Perfect Practice Makes Perfect

1. Perfect Practice Makes Perfect • Utilizing Deliberate Practice to Improve Knowledge and Skills Acquisition • Bill Cutrer, M.D., M.Ed. Meg Keeley M.D., Satid Thammasitboon M.D., M.H.P.E. • IAMSE Annual Meeting • June 8, 2014

2. Titus: The Hooper Prodigy

4. Workshop Outlines Novice Expert Deliberate Practice • Cognitive • Spaced Learning • Skills • 4-Step Coaching Ignition Master Coaching

5. 10,000-Hour Rule

6. Inside the SpartakTennis Club

7. “Technique is everything” “Imitatsiya” Imitate

8. “Expertise Broadband” Myelin

9. Myelin Broadband = Skill • Every movement, thought, or feeling is a precisely timed electrical signal ina circuit of nerve fibers. • Myelin is the nerve fiber insulation to increase signal strength, speed & accuracy

10. 3. The more we fire the circuit, the more myelin optimizes the performance Myelin sheath

11. Neurobiology of Expertise Chang, Y (2014)

12. John, V 2014

13. The hippocampus showed an increase in gray matter during the learning period and more pronounced in the scan after the learning period.

14. Deliberate practice • A goal-oriented, highly targeted, error-focused, repetitive, effortful practice • Focus on the process as opposed to the outcome • Prompt feedback from knowledgeable people • Apply it immediately

15. DP Learning Modules Module 1: Cognitive • Spaced Repetition Learning Module 2: Clinical/Procedural skills • 4-Step procedural coaching (Walker & Peyton)

16. Module 1

17. Spaced Repetition Learning

18. Spaced Learning What is it? • Learning that is spaced out over time involving repetition to increase learning • Particularly beneficial when retention is the goal • Difference between rote memorization and revisiting a topic over time

19. Spacing creates difficulty & failure

20. Spaced Learning

21. Spaced Learning

22. Spaced Learning

27. Spaced Learning Within an Educational Session

28. Formats for repetitions

29. Group Exercise • Divide into groups • Select a topic for your Spaced Learning Educational Session • Create Learning objectives • Design Session using Spaced Learning Content—Break—Recall—Break—Understanding

30. Module 2

31. Practice, Practice, Practice

32. Practice makes perfect 10,000 hr

33. Perfect Practice Makes Perfect Motivation, focus and concentration Designed specifically to improve performance Design of task takes into account pre-existing knowledge Must repeatedly perform same or similar task Individual supervision Immediate and informative feedback

34. Skills Acquisition Peyton JWR. Teaching and learning in medical practice. 1998

35. See One, Do One, Teach One Revisited See one Do one Teach one Demonstration Deconstruction Formulation Performance

36. Demonstration

37. Deconstruction

38. Formulation

39. Performance

40. Kolb’s Learning Cycle

41. Four Step Skills Instruction

42. Unconsciously Competent We are what we repeatedly do. Excellence, then, is not an act but a habit. Aristotle

44. Group Discussion • Deconstruct the steps for skill in question • Discuss Practical Steps for Implementation • Resources needed (e.g. Task Trainer vs. Patient) • Frequency and location of training • Trial Technique

45. Think of someone who taught you a skill…

46. Master Coaching Master coach Struggling leaner Locate the impaired circuits Deliver repetitive HD signals to fire the particular skill circuits “Human delivery system of signals that fuel skill circuits”

47. Virtues of Master Coaches Deep knowledge GPS reflex Deep and broadprinciples, strategies and practiced instinct Deliver small, highly targeted and specific adjustments Theatrical honesty Perceptiveness Very dramatic Full of characters Authentic connections Always learn about learners Create customized teaching

48. What makes a great clinical teacher? Bannister SL, et al, Pediatrics, 2010

49. Doctor Coach Framework Gifford KA and Fall LH, Acad Med, 2014

50. The Journey Novice Expert Deliberate Practice Ignition Master Coaching