This writing was inspired by a recent post by Chris Nickson on, which was entitled “The Art of Medicine is in Observation”. In his post, Chris cites one of the most famous teachers and practitioners of medicine, William Osler:

“Learn to see, learn to hear, learn to feel, learn to smell, and know that by practice alone can you become expert.”

But what type of practice is Osler talking about? Countless studies have shown that the mere number of years of experience is a weak predictor of expert performance. This has been nicely elaborated in Geoff Colvin’s book “Talent is Overrated”. True expertise – according to Colvin – always derives from “deliberate practice”. What exactly is deliberate practice? There are several key elements that characterize it:

  1. It is activity specifically designed to improve performance, often with a teacher’s help.
  2. It can be repeated a lot.
  3. Feedback on results is continuously available.
  4. It’s highly demanding mentally; whether the activity is purely intellectual such as chess or business-related activities or heavily physical, such as sports.
  5. It isn’t much fun.
  6. Pre-performance preparation is essential.
  7. It requires self-observation and self-reflection during the activity.
  8. It involves careful reflection on performance after the practice session is over.

K. Anders Ericsson, the godfather of expertise research found that ten years of deliberate practice are necessary in order to acquire true expertise. Countless examples of famous and successful individuals are specified in Colvin’s book from Mozart to Tiger Woods to Jack Welch. They all needed at least ten years to get to the level of performance that would make them icons in their respective fields. They all followed the deliberate practice approach. There are some very important take-aways for medical doctors from Colvin’s and Ericsson’s writings:

  • Don’t assume that you will automatically become an expert over time.
  • Design your practice activities (e.g., Think about the therapeutic approach you would choose before calling the specialty consultant and then compare their choice with yours. Subsequently, think about which approach is better and why. Read published cases to improve your diagnostic skills. Find your weak spots, think about how you could improve them and then practice accordingly etc.)
  • Get feedback from a mentor or colleague who is more advanced. Write down your patients’ names and diagnoses and follow them up in order to re-evaluate your diagnostic accuracy and treatment strategies in retrospect.
  • Fit in deliberate practice activities into your daily routines but be aware that 4 hours per day is the maximum amount a person can engage in.

We are sure, you will be able to think of many more implications and would be happy to read about those in the comments section. Most of us spend a lot of time with our patients, we might as well re-design our practice of medicine so as to make it a true and valuable learning experience.