What Does Deliberate Practice Look Like for Me?

I recently read the book, Peak, by Anders Ericsson and Robert Pool. In this book, the authors discuss the research and current understanding of how "expertise" develops. Needless to say, I’ve got several questions rolling around in my head now. The first question is: "What does deliberate practice look like for me?"

Wait, let’s back up and talk about the different forms of practice that Ericsson and Pool discussed. They call the first level of practice "naïve practice." This is how I learned to play guitar for the first 16 years that I had one. I would practice a few finger exercises that someone told me and try playing a song from a guitar magazine. I didn’t really have a plan. I certainly practiced; however, that practice was haphazard. The next level of practice is "purposeful practice." I started doing this a few years ago when I joined a guitar lessons website. I would go online with my guitar a few times a week and diligently work through one of the video lessons. The top level of practice, as described by Ericsson and Pool, is "deliberate practice." I actually started doing this about two years ago when I started taking guitar lessons from a music teacher in town. What distinguished this from purposeful practice is that my music teacher was an expert, and I received specific feedback and prescribed practice activities based on my skills. I have to admit, my ability to play guitar as well as my knowledge of music went into overdrive.

I learned and progressed so much from the insights made possible from this deliberate practice.

Reading Peak taught me a few lessons, as well as gave me some surprises. First, I have come to appreciate the need for a teacher. Without that expert, I am self-reliant to recognize my faults and determine how to achieve that next goal. And, I’m certain that a number of biases cloud my ability to accurately perceive my weaknesses as well as how I am progressing on professional goals. Second, I have come to appreciate that learning skills, rather than developing knowledge, is the way forward. Notably, this is opposite of what I had always believed. When learning guitar, I have always been most interested in developing my knowledge of music theory. When learning pathology, I have always been most focused on acquiring new knowledge. Ericsson and Pool make the point that by focusing on skills, the knowledge will naturally come along for the ride. The opposite is not true. When focusing on knowledge, we run into transferability problems. I’m sure that we all have experiences of recently teaching someone, but when that newly learned knowledge becomes clinically relevant, the person cannot see how to apply his or her knowledge to the situation. Third, I have come to appreciate that performing is not practicing. In other words, just being a clinically active pathologist does not mean that I should count all of my clinical work as practice. Experience alone doesn’t necessarily mean competence. I suppose that is why I’ll need to periodically re-certify.

Fourth, I have come to appreciate the importance for continuing to press beyond my comfort zone. What was once a stretch becomes my new normal, which means that it’s time to stretch yet again.

I opened this blog post with the first question still rolling around in my head. Once I answer that first question, my next question is: "How does my current plan for continuous medical education differ from a deliberate practice approach?" Once I understand the contrast, then: "What is getting in my way of trying deliberate practice?" Maybe I’ll still need to challenge myself . . . . "If my success with deliberate practice was completely guaranteed, what bold steps would I take today?"

I’m curious about how others think about this concept of deliberate practice, as described by Ericsson and Pool, in the context of continuous medical education. If deliberate practice is the secret of developing and maintaining expertise, should the medical community embrace this practice? Thanks in advance for sharing your thoughts below.

Justin Kreuter

Justin Kreuter, M.D., is a clinical pathologist at Mayo Clinic in Rochester, Minnesota. His practice consists of both general and subspecialty aspects of clinical pathology. At Federal Medical Center-Rochester, Dr. Kreuter runs the general laboratory that supports a local in-patient population and does a large amount of reference work. At Mayo Clinic, Dr. Kreuter's time is split between the transfusion medicine service and transplant laboratory. In addition to clinical activities, his academic interests include several aspects of medical education, including teaching clinical judgment, frameworks for feedback, and reflection in medical practice.