The Deliberate Practice of Healthcare

Everyone is familiar with the concept of practice in medicine and dentistry. We know that the craft of delivering care is referred to as “practice.” The practice of medicine or dentistry has noble connotations associated with it; it implies that effort is being made to improve and become better tomorrow than we are today. Unfortunately, science does not prove this theory to be true.. “Physicians’ scores on tests of medical knowledge declining with experience: N.K. Choudhry, R.H. Fletcher and S.B. Soumeri, “Systematic Review: The Relationship Between Clinical Experience and Quality of Health Care,” Annals of Internal Medicine 142 (2005), pp. 260-73. How can this common misunderstanding of reality be so persuasive?

When given consideration it makes sense. Think about typing. Typing is a skill that typically grows for a period and then reaches a plateau where no further progress in speed or accuracy occurs. Does this mean that people meet their innate talent level for typing and then cannot improve beyond this point? If typing were a skill in which practicing could elevate that skill, then why don’t we all continue to get better year after year as we have more familiarity and time typing. The answer is that performing a task is not the same thing as practicing a task. The extent of human potential to improve in skill in every field is unknown. The reason that our potential is unknown is that year after year the best of the best continue to break records and shatter ceilings of performance that were previously thought to be impossible to break. The continued growth in accomplishment is not because human potential is growing, but because human execution is improving. The explanation for improvement is deliberate practice, as was most notable demonstrated by K. Andres Ericson, “The Role of Deliberative Practice in the Acquisition of Expert Performance,” Psychological Review 100, no. 3 (1993), pp.363-406.

It is unfortunate in the health sciences that what we do is called practice when in fact it is often just repetition. Practice insinuates that we are purposefully trying to improve and get better or to learn. Commonly, medical professionals are trained through a process that includes deliberate practice and then continue their career by having the same year of experience year after year. These professionals provide good and in some cases amazing services for their clients, but growing into the best of their potential they are not.

If a health care professional has the desire to become better year after year, they must engage in deliberate practice. Deliberate practice as described in the book “Talent is Overrated” by Geoff Colvin is: “ an activity designed specifically to improve performance, often with a teacher’s help; it can be repeated a lot; feedback on results is continuously available; it is highly demanding mentally; and it isn’t much fun.” For most healthcare providers this is also a definition of residency and or the clinical aspects of training. But, once we have achieved working competency of our care, skill and judgment deliberate practice stops.

Some healthcare providers have a higher ambition. For some it is a desire to become better, for others, it is to become great and for a small few it is to become a master. No one would suggest that this higher ambition is necessary to live a full life and provide needed services. Fewer would say that this path is the best route to increasing the compensation and lifestyle of healthcare providers. But, without some people choosing to embark on this journey healthcare will not expand or improve at the pace that the human potential will allow.

For those who are interested in becoming better tomorrow than they are today, the path to improvement is through deliberate practice.

Breaking down deliberate practice in Dentistry:

1. Designed to improve performance.

First, determine what aspect of dentistry you want to improve. Do you want to cut better crown preparations, do you want to do something faster, or do you want to become a better diagnostician? Holding a vision of what you want to improve is a major step. Next, get yourself out of autopilot as you approach your work. The moment you begin to approach the task without being mindful of what, how and why you are doing something is when deliberate practice stops. Growth occurs just outside of your comfort level, stretch a little further to reach that spot while you perform your task.

2.Repeated a lot.

You will have to create the conditions necessary to get a lot of practice when the opportunity for frequent repetition does not present itself in your daily work. If you decide that you would like to master direct composite veneers, you will likely not get better doing one case per month. Create an environment that allows you to do, stretch, achieve, learn, and then do it all over again.

3.Continuous feedback.

In dentistry, we are mostly isolated from one another and are not awarded the ability to get much feedback. Find a kindred spirit or network of peers who have the desire to grow and improve and establish a way for you all to evaluate one another. Make sure that the evaluation comes from a place of acceptance and good will. In today’s electronic age, we can easily share photos of every step of our work and seek out guidance, feedback, and support. Ideally, your peer should technically not be a peer but someone who is better than you at the particular skill. Try to time the feedback as quickly to the performance of the practice as possible.

Geoff Colvin suggests that deliberate practice in this way is mentally demanding and not much fun. So, why would a dentist or a physician ever choose to approach their vocation in this way? The answer lies within the purpose of their work and the higher ambition that they hold for their work. For those few who share a desire to become better and approach the top of their field deliberate practice throughout their carrier is an essential component to becoming the one of the best.

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