Physicians who deliberately practice the art and skill of medicine are more likely to achieve excellence.

Guest et al concluded that teaching deliberate practice means providing learners with opportunities to:

1. Address problems in medicine at the upper level of their ability

Suggestions:
• Take an educational history
• Plan appropriate challenging patients at least once a week
• Suggest an independent learning project of interest to the student

2. Develop a livelong habit of self monitoring (seek out blind spots)

Suggestions:

• Assist students to identify their strengths
• Provide students with opportunities to identify and correct mistakes in a safe environment
• Reflective Learning
• Significant Event Audit http://www.projects.ex.ac.uk/sigevent/
• One Minute Preceptor http://www.practicalprof.ab.ca/teaching_nuts_bolts/one_minute_preceptor.html
  

3. Repeat tasks to improve performance

Suggestions:
• Guide through multiple cases
• Skills and knowledge increase with repetition to the point where you are unconsciously competent (automatic)
• Key is timely feedback to prevent mistakes that might result in becoming unconsciously incompetent.

Here are some articles about deliberate practice:

The Role of Deliberate Practice in the Acquisition of Expert Performance
The definitive article from K.A. Ericsson who initially proposed the concept although not specifically medical

The Effects of Deliberate Practice in Undergraduate Medical Education
The present study investigated the relationship between several aspects of deliberate practice and study achievements among undergraduate medical students

The Rigorous Application of Deliberate Practice Methods in Skills Courses
Prepared for: UCLA/IALS Sixth International Clinical Conference Enriching Clinical Education

Clinical Skills Training – practice makes perfect Research in instructional science demonstrates that the acquisition and maintenance of skills expertise in clinical medicine depend upon the learner’s engagement in deliberate practice of desired educational outcomes

The Lifelong Challenge of Expertise
The development and maintenance of expertise requires extensive time dedicated specifically to the improvement of skills, an activity termed deliberate practise

Developing Clinical Reasoning: The role of deliberate practice, reflection and analogical mapping
Research indicated that practice, reflection, and cognitive processes are necessary for effective clinical reasoning ability but do not adequately answer the question of how they are related

The Structure of Reflective Practice in Medicine The capability to reflect consciously upon one’s professional practice is generally considered important for the development of expertise and, hence, for education

Deliberate Practice and CPD in Psychiatry
This editorial outlines the philosophy of deliberate practice and potential difficulties in making use of it in psychiatry

Mastery Learning Of Advanced Cardiac Life Support Skills
Our objective was to use a medical simulator to assess PGY-2 medical residents' baseline proficiency in six ACLS scenarios and evaluate the impact of an educational intervention grounded in deliberate practice on skill development to mastery standards

Mastery Learning of Thoracentesis Skills
Our aim was to use a thoracentesis simulation to assess graduating residents' proficiency in thoracentesis procedural skills and to evaluate the impact of an educational intervention on skill development to mastery standards.

Reflection, perception and the acquisition of wisdom Medical Education 2008

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