Blog | Friday, August 21, 2015

On feedback and deliberate practice


Medical learners often complain that they receive inadequate feedback. Most programs develop solutions of “formal feedback” sessions. To that I say, “Bah, humbug”.

As a devotee of deliberate practice, I understand that formal feedback does not do the intended job. Rather we need to provide immediate feedback and then repeat the practice session with another immediate evaluation.

This quotation from a blog post (Deliberate Practice: What It Is and Why You Need It) should help:

The 4 Essential Components of Deliberate Practice

Research into the history of education (dating back several thousand years), combined with more recent scientific experiments have uncovered a number of conditions for optimal learning and improvement. Again, from K. Anders Ericsson, here are the 4 essential components of deliberate practice.

When these conditions are met, practice improves accuracy and speed of performance on cognitive, perceptual, and motor tasks:

1. You must be motivated to attend to the task and exert effort to improve your performance.

2. The design of the task should take into account your pre-existing knowledge so that the task can be correctly understood after a brief period of instruction.

3. You should receive immediate informative feedback and knowledge of results of your performance.

4. You should repeatedly perform the same or similar tasks.

It's important to note that without adequate feedback about your performance during practice, efficient learning is impossible and improvement is minimal.

Simple practice isn't enough to rapidly gain skills.

Telling a student after 2 weeks that their presentations are confusing will not help the student. Interrupting and giving immediate feedback on the deficiencies (as they occur) will make the points much more clear. Providing immediate positive feedback will reinforce their improvements.

We have a responsibility to give specific feedback throughout our rounds (whether in the inpatient or outpatient arena). We must tell our learners that we are giving feedback. We must celebrate good work and suggest how learners can improve in a balanced fashion.

We should not be so obsessed with “formal feedback.” It does not lead us to expertise.

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Regional Associate Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds over 100 days each year. This post originally appeared at his blog, db's Medical Rants.