VR simulator as well as on a physical mannequin. A subgroup of 6 participants underwent subsequent clinical training. During each of the 3 steps, the participants' performance was assessed using instruments with established validity evidence, and they advanced to the next level only after attaining predefined levels of performance. The number of repetitions and time needed to achieve predefined performance levels were recorded along with the performance scores in each setting. Finally, the outcomes were correlated across settings.
Results:
A good correlation was found between time needed to achieve predefined performance levels on the VR simulator and the physical mannequin (Pearson correlation coefficient .78; P < .001). Performance scores on the VR simulator correlated well to the clinical performance scores (Pearson correlation coefficient .81; P = .049). No significant correlations were found between numbers of attempts needed to reach proficiency across the 3 different settings. A post hoc analysis found that the 50% fastest trainees at reaching proficiency during simulation-based training received higher clinical performance scores compared to trainees with scores placing them among the 50% slowest (P = .025).
Conclusions:
Performances during simulation-based sonography training may predict performance in related tasks and subsequent clinical learning curves.
... We believe these constraints place a huge cognitive charge on the performer. Many decades of research have demonstrated that deliberate practice is a necessary requirement to reach expertise in a specific domain (Kulasegaram, Grierson, & Norman, 2013), and that this repeated exercise might benefit broader cognitive skills (Bidelman et al., 2013). Thus, although the role of brain regions associated with executive functions during improvisation still remains ambiguous and potentially task-dependent (Beaty, 2015), we hypothesize that the repeated practice of lyrical improvisation, not only could improve domain specific abilities, but also potentially increase general cognitive capabilities. ...
Freestyle rap represents a particularly engaging cognitive activity, although some studies show a deactivation of areas associated with working memory, and other studies the opposite pattern. Methodological differences such as task demands are a possible explanation. Other scholars show that musicians have higher general cognitive abilities, and that people with higher working memory produce more creative improvisatory musical performances. Due to the presumed key role of cognitive resources during lyrical improvisation, we hypothesized that freestyle performers with at least three years experience, not only possessed higher domain specific skills than non-performers, but also more general cognitive abilities. We administered to both groups cognitive tasks (Go/No-Go, Stroop, Task Switching, 2-Back) and verbal fluency tasks (Rhyme Fluency and Category Fluency). Groups did not significantly differ on the cognitive tasks. The experimental group performed significantly better on the rhyme fluency task but not on the category fluency task. We address methodological discrepancies that might explain past research results, and suggest alternatives that might reduce these differences. We also propose to devise cognitive trainings able to improve lyrical improvisation abilities, and produce more sound studies. In addition, we put forward some experiments that could contribute to our understanding of lyrical improvisation and improvisation mechanisms in general.
... Another potential limitation of deliberate practice may be that it is not well-known or understood among anesthesiology faculty educators and programs so ongoing dissemination nationally may be helpful [18]. Innate ability and learner differences may also confound the study of deliberate practice [19]. ...
Introduction: Properly obtaining informed consent for spinal anesthesia is a skill expected of anesthesiology residents. The goals of the study were to 1) use a Delphi method to develop a curriculum for teaching informed consent for spinal anesthesia, and a checklist of required elements; 2) determine which elements of the informed consent process were most frequently missed prior to the curriculum; 3) quantify if this curriculum improved performance of correctly obtaining informed consent from a standardized patient; and 4) measure retention of learning as measured by how residents performed on actual patients. Methods: Performance on obtaining informed consent was tested with an 11-item checklist on a standardized patient before and after completing the curriculum. Resident performance on their next three patients scheduled to have spinal anesthesia was evaluated at the bedside using the same checklist. Results: At baseline before completing the curriculum 18 anesthesia residents (39% female) with a mean 6.29 months (SD 3.59, median 6.5, 25th-75th quartile range 4.25-9.75) of residency completed and 11.39 prior spinals (SD 13.1, median 13.14, 25th-75th quartile range 3-14) successfully performed 47% (SD 20%, median 45%, 25th-75th quartile range 36-41%) of the 11 required elements. The 3 most commonly missed elements were: “Teach back: Ask the patient to repeat key items in discussion” (0% correct), “Connect, Introduce, Communicate, Ask permission, Respond, Exit” (6%), and “Have the patient verbally agree with the consent forms (17%).” 7 residents completed the written materials and video curriculum and significantly increased their performance to successfully complete 90% of the required elements on a standardized patient, and 86% on actual patients 1-5 days later (P<0.01). 11 other residents completed the written materials and video curriculum supplemented with a 1:1 session with a faculty and significantly increased the percentage of properly completed elements to 97% on the standardized patient, and to 88% on actual patients (P<0.01). Conclusions: The curriculum developed increased performance on how well informed consent was obtained by junior anesthesia residents on an 11 item checklist and may be used by training programs to teach and evaluate their residents.
... Recently, the deliberate practice approach has been criticized on the basis that the power of deliberate practice for explaining improvements in performance has been ''oversold''. Researchers have proposed that, while deliberate practice may well be necessary to explain improvements in performance, it is not sufficient in this regard, and that the effect of other individual differences (e.g., in an individual's working memory capacity) on learning must be considered also (Campitelli and Gobet 2011;Kulasegaram et al. 2013;Hambrick et al. 2014). Certainly, caution is warranted until research has been conducted on the effectiveness of team deliberate practice. ...
A better understanding of the factors influencing medical team performance and accounting for expert medical team performance should benefit medical practice. Therefore, the aim here is to highlight key issues with using deliberate practice to improve medical team performance, especially given the success of deliberate practice for developing individual expert performance in medicine and other domains. Highlighting these issues will inform the development of training for medical teams. The authors first describe team coordination and its critical role in medical teams. Presented next are the cognitive mechanisms that allow expert performers to accurately interpret the current situation via the creation of an accurate mental “model” of the current situation, known as a situation model. Following this, the authors propose that effective team performance depends at least in part on team members having similar models of the situation, known as a shared situation model. The authors then propose guiding principles for implementing team deliberate practice in medicine and describe how team deliberate practice can be used in an attempt to reduce barriers inherent in medical teams to the development of shared situation models. The paper concludes with considerations of limitations, and future research directions, concerning the implementation of team deliberate practice within medicine.
... However, there is a growing consensus on the utility of certain models and ideas that can guide our acquisition and maintenance of clinical expertise. [1][2][3][4][5][6][7][8] Understanding and applying these can, in turn, make us better clinician teachers and learners. ...
Understanding the process of expert clinical reasoning improves our ability to develop, practice, maintain, teach, and assess clinical diagnostic expertise. The dual process model describes a synergistic interplay of associative thinking and analytical reasoning. These complimentary processes facilitate the efficient abstraction of data from clinical presentations, the identification of key features, and the production of useful problem representations. These are compared unconsciously to prototypical cases stored in memory as illness scripts for a best match. A lack of a satisfactory match may stimulate a conscious, analytic analysis of discordance, ideally reducing bias and error and promoting further script development.
An awareness of this process and the use of existing observation and assessment techniques can enable both the teaching and the assessment of clinical reasoning. Learners can also be taught to use these techniques to help develop self-assessment of clinical reasoning performance. Teaching and assessing clinical reasoning in others stimulates clinician teachers to reflect on their own clinical reasoning and practice, serving as an effective form of continuous professional learning.
... And while some studies have indicated that general aptitude is not a significant predictor of performance, other studies contradict this. Finally, to revisit a common theme, deliberate practice is not a good predictor of expertise in more complex and multifaceted domains like the professions (Kulasegaram et al. 2013). ...
... It may be that engaging in teaching involves more explicit and reflective thinking about the content to be taught (Ericsson 2004(Ericsson , 2008Wenrich et al. 2011;Kulasegaram et al. 2013). Clinician educators who provide scaffolding (or support) and coaching in authentic clinic contexts to promote learner development, and role modelling and comparisons to their own practice, may be stimulated to self-reflect on their own clinical work. ...
Introduction:
Physicians identify teaching as a factor that enhances performance, although existing data to support this relationship is limited.
Purpose:
To determine whether there were differences in clinical performance scores as assessed through multisource feedback (MSF) data based on clinical teaching.
Methods:
MSF data for 1831 family physicians, 1510 medical specialists, and 542 surgeons were collected from physicians' medical colleagues, co-workers (e.g., nurses and pharmacists), and patients and examined in relation to information about physician teaching activities including percentage of time spent teaching during patient care and academic appointment. Multivariate analysis of variance, partial eta squared effect sizes, and Tukey's HSD post hoc comparisons were used to determine between group differences in total MSF mean and subscale mean performance scores by teaching and academic appointment data.
Results:
Higher clinical performance scores were associated with holding any academic appointment and generally with any time teaching versus no teaching during patient care. This was most evident for data from medical colleagues, where these differences existed across all specialty groups.
Conclusion:
More involvement in teaching was associated with higher clinical performance ratings from medical colleagues and co-workers. These results may support promoting teaching as a method to enhance and maintain high-quality clinical performance.
... More specifically, four prevalent and four less prevalent were used for this study. We chose prevalent cases and less prevalent cases because these different types of cases solicit different cognitive processes (Coderre et al. 2004;Kulasegaram et al. 2013;Mamede et al. 2008a;McLaughlin et al. 2008;Rikers et al. 2000). That is, less prevalent, in contrast to prevalent cases, will be more difficult to solve based on pattern recognition and hence will require more working memory capacity. ...
Since cognitive abilities have been shown to decrease with age, it is expected that older physicians would not perform as well as their younger counterparts on clinical cases unless their expertise can counteract the cognitive effects of aging. However, studies on the topic have shown contradictory results. This study aimed to further investigate the effect of aging on physicians' diagnostic accuracy when diagnosing prevalent and less prevalent cases based on clinical vignettes. A mixed design was used to assess the influence of case prevalence (high vs. low) as a within-subjects factor, and age group as a between subjects factor (<30; n = 23, 30-39; n = 19, 40-49; n = 27, >50 years old; n = 19) on the diagnostic accuracy of 65 family physicians and 25 residents. Repeated Measure ANOVA revealed a significant effect of case prevalence (p < .001) and age group (p < .001). Post-hoc analyses revealed that younger physicians showed the best performance. This study did not demonstrate the positive effect of experience in older physicians. In line with previous studies on expertise development, findings of the present study suggest that skills should be actively maintained to assure a high performance level throughout one's lifespan. If not, performance level could gradually decline with age.
... Intensive deliberate practice is now recognized as a crucial prerequisite for expertise development. 36,37 Kulasegaram et al. 38 acknowledge in their review on deliberate practice and working memory in expertise development that the influence of cognitive aptitude, such as working memory, is likely to be highly task-and context dependent. For nonroutine tasks, individual differences can still influence task performance of experts. ...
Performing minimally invasive surgery puts high demands on a surgeon's cognitive and psychomotor abilities. Assessment of these abilities can be used to predict a surgeon's learning curve, to create individualized training programs, and ultimately in selection programs for surgical training. The aim of this study was to examine the influence of cognitive and psychomotor ability on the training duration and learning rate.
A prospective quasiexperimental field study regarding the influence of cognitive and psychomotor ability, baseline measures of time to complete task, damage to tissue, and efficiency of movement, age, and gender on the number of sessions needed to reach a predefined performance level on a laparoscopy simulator. The same variables were investigated as predictors of the learning rate.
The study was performed at the Experimental Center for Technical Medicine at the University of Twente, The Netherlands.
In all, 98 novices from the Master program of Technical Medicine followed a proficiency-based basic laparoscopic skills training.
Perceptual speed (PS) predicted training duration (hazard ratio = 1.578; 95% CI = 1.084, 2.300; p = 0.017). Cognitive (b = -0.721, p = 0.014) and psychomotor ability (b = 0.182, p = 0.009) predicted the learning rate of time to complete the task. Also, the learning rate for participants with higher levels of PS was lower (b = 0.167, p = 0.036). Psychomotor ability also predicted the learning rate for damage to tissue (b = 0.194, p = 0.015) and efficiency of movement (b = 0.229, p = 0.004). Participants with better psychomotor ability outperformed other participants across all sessions on all outcome measures.
PS predicted training duration in a basic laparoscopic skills training and the learning rate for the time to complete the task. Psychomotor ability predicted the learning rate for laparoscopic skill acquisition in terms of time to complete task, damage to tissue, and efficiency of movements. These results indicate early automation of basic laparoscopic skill. Careful selection of the cognitive abilities tests is advised for use in training programs and to identify individuals who need more training.
Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.
... This interpretation is supported by an extensive evidence base in educational psychology which suggests that SRME is sensitive to relatively small differences in CL arising from different instructional designs. 20,24,25,44 Conversely, a number of studies have documented individual variance in working memory capacity, 36,45 which may impact the amount of 'spare' cognitive resources individual participants are able to invest in the secondary task, thereby increasing the variance in this measure. Alternatively, it is possible that our study was not sufficiently powered to detect significant group differences in SRT, given the smaller effect sizes associated with the task complexity manipulation compared with those associated with the change in SRT over the training period. ...
Interest in applying cognitive load theory in health care simulation is growing. This line of inquiry requires measures that are sensitive to changes in cognitive load arising from different instructional designs. Recently, mental effort ratings and secondary task performance have shown promise as measures of cognitive load in health care simulation.
We investigate the sensitivity of these measures to predicted differences in intrinsic load arising from variations in task complexity and learner expertise during simulation-based surgical skills training.
We randomly assigned 28 novice medical students to simulation training on a simple or complex surgical knot-tying task. Participants completed 13 practice trials, interspersed with computer-based video instruction. On trials 1, 5, 9 and 13, knot-tying performance was assessed using time and movement efficiency measures, and cognitive load was assessed using subjective rating of mental effort (SRME) and simple reaction time (SRT) on a vibrotactile stimulus-monitoring secondary task.
Significant improvements in knot-tying performance (F(1.04,24.95) = 41.1, p < 0.001 for movements; F(1.04,25.90) = 49.9, p < 0.001 for time) and reduced cognitive load (F(2.3,58.5) = 57.7, p < 0.001 for SRME; F(1.8,47.3) = 10.5, p < 0.001 for SRT) were observed in both groups during training. The simple-task group demonstrated superior knot tying (F(1,24) = 5.2, p = 0.031 for movements; F(1,24) = 6.5, p = 0.017 for time) and a faster decline in SRME over the first five trials (F(1,26) = 6.45, p = 0.017) compared with their peers. Although SRT followed a similar pattern, group differences were not statistically significant.
Both secondary task performance and mental effort ratings are sensitive to changes in intrinsic load among novices engaged in simulation-based learning. These measures can be used to track cognitive load during skills training. Mental effort ratings are also sensitive to small differences in intrinsic load arising from variations in the physical complexity of a simulation task. The complementary nature of these subjective and objective measures suggests their combined use is advantageous in simulation instructional design research.
© 2015 John Wiley & Sons Ltd.
... Although the development of expertise had been studied extensively in disciplines such as athletics, music, and other arts for some time, it is only within the last few years that its value has become increasingly recognized within the medical community [5,6]. Many fields such as internal medicine, emergency medicine, and general surgery have studied the importance of deliberate practice in transforming learners into experts, but little has been published regarding its role in creating expert orthopedic surgeons [4,[9][10][11]. ...
Although much attention has been paid to the role of deliberate practice as a means of achieving expert levels of performance in other medical specialties, little has been published regarding its role in maximizing orthopaedic surgery resident potential. As an initial step in this process, this study seeks to determine how residents and program directors (PDs) feel current time spent in training is allocated compared with a theoretical ideal distribution of time.
According to residents and PDs, (1) how do resident responsibilities change by level of training as perceived and idealized by residents and PDs? (2) How do resident and PD perceptions of current and ideal time distributions compare with one another? (3) Do the current training structures described by residents and PDs differ from what they feel represents an ideal time allocation construct that maximizes the educational value of residency training?
A survey was sent to orthopaedic surgery resident and PD members of the Midwest Orthopedic Surgical Skills Consortium asking how they felt residents' time spent in training was distributed across 10 domains and four operating room (OR) roles and what they felt would be an ideal distribution of that time. Responses were compared between residents and PDs and between current schedules and ideal schedules.
Both residents and PDs agreed that time currently spent in training differs by postgraduate year with senior-level residents spending more time in the OR (33.7% ± 8.3% versus 17.9% ± 6.2% [interns] and 27.4% ± 10.2% [juniors] according to residents, p < 0.001; and 38.6% ± 8.1% versus 11.8% ± 6.4% [interns] and 26.1% ± 5.7% [juniors] according to PD, p < 0.001). The same holds true for their theoretical ideals. Residents and PDs agree on current resident time allocation across the 10 domains; however, they disagree on multiple components of the ideal program with residents desiring more time spent in the OR than what PDs prefer (residents 40.3% ± 10.3% versus PD 32.6% ± 14.6% [mean difference {MD}, 7.7; 95% confidence interval {CI}, 4.4, 11.0], p < 0.001). Residents would also prefer to have more time spent deliberately practicing surgical skills outside of the OR (current 1.8% ± 2.1% versus ideal 3.7% ± 3.2% [MD, -1.9; 95% CI, -.2.4 to -1.4], p < 0.001). Both residents and PDs want residents to spend less time completing paperwork (current 4.4% ± 4.1% versus ideal 0.8% ± 1.6% [MD, 3.6; 95% CI, 3.0-4.2], p < 0.001 for residents; and current 3.6% ± 4.1% versus ideal 1.5% ± 1.9% [MD, 2.1; 95% CI, 0.9-3.3], p < 0.001 for PDs).
Residents and PDs seem to agree on how time is currently spent in residency training. Some differences of opinions continue to exist regarding how an ideal program should be structured; however, this work identifies a few potential targets for improvement that are agreed on by both residents and PDs. These areas include increasing OR time, finding opportunities for deliberate practice of surgical skills outside of the OR, and decreased clerical burden. This study may serve as a template to allow programs to continue to refine their educational models in an effort to achieve curricula that meet the desired goals of both learners and educators. Additionally, it is an initial step toward more objective identification of the optimal educational structure of an orthopaedic residency program.
Background/Objectives: The child and adolescent psychiatry (CAP) subspecialty training program at the University of Toronto was among the first fully accredited CAP programs in Canada. As one of Canada's largest CAP subspecialty programs, we attract many excellent applicants annually. While objectivity and transparency in the selection of candidates have been valued, it was unclear which applicant attributes should be prioritized. This quality improvement project was undertaken to identify the key applicant attributes that should be prioritized for admission to the program.
Materials/Methods: An initial list of attributes was compiled by project team members and feedback solicited. Through iterative design, this list was categorized into “end products,” “branding attributes” and “generic attributes.” The “end products” were removed as these represented outputs of training rather than attributes on which applicant selection should be based. Subsequent steps involved only the “branding” and “generic” attributes. A consensus-building exercise led to the creation of two short-lists of five attributes within each category. Finally, a paired-comparison forced choice methodology was used to determine the ranking of these attributes in order of importance when assessing applicants.
Results: The final lists of “generic” and “branding” attributes developed through a consensus-building exercise are presented in rank order based on the paired-comparison methodology. The overall response rate for the forced choice electronic survey was 49% of faculty and learners.
Conclusions/Discussion: This project used an iterative process of consensus building & pairwise comparison to prioritize key attributes for assessing trainee selection to the program. Going forward, these attributes will be incorporated into the file review and interview portions of our admissions process. In addition to emphasizing these priority attributes in admissions, there are implications for other aspects of the program including curriculum and faculty development, as well as guiding the overall mission and vision for the Division. A similar process could be undertaken by other training programs seeking to identify priority attributes for admission to their programs.
The current demands of medicine extend well beyond the diagnostic and therapeutic domains. Thus all physicians need to acquire a variety of dexterities in order to advance their practice. This chapter presents the related topics of expertise and competence. By “expertise” I mean the mastery of detection and interpretation skills”. By “competence” I mean the mastery or a high level of operation of non-interpretive skills, such as team working, knowledge sharing and leadership. The focus of this chapter is expertise, what it is and how we achieve it, drawing on extensive knowledge from the fields of expertise, accelerated learning, and medical decision making.
Introduction
Operative case volumes for military surgeons are reported to be significantly lower than civilian counterparts. Among the concern that this raises is an inability of military surgeons to achieve mastery of their craft.
Material and Methods
Annual surgical case reports were obtained from seven Army military treatment facilities (MTF) for 2012–2016. Operative case volume and cumulative operative time were calculated for active duty general surgeons and for individual MTFs. Subgroup analyses were also performed based upon rank. Results were extrapolated to calculate the amount of time it would take to reach a cumulative of 10,000 hours of operative time (the a priori definition for achieving mastery).
Results
One hundred and two active duty general surgeons operated at the seven MTFs during the study period and met the inclusion criteria. The average surgeon performed 108 ± 68 cases/year. The average surgeon operated 122 ± 82 hours/year. At this rate, it would take over 80 years to reach mastery of surgery. When stratified based upon rank, Majors averaged 113 ± 75 hours/year, Lieutenant Colonels averaged 170 ± 100 hours/year, and Colonels averaged 136 ± 101 hours/year (p < 0.05). When stratified based upon individual MTF, surgeons at the busiest facility averaged 187 ± 103 hours/year and those at the least busy facility averaged 85 ± 56 hours/year (p < 0.05).
Conclusions
Obtaining mastery of general surgery is a nearly impossible proposition given the current care models at Army MTFs. Alternative staffing and patient care models should be developed if Army surgeons are to be masters at their craft.
Introduction. Neurosurgical emergencies are complex tasks. The current learning environment limits students’ ability to manage acute neurosurgical emergencies due to legal and safety concerns. Simulation provides an opportunity to participate in the care of neurosurgical emergencies and develop clinical decision making skills.
Aim. We aim to determine whether neuroscience simulation curriculum improves student ability to: manage a critically ill patient, recognize neurosurgical emergencies, to assess how stress tolerance affects experience during simulations and effectiveness of students performance. The third objective is to develop a tool for student assessment.
Material and Methods. The simulation was performed on SimMan 3G Human Patient Simulator (Laerdal Medical). Scenarios included common neurosurgical emergencies. Students were assessed before and after the course by completing a Likert type questionnaire. Response data was analysed using Cronbach’s reliability for Likert-type response data and Spearman's monotonic correlation.
Results. 60 students of fifth and sixth year of medical studies attended the course. 39 students of them replied to the questionnaire. The simulated clinical experience was positive and it improved their knowledge about neurosurgical emergencies. There was an improvement in their confidence. Improvement in individual and team performance was also observed.
Conclusions. Neurosurgical simulations improve students` ability to recognize neurosurgical emergencies. The level of stress related to simulation is important factor of the education process and should be reduced to improve students’ development. Our questionnaire is an effective tool for assessment of students experience during clinical simulations.
Traditional methods of surgical education have been based on an apprenticeship model and the Halsteadian approach of graduated responsibility through residency training. However, current paradigms of surgical skills assessment are limited by subjectivity, poor timeliness, and cost, as they rely on faculty mentors and their pre-existing relationships with trainees. With the increasing use of simulation in surgical education, the challenge of providing appropriate feedback to trainees on a large scale remains unsolved. Crowdsourcing or crowd-based evaluation of technical skills may be one possible solution. The capability of this technology to deliver similarly equivalent feedback as that provided by expert surgeons has been demonstrated across a myriad of simulated and live surgical tasks in a variety of surgical specialties through multiple studies. The potential of this technology has been further explored in its application to surgical quality improvement and identifying surgically precocious trainees and may become even more widely applied in the current model of competency-based surgical education as additional research in this field progresses. Moreover, with the continued introduction of new surgical technology, it may come to play a significant role in enhancing new skills acquisition for surgeons already in practice.
Background: Surgical training requires exposure to clinical decision-making and operative experience in a supervised environment. It is recognised that learning ability is compromised when fatigued. The European Working Time Directive requires a decrease in working hours, but compliance reduces trainees’ clinical exposure, which has profound implications for plastic surgery training. The aim of this study was to evaluate plastic surgery registrars’ experience of an EWTD-compliant rota, and to examine its impact on patient care, education, and logbook activity.
Methods: An electronic survey was distributed to plastic surgery registrars in a university teaching hospital. Registrars were asked to rate 31 items on a five-point Likert scale, including statements on patient care, clinical and operative duties, training, and quality-of-life. Interquartile deviations explored consensus among responses. Operative caseload was objectively evaluated using eLogbook data to compare activity at equal time points before and after implementation of the EWTD rota.
Results: Highest levels of consensus among respondents were found in positive statements addressing alertness and preparation for theatre, as well as time to read and study for exams. Registrars agreed that EWTD compliance improved their quality-of-life. However, it was felt that continuity of patient care was compromised by work hours restriction. Registrars were concerned about their operative experience. eLogbook data confirmed a fall-off in mean caseload of 31.8% compared to activity prior to EWTD rota implementation.
Conclusion: While EWTD compliant rotas promote trainee quality-of-life and satisfaction with training, attention needs to be paid to optimising operative opportunities.
Context:
Fidelity is widely viewed as an important element of simulation instructional design based on its purported relationship with transfer of learning. However, higher levels of fidelity may increase task complexity to a point at which novices' cognitive resources become overloaded.
Objectives:
In this experiment, we investigate the effects of variations in task complexity on novices' cognitive load and learning during simulation-based procedural skills training.
Methods:
Thirty-eight medical students were randomly assigned to simulation training on a simple or complex lumbar puncture (LP) task. Participants completed four practice trials on this task (skill acquisition). After 10 days of rest, all participants completed one additional trial on their assigned task (retention) and one trial on a 'very complex' simulation designed to be similar to the complex task (transfer). We assessed LP performance and cognitive load on each trial using multiple measures.
Results:
In both groups, LP performance improved significantly during skill acquisition (p ≤ 0.047, f = 0.29-0.96) and was maintained at retention. The simple task group demonstrated superior performance compared with the complex task group throughout these phases (p ≤ 0.002, d = 1.13-2.31). Cognitive load declined significantly in the simple task group (p < 0.009, f = 0.48-0.76), but not in the complex task group during skill acquisition, and remained lower at retention (p ≤ 0.024, d = 0.78-1.39). Between retention and transfer, LP performance declined and cognitive load increased in the simple task group, whereas both remained stable in the complex task group. At transfer, no group differences were observed in LP performance and cognitive load, except that the simple task group made significantly fewer breaches of sterility (p = 0.023, d = 0.80).
Conclusions:
Reduced task complexity was associated with superior LP performance and lower cognitive load during skill acquisition and retention, but mixed results on transfer to a more complex task. These results indicate that task complexity is an important factor that may mediate (via cognitive overload) the relationship between instructional design elements (e.g. fidelity) and simulation-based learning outcomes.
The practice of pharmacy is highly influenced by the training pharmacy clinicians receive through experiential education (EE) programs, for it is within this “total practice immersion” that their skills are shaped, honed, and refined.[1][1] However, not all rotation experiences are positive for
This study examined the contributions of the different components of the working memory (WM) model to a range of mathematical skills in children, using measures of WM function that did not involve numerical stimuli. A sample of 148 children (78 Year 3, mean age 8 years and 1 month, and 70 Year 5 pupils, mean age 9 years and 10 months) completed WM measures and age‐appropriate mathematics tests designed to assess four mathematical skills defined by the National Curriculum for England. Visuo‐spatial sketchpad and central executive, but not phonological loop, scores predicted unique variance in children's curriculum‐based mathematical attainment but the relative contributions of each component did not vary much across the different skills. Subsequently, the mathematics data were re‐analysed using cluster analysis and new performance‐related mathematics factors were derived. All three components of WM predicted unique variance in these performance‐related skills, but revealed a markedly distinct pattern of associations across the two age groups. In particular, the data indicated a stronger role for the visuo‐spatial sketchpad in the younger children's mathematics performance. We discuss our findings in terms of the importance of WM in the development of early mathematical ability.
Following an overview of the current knowledge about the structure and acquisition of expert performance in the arts, sciences and sports, we discuss practical implications for music training, focussing on the development of levels of instrumental skill typically attained by high school students and amateurs. Recent studies found that even the highest levels of music achievement are primarily the result of skill acquisition and physiological adaptation in response to extended deliberate practice. Increases in performance over historical time also document the importance of training and practice. Although learning conditions encountered by music students and amateurs often may be less favorable than learning environments in which experts develop, the quality of training can be increased at all levels of performance by incorporating features commonly found in the training of experts (individualized practice assignments, improved monitoring of feedback).
The present study tested both the processing and storage of functions of working memory (WM) and whether WM in low-order and high-order writing processes follows the same pattern as in reading. The influence of WM on creative writing was also tested. Forty-seven high school students participated in this study. A test of written language was administered to the subjects, comprising the following subtests spelling, vocabulary, style, logical sentence, sentence combining, thematic maturity, contextual vocabulary, syntactic maturity, contextual spelling, contextual style. A WM reading comprehension test was also conducted. The overall findings of the study indicate significant relationships between WM measures and reading and writing in English as a second language.
Counter to the common belief that expert performance reflects innate abilities and capacities, recent research in different domains of expertise has shown that expert performance is predominantly mediated by acquired complex skills and physiological adaptations. For elite performers, supervised practice starts at very young ages and is maintained at high daily levels for more than a decade. The effects of extended deliberate practice are more far-reaching than is commonly believed. Performers can acquire skills that circumvent basic limits on working memory capacity and sequential processing. Deliberate practice can also lead to anatomical changes resulting from adaptations to intense physical activity. The study of expert performance has important implications for our understanding of the structure and limits of human adaptation and optimal learning. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Replies to H. Gardner's (see record
1996-10360-001) comments on K. A. Ericsson and N. Charness's (see record
1994-43905-001) review of the structure and acquisition of expert performance. In contrast to Gardner, they attribute differences to the individuals' history of relevant activities that differentially benefit the acquisition of associated skills. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Two studies tested the theory of deliberate practice (K. A. Ericsson et al, 1993) and contrasted results with the sport commitment model (T. K. Scanlan et al, 1993a, 1993b). In Part I, international (mean age 25.6 yrs), national (mean age 24.0 yrs), and provincial (mean age 25.4 yrs) soccer and field hockey players recalled the amount of time they spent in individual and team practice, sport-related activities, and everyday activities at the start of their career and every 3 years since. In Part II, these activities were rated in terms of their relevance for improving performance, effort and concentration required, and enjoyment. A monotonic relationship between accumulated individual plus team practice and skill level was found. In contrast with Ericsson et al's findings for musicians, relevant activities were also enjoyable, while concentration became a separate dimension from effort. The viability of a generalized theory of expertise is discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Presents findings of a task force established by the American Psychological Association to report on the issues of what is known and unknown about intelligence. Significant conceptualizations of intelligence are reviewed, including the psychometric approach, theories of multiple forms of intelligence, cultural variations, theories of developmental progressions, and biological approaches. The meaning of intelligence test scores, what they predict, and how well they predict intelligence is discussed. Genetic factors and intelligence, focusing on individual differences, conventional IQ tests, and other tests intended to measure cognitive ability, are described. Environmental factors such as social and biological variables are discussed, and sex and ethnic group differences are addressed. Recommendations for future research are presented. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Being able to work on several tasks at the same time (multitasking) is an important performance aspect of many jobs. Recent research findings pointed out the important role of working memory for multitasking performance in general. To understand more about the role of working memory in predicting the speed and the error aspect of multitasking performance, this research was based on a newly developed and well-elaborated multidimensional model of working memory (Oberauer, Süß, Wil-helm, & Wittmann, 2003). Its 3 dimensions are storage in the context of processing, coordination, and supervision. In additiony, attention and reasoning were controlled when predicting multitasking speed and error. A multitasking scenario, a battery of working memory tests, a battery of reasoning tests, and 2 attention tests were administered to 135 participants. As expected working memory was the best predictor of multitasking performance, followed by reasoning and attention. Working memory components showed a differential validity when predicting multitasking speed and multitasking error: Multitasking speed was predicted mainly by coordination, and multitasking error mainly by storage in the context of processing. Thus, this study provided a deeper insight into the relevant abilities of multitasking. Implications for personnel selection are discussed.
Expertise is the consistently superior performance on a set of tasks in some area of human activity. Software engineering expertise is difficult to define, and characterize empirically. In this paper, we present and evaluate three candidate criteria for assessing software engineering expertise. These three criteria are: experience; characteristics common to experts across fields; and software-specific proficiencies. We conducted an initial empirical study to evaluate these three definitions. In a laboratory experiment, we asked novice and expert subjects to complete a number of software engineering tasks on a web application. We found that all three criteria should be used to provide a full categorization of an individual's level of expertise. Experience is a useful first filter, but cannot be used as the only criterion. Domain-independent characteristics are most useful for assessing the quality of the criteria for labeling an individual as novice or expert. Software-specific proficiencies appear to be the most promising, but assessments for various skills, technologies, and problem domains will need to be developed separately.
Individual differences in performance on a variety of selection tasks were examined in three studies employing over 800 participants. Nondeontic tasks were solved disproportionately by individuals of higher cognitive ability. In contrast, responses on two deontic tasks that have shown robust performance facilitation— the Drinking-age Problem and the Sears Problem—were unrelated to cognitive ability. Performance on deontic and nondeontic tasks was consistently associated. Individuals in the correct/correct cell of the bivariate performance matrix were over-represented. That is, individuals giving the modal response on a nondeontic task (P and Q) were significantly less likely to give the modal response on a deontic task (P and not-Q) than were individuals who made the non-modal P and not-Q selection on nondeontic problems. The implications of the results are discussed within the heuristic-analytic framework of Evans (1996; Evans & Over, 1996) and the optimal data selection model of Oaksford and Chater (1994).
Presents findings of a task force established by the American Psychological Association to report on the issues of what is known and unknown about intelligence. Significant conceptualizations of intelligence are reviewed, including the psychometric approach, theories of multiple forms of intelligence, cultural variations, theories of developmental progressions, and biological approaches. The meaning of intelligence test scores, what they predict, and how well they predict intelligence is discussed. Genetic factors and intelligence, focusing on individual differences, conventional IQ tests, and other tests intended to measure cognitive ability, are described. Environmental factors such as social and biological variables are discussed, and sex and ethnic group differences are addressed. Recommendations for future research are presented.
The theoretical framework presented in this article explains expert performance as the end result of individuals' prolonged efforts to improve performance while negotiating motivational and external constraints. In most domains of expertise, individuals begin in their childhood a regimen of effortful activities (deliberate practice) designed to optimize improvement. Individual differences, even among elite performers, are closely related to assessed amounts of deliberate practice. Many characteristics once believed to reflect innate talent are actually the result of intense practice extended for a minimum of 10 yrs. Analysis of expert performance provides unique evidence on the potential and limits of extreme environmental adaptation and learning. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This paper compares four current theories of expertise with respect to chess players' memory: Chase and Simon's chunking theory, Holding's SEEK theory, Ericsson and Kintsch's long-term working memory theory, and Gobet and Simon's template theory (Chase, W.G., Simon, H.A., 1973a. Perception in chess. Cognitive Psychology 4, 55–81; Holding, D.H., 1985. The Psychology of Chess Skill. Erlbaum, Hillsdale, NJ; Ericsson, K.A., Kintsch, W., 1995. Long-term working memory. Psychological Review 102, 211–245; Gobet, F., Simon, H.A., 1996b. Templates in chess memory: a mechanism for recalling several boards. Cognitive Psychology 31, 1–40). The empirical areas showing the largest discriminative power include recall of random and distorted positions, recall with very short presentation times, and interference studies. Contrary to recurrent criticisms in the literature, it is shown that the chunking theory is consistent with most of the data. However, the best performance in accounting for the empirical evidence is obtained by the template theory. The theory, which unifies low-level aspects of cognition, such as chunks, with high-level aspects, such as schematic knowledge and planning, proposes that chunks are accessed through a discrimination net, where simple perceptual features are tested, and that they can evolve into more complex data structures (templates) specific to classes of positions. Implications for the study of expertise in general include the need for detailed process models of expert behavior and the need to use empirical data spanning the traditional boundaries of perception, memory, and problem solving.
Research suggests that both working memory capacity and domain knowledge contribute to individual differences in higher-level cognition. This study evaluated three hypotheses concerning the interplay between these factors. The compensation hypothesis predicts that domain knowledge attenuates the influence of working memory capacity on higher-level cognition, whereas the rich-get-richer hypothesis predicts that working memory capacity enhances use of domain knowledge. The independent influences hypothesis states simply that working memory capacity and domain knowledge make additive contributions to higher-level cognition. Participants representing wide ranges of working memory capacity and knowledge of baseball performed tasks that emphasized keeping track of information in a dynamic environment. The baseball task involved tracking the movements of baseball players on a baseball diamond. The spaceship task was structurally isomorphic to this task but its content was arbitrary. Results revealed greater use of baseball knowledge in the baseball task than in the spaceship task. However, even at high levels of baseball knowledge, this knowledge use did not alter the relationship between working memory capacity and task performance. This finding is inconsistent with compensation and rich-get-richer hypotheses. Instead, it suggests that working memory capacity and domain knowledge may operate independently under certain conditions.
Distinctions have been proposed between systems of reasoning for centuries.
This article distills properties shared by many of these distinctions
and characterizes the resulting systems in light of recent findings
and theoretical developments. One system is associative because its
computations reflect similarity structure and relations of temporal
contiguity. The other is "rule based" because it operates on symbolic
structures that have logical content and variables and because its
computations have the properties that are normally assigned to rules.
The systems serve complementary functions and can simultaneously
generate different solutions to a reasoning problem. The rule-based
system can suppress the associative system but not completely inhibit
it. The article reviews evidence in favor of the distinction and
its characterization.
The role of deliberate practice in medical students' development from novice to expert was examined for preclinical skill training.
Students in years 1-3 completed 34 Likert type items, adapted from a questionnaire about the use of deliberate practice in cognitive learning. Exploratory factor analysis and reliability analysis were used to validate the questionnaire. Analysis of variance examined differences between years and regression analysis the relationship between deliberate practice and skill test results.
875 students participated (90%). Factor analysis yielded four factors: planning, concentration/dedication, repetition/revision, study style/self reflection. Student scores on 'Planning' increased over time, score on sub-scale 'repetition/revision' decreased. Student results on the clinical skill test correlated positively with scores on subscales 'planning' and 'concentration/dedication' in years 1 and 3, and with scores on subscale 'repetition/revision' in year 1.
The positive effects on test results suggest that the role of deliberate practice in medical education merits further study. The cross-sectional design is a limitation, the large representative sample a strength of the study. The vanishing effect of repetition/revision may be attributable to inadequate feedback. Deliberate practice advocates sustained practice to address weaknesses, identified by (self-)assessment and stimulated by feedback. Further studies should use a longitudinal prospective design and extend the scope to expertise development during residency and beyond.
Participants memorized briefly presented sets of digits, a subset of which had to be accessed as input for arithmetic tasks (the active set), whereas another subset had to be remembered independently of the concurrent task (the passive set). Latencies for arithmetic operations were a function of the setsize of active but not passive sets. Object-switch costs were observed when successive operations were applied to different digits within an active set. Participants took 2 s to encode a passive set so that it did not affect processing latencies (Experiment 2). The results support a model distinguishing 3 states of representations in working memory: the activated part of long-term memory, a capacity limited region of direct access, and a focus of attention.
The theoretical framework presented in this article explains expert performance as the end result of individuals' prolonged efforts to improve performance while negotiating motivational and external constraints. In most domains of expertise, individuals begin in their childhood a regimen of effortful activities (deliberate practice) designed to optimize improvement. Individual differences, even among elite performers, are closely related to assessed amounts of deliberate practice. Many characteristics once believed to reflect innate talent are actually the result of intense practice extended for a minimum of 10 years. Analysis of expert performance provides unique evidence on the potential and limits of extreme environmental adaptation and learning.
This paper is concerned with the relationship between two central constructs—reasoning ability and working-memory capacity—which arise from two distinct bodies of literature on individual differences in cognition, the psychometric and the information-processing, respectively. In four separate studies (N = 723, 412, 415, and 594), we assessed reasoning ability using various tests from the psychometric literature, and working-memory capacity using tests constructed according to Baddeley's (1986) definition of working memory. Confirmatory factor analysis yielded consistently high estimates of the correlation between working-memory capacity and reasoning ability factors (r = .80 to .90). We also found differentiation between the two factors: Reasoning correlated comparatively highly with general knowledge; working-memory capacity correlated comparatively highly with processing speed. Inspection of residuals from model fitting suggested the existence of a verbal versus quantitative content factor. We discuss the implications of our results for what they tell us about the nature of reasoning, and the nature of working memory.
Professor James Flynn is one of the most creative and influential psychologists in the field of intelligence. The ‘Flynn Effect’ refers to the massive increase in IQ test scores over the course of the twentieth century and the term was coined to recognize Professor Flynn’s central role in measuring and analyzing these gains. For over twenty years, psychologists have struggled to understand the implications of IQ gains. Do they mean that each generation is more intelligent than the last? Do they suggest how each of us can enhance our own intelligence? Professor Flynn is finally ready to give his own views. He asks what intelligence really is and gives a surprising and illuminating answer. This book bridges the gulf that separates our minds from those of our ancestors a century ago. It is a fascinating and unique book that makes an important contribution to our understanding of human intelligence.
Traditional theories of aging claim that basic processing speed and memory capacities show inevitable decline with increasing age. Recent research, however, has shown that older experts in some domains are able to maintain their superior performance into old age, but even they display the typical age-related decline in performance on psychometric tests of fluid intelligence. The study of expert performance shows that adults retain the capacity to acquire and maintain performance with the appropriate type of training and practice, even speeded actions and many physiological adaptations. In fact, experts' performance keeps improving for several decades into adulthood and typically reaches its peak between 30 and 50 years of age. The experts can then maintain their attained performance level into old age by regular deliberate practice. Much of the observed decline in older adults' performance can be attributed to age-related reductions in engagement in domain-related activities - in particular, regular deliberate practice.
Ericsson, Krampe and Tesch-Römer (1993) have concluded from work with musicians that expertise is the result of ≪deliberate practice≫, so how valid is this conclusion in sport? Four groups of male amateur wrestlers (n = 42); 2 international and 2 club (current and retired) recalled the number of hours they had spent in wrestling and everyday activities since beginning wrestling. All groups had begun wrestling at a similar age (M = 13 yrs) and had been wrestling for 10 years or more. Data were examined as a function of age and years spent wrestling. Contrary to Ericsson et al. practice alone activities did not differentiate between the groups, only practice with others. At 6 years into their careers, the international group practised 4.5 hrs/week more than the club wrestlers. At 20 years of age the international wrestlers had accumulated over 1000 more hours of practice with others compared to the club wrestlers. Evaluations of wrestling related activities showed that activities judged to be relevant were also rated high with regards to concentration and enjoyment. Diary data were collected from current wrestlers to validate the retrospective reports. The time spent in all wrestling related activities was comparable for the club and international wrestlers, however, the international wrestlers spent longer travelling to practice, which reflected the necessity to train at a club with the best sparring partners. Practice with others yielded high correlations between estimates for a typical week and the diary data for the international wrestlers. In conclusion Ericsson et al.'s definition of ≪deliberate practice≫ needs to be considered, especially as ≪relevancez≫ correlates highly with ≪enjoyment≫. It is recommended that future studies focus on what it is that motivates people to spend the necessary hours of practice to achieve expertise.
IntroductionProblem solving: diagnosis as hypothesis selectionThe hypothetico-deductive methodPattern recognition or categorizationErrors in hypothesis generation and restructuringDecision making: diagnosis as opinion revisionErrors in probability estimationErrors in probability revisionTwo-system theories of cognitionEducational implicationsMethodological guidelinesConclusion
AcknowledgmentsReferences
The extent to which individual differences in working memory capacity were related to differences in comprehension and following direction was studied in first, third, and sixth graders. Working memory was tested by a simple word span and Daneman and Carpenter’s (1980) reading span. A reading comprehension test and a following directions test, including directions heard in a classroom, were also given. The number of words recalled in both the word span and the reading span predicted comprehension for all grades. This relationship showed no age differences. However, the relationship between the span measures and following directions indicated that the role of working memory in following directions may increase with age. As the complexity of directions increased, low-span subjects in each grade had more difficulty performing directions than high-span subjects did. Implications for giving directions to school children are discussed.
Domain knowledge is a powerful predictor of success in many complex tasks, but do general cognitive abilities also play a role? To investigate this question, we had 155 participants representing a wide range of poker experience and skill complete tests of poker knowledge, working memory capacity (WMC), and two components of skill in Texas Hold’Em poker: the ability to remember hands and the ability to evaluate hands. Not surprisingly, poker knowledge positively predicted performance in all of the Hold’Em tasks. However, WMC added significantly to the prediction, and there was no evidence for interactions between poker knowledge and WMC. That is, WMC was as important as a predictor of performance at high levels of poker knowledge as at low levels, suggesting that domain knowledge may not always enable circumvention of WMC in domain-relevant tasks.
Our understanding of the determinants of physician skill and the extent to which skill is valued in the marketplace is superficial. Using a large, detailed panel of new obstetricians, we find that, even though physicians’ maternal complication rates improve steadily with years of practice, initial skill (as measured by performance in a physician’s first year of practice) explains most of the variation in physician performance over time. At the same time, we find that the trajectories of new physicians’ delivery volume develop in a way partially consistent with Bayesian learning about physician quality. In particular, as physicians gain experience, their volume becomes increasingly sensitive to the information in their accumulated prior.Institutional subscribers to the NBER working paper series, and residents of developing countries may download this paper without additional charge at www.nber.org.
Background: Psychological theories of categorization based on prior instances predict that clinicians' accuracy in visual diagnosis may be influenced by prior similar cases. Purpose: To examine whether prior instructional examples influence electrocardiogram (ECG) interpretation. Methods: Forty-one medical students and 27 family medicine residents were allocated to 1 of 2 instructional sessions, where each ECG was accompanied by a clinical scenario. In the subsequent test phase, new ECGs with a correct diagnosis different from that in the instructional session were accompanied by clinical scenarios reminiscent of the prior scenarios of the instructional session. Results: For residents, the prior scenarios resulted in a 50% loss of accuracy, from 46% accuracy without exposure to a similar scenario to 23% accuracy with exposure to a similar prior scenario. Students accuracy was equivalent under both conditions. Conclusions: Residents were influenced by the prior clinical scenarios in their subsequent ECG diagnoses. The same scenarios had an attenuated effect on the medical students.
Reports some unexpected byproducts of experiments with chess-playing tasks and computer simulation of skilled performance and problem solving. First, the theory of the processes used by expert chess players in discovering checkmating combinations and the MATER computer simulation of these processes are reviewed. Next phenomena involving the perceptual bases of mastery in chess and eye movements at the chess board are described. Perceptual processes were evaluated by way of the MATER program, and a new program, PERCEIVER, was used to explain the eye movement phenomenon. To further refine the above findings, other more sophisticated simulation programs were introduced. Findings indicate that acquisition of chess skills depends, in large part, on building up recognition memory for many familiar chess patterns. (26 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
An integrative theory that links general models of skill acquisition with ability determinants of individual differences in performance is presented. Three major patterns of individual differences during skill acquisition are considered: changes in between-subjects variability, the simplex pattern of trial intercorrelations, and changing ability–performance correlations with practice. In addition to a review of previous theory and data, eight experimental manipulations are used to evaluate the cognitive ability demands associated with different levels of information-processing complexity and consistency. Subjects practiced category word search, spatial figure, and choice reaction time tasks over several hundred trials of task practice. An air traffic controller simulation was used to show generalization to a complex task. Examinations of practice-related between-subjects variance changes and ability–performance correlations are used to demonstrate that an equivalence exists between three broad phases of skill acquisition and three cognitive–intellectual determinants of individual differences. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This is the fourth in a series of five articlesThis article reviews our current understanding of the cognitive processes involved in diagnostic reasoning in clinical medicine. It describes and analyses the psychological processes employed in identifying and solving diagnostic problems and reviews errors and pitfalls in diagnostic reasoning in the light of two particularly influential approaches: problem solving1, 2, 3 and decision making.4, 5, 6, 7, 8 Problem solving research was initially aimed at describing reasoning by expert physicians, to improve instruction of medical students and house officers. Psychological decision research has been influenced from the start by statistical models of reasoning under uncertainty, and has concentrated on identifying departures from these standards.
Summary points
Problem solving and decision making are two paradigms for psychological research on clinical reasoning, each with its own assumptions and methods
The choice of strategy for diagnostic problem solving depends on the perceived difficulty of the case and on knowledge of content as well as strategy
Final conclusions should depend both on prior belief and strength of the evidence
Conclusions reached by Bayes's theorem and clinical intuition may conflict
Because of cognitive limitations, systematic biases and errors result from employing simpler rather than more complex cognitive strategies
Evidence based medicine applies decision theory to clinical diagnosis
Problem solving
Diagnosis as selecting a hypothesis
The earliest psychological formulation viewed diagnostic reasoning as a process of testing hypotheses. Solutions to difficult diagnostic problems were found by generating a limited number of hypotheses early in the diagnostic process and using them to guide subsequent collection of data.1 Each hypothesis can be used to predict what additional findings ought to be present if it were true, and the diagnostic process is a guided search for these findings. Experienced physicians form hypotheses and their diagnostic plan rapidly, and the …
Admissions committees and researchers around the globe have used diligence and imagination to develop and implement various
screening measures with the ultimate goal of predicting future clinical and professional performance. What works for predicting
future job performance in the human resources world and in most of the academic world may not, however, work for the highly
competitive world of medical school applicants. For the job of differentiating within the highly range-restricted pool of
medical school aspirants, only the most reliable assessment tools need apply. The tools that have generally shown predictive
validityin future performance include academic scores like grade point average, aptitude tests like the Medical College Admissions
Test, and non-cognitive testing like the multiple mini-interview. The list of assessment tools that have not robustly met
that mark is longer, including personal interview, personal statement, letters of reference, personality testing, emotional
intelligence and (so far) situational judgment tests. When seen purely from the standpoint of predictive validity, the trends
over time towards success or failure of these measures provide insight into future tool development.
Two large, diverse samples of tournament-rated chess players were asked to estimate the frequency and duration of their engagement in a variety of chess-related activities. Variables representing accumulated time spent on serious study alone, tournament play, and formal instruction were all significant bivariate correlates of chess skill as measured by tournament performance ratings. Multivariate regression analyses revealed that among the activities measured, serious study alone was the strongest predictor of chess skill in both samples, and that a combination of various chess-related activities accounted for about 40% of the variance in chess skill ratings. However, the relevance of tournament play and formal instruction to skill varied as a function of skill measurement time (peak vs. current) and age group (above vs. below 40 years). Chess players at the highest skill level (i.e. grandmasters) expended about 5000 hours on serious study alone during their first decade of serious chess play-nearly five times the average amount reported by intermediate-level players. These results provide further evidence to support the argument that deliberate practice plays a critical role in the acquisition of chess expertise, and may be useful in addressing pedagogical issues concerning the optimal allocation of time to different chess learning activities. Copyright (c) 2005 John Wiley & Sons, Ltd.