Simulation technology is widely used in undergraduate and graduate medical education as well as for personnel training and evaluation in other healthcare professions. Simulation provides safe and ...effective opportunities for learners at all levels to practice and acquire clinical skills needed for patient care. A growing body of research evidence documents the utility of simulation technology for educating healthcare professionals. However, simulation has not been widely endorsed or used for continuing medical education (CME).
This article reviews and evaluates evidence from studies on simulation technology in undergraduate and graduate medical education and addresses its implications for CME.
The Agency for Healthcare Research and Quality Evidence Report suggests that simulation training is effective, especially for psychomotor and communication skills, but that the strength of the evidence is low. In another review, the Best Evidence Medical Education collaboration supported the use of simulation technology, focusing on high-fidelity medical simulations under specific conditions. Other studies enumerate best practices that include mastery learning, deliberate practice, and recognition and attention to cultural barriers within the medical profession that present obstacles to wider use of this technology.
Simulation technology is a powerful tool for the education of physicians and other healthcare professionals at all levels. Its educational effectiveness depends on informed use for trainees, including providing feedback, engaging learners in deliberate practice, integrating simulation into an overall curriculum, as well as on the instruction and competence of faculty in its use. Medical simulation complements, but does not replace, educational activities based on real patient-care experiences.
Over 25 years ago
Ericsson et al. (1993)
published the results of their search for the most effective forms of training in music, a domain where knowledge of effective training has been accumulated ...over centuries. At music academies master teachers provide students individualized instruction and help them identify goals and methods for their practice sessions between meetings – this form of solitary practice was named
deliberate practice
, and its accumulated duration during development was found to distinguish groups with differing levels of attained music performance. In an influential meta-analysis
Macnamara et al. (2014)
identified studies that had collected estimates of practice accumulated during development and attained performance and reported that individual differences in deliberate practice accounted for only 14% of variance in performance. Their definition of “deliberate practice” differs significantly from the original definition of deliberate practice and will henceforth be referred to as
structured practice
. We explicate three criteria for reproducible performance and purposeful/deliberate practice and exclude all effect sizes considered by
Macnamara et al. (2014)
that were based on data not meeting these criteria. A reanalysis of the remaining effects estimated that accumulated duration of practice explained considerably more variance in performance (29 and 61% after attenuation correction). We also address the argument that the limited amount of variance explained by the duration of practice necessarily implies an important role of genetic factors, and we report that genetic effects have so far accounted for remarkably small amounts of variance – with exception of genetic influences of height and body size. The paper concludes with recommendations for how future research on purposeful and deliberate practice can go beyond recording only the duration of practice to measuring the quality of practice involving concentration, analysis, and problem solving to identify conditions for the most effective forms of training.
Twenty years ago, Ericsson, Krampe, and Tesch-Römer (1993) proposed that expert performance reflects a long period of deliberate practice rather than innate ability, or “talent”. Ericsson et al. ...found that elite musicians had accumulated thousands of hours more deliberate practice than less accomplished musicians, and concluded that their theoretical framework could provide “a sufficient account of the major facts about the nature and scarcity of exceptional performance” (p. 392). The deliberate practice view has since gained popularity as a theoretical account of expert performance, but here we show that deliberate practice is not sufficient to explain individual differences in performance in the two most widely studied domains in expertise research—chess and music. For researchers interested in advancing the science of expert performance, the task now is to develop and rigorously test theories that take into account as many potentially relevant explanatory constructs as possible.
•Ericsson and colleagues argue that deliberate practice explains expert performance.•We tested this view in the two most studied domains in expertise research.•Deliberate practice is not sufficient to explain expert performance.•Other factors must be considered to advance the science of expertise.
This study investigated children's choices of deliberate practice strategies. Six-to 11-year-olds (n = 85) were presented with three outwardly similar motor tasks that varied only in the precision of ...the motor response required to succeed. Children then had the opportunity to practice these tasks before a “test” in which they had to complete all three tasks in the fastest overall time. While children of all ages spent relatively more time practicing the hardest task, only 10- and 11-year-olds scored more successes on the hardest task than the other tasks during the initial practice period. After verbal instruction, however, children of all ages scored more successes on the hardest task during practice, and younger children became more likely to persevere with the hardest task rather than switching tasks after a success. Children's practice choices may vary as a function of age and verbal instruction.
•Six-to 11-year-olds spent more time practicing harder than easier task components.•Only 10- and 11-year-olds spontaneously scored more hard successes during practice.•After instruction, children of all ages scored more hard successes during practice.•Children's practice choices appear to vary with age and verbal instruction.
This study, conducted within an educational design research (EDR) framework, assessed the use of customized 3D-printed tooth models at various difficulty levels to enhance mastery learning and ...deliberate practice in preclinical endodontic training.
The EDR was conducted in a preclinical endodontic training involving 42 third-year students. The study focused on developing and evaluating 3D-printed tooth models customized into 3 difficulty levels to facilitate mastery learning for the access opening procedure on upper anterior teeth. To promote deliberate practice, we ensured ample availability of these models. The evaluation combined quantitative analysis, using Friedman and Wilcoxon Signed-Rank tests to assess practice volume and performance, with qualitative feedback from interviews and focus groups, analyzed via content analysis.
There was a significant reduction in practice time across the different model levels, with students using an average of 1.5–1.8 models per level. No significant differences in performance scores were observed across levels and natural tooth (P = .333). Feedback highlighted the models' educational value in enhancing dental training, indicating their effectiveness in improving learning experiences and skill development in endodontic education.
The innovative design of a 3D-printed tooth model system, which features 3 levels of difficulty and was developed within an EDR framework, allowed for tailored learning progressions and ample practice opportunities. This significantly enhanced the endodontic training experience and skill development by providing varied and realistic challenges.
Building upon athletes' positive attributes recognized by the theory of deliberate
practice and research in sports psychology, this study examines the relationship between a person's participation in ...competitive sports during formative years and the propensity for creating a new venture later in life. The analysis of the biographies of 2,084 American executives reveals that individuals who participated in competitive sports in their youth are more likely to become entrepreneurs. Our research indicates that participation in individual sports (such as tennis, running, and swimming), but not in team sports, drives the results. Moreover, being a star youth athlete further enhances the likelihood of entrepreneurial action. Thus, we contribute to research on personal characteristics in entrepreneurship by shedding light on the relevance and importance of an athletic background and qualities developed through sports to entrepreneurs. We discuss the practical policy implications of our findings.
Good communication is vital in providing optimal medical care. We developed a simulation-based communication-training program for healthcare providers using methodologies of Verbal Judo.
To evaluate ...the effectiveness of improving resident communication with nurses by teaching Verbal Judo communication tactics using deliberate practice (intervention) versus traditional debriefing (control).
Thirty-five residents were randomized into control or intervention groups. Communication skills were evaluated using self-assessment, real-life assessment by nurses, and video-observed graded assessment.
The nurse assessments found improvement in both groups from baseline to 6-month follow-up. There was improvement in self-assessments in both groups but only the intervention group reached statistical significance. There was no significant difference in blinded assessments. There was no difference in scores between the 3 time points. Participants scored themselves lower than the observer.
Our study found an improvement in communication over time but was unable to find a difference between teaching with deliberate practice or traditional debriefing.
Ericsson, Krampe, and Tesch- Römer published their research on "The role of deliberate practice in the acquisition of expert performance" over 25 years ago. Since then, hundreds of new articles have ...been published with findings regarding the effects of practice on performance in sports. The original paper searched for conditions underpinning optimal acquisition of reproducibly superior (expert) performance in domains, where methods for producing such performance had been refined over centuries. At an elite music academy, superior music students were found to have engaged for longer periods in solitary practice guided by their music teachers - an explication of the conditions of this type of practice led to a definition of deliberate practice. When other researchers in sports started searching for optimal practice, they could not find any practice activities meeting all the criteria for "deliberate practice", yet referred to somewhat similar activities using that same term. This paper shows that the effects of these different types of practice activities on attained performance differ from those of deliberate practice and should be given different distinct names. The paper concludes with recommendations for how future research on purposeful and deliberate practice can inform, not just athletes and their coaches, but all adults about how their achievements can be improved with individualized forms of effective practice.
Deliberate practice (DP) is recommended as a new approach to facilitate the acquisition of discrete therapeutic skills, however, its implementation and effectiveness in psychotherapy remains unclear.
...A systematic search on DP for therapeutic skills among psychotherapy trainees and psychotherapists yielded eleven studies for inclusion. Nine were randomized controlled studies (RCTs), including seven unique RCTs, and two were within-group studies.
Risk of bias was assessed as "high" for one RCT, "some concerns" for the remaining RCTs, and "serious" for within-group studies. All RCTs found the DP group performed better than the control group. All studies involved efforts to improve performance based on learning objectives and iterative practice but varied in the source of expert guidance and feedback. The included studies provide limited insight into best practice for delivering DP.
The results highlight the paucity of research in this field; however they offer insight into current applications of DP and provide preliminary empirical support DP for as a model for promoting the development of discrete therapeutic skills. Given the rapid dissemination of DP publications and manuals in psychotherapy, future research is strongly encouraged.
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