Duckworth on Education: Deliberate Practice

Practice may make perfect, but deliberate practice makes permanent.  

The latest resuscitation research shows if you practice with a defined objective, relevant feedback, and the opportunity to improve, you are on your way to skill mastery. Repetition without these factors is more likely to ingrain bad habits than develop good ones.

The American Heart Association’s 2018 scientific statement on resuscitation education explained how regular education and practice lead to improved critical healthcare skills and have been shown to improve patient outcomes.¹ However, not all EMS and healthcare education is created equal. Inconsistent approaches produce inconsistent learning outcomes, and skill degradation can occur in as little as three months after training.

While no single method will work best for all students in all situations, one educational technique that improves performance is deliberate practice.² For healthcare and EMS educators, we can think of deliberate practice as an instructional technique consisting of a clearly defined learning objective (rather than a general goal), immediate and actionable feedback (rather than blind repetition), and an opportunity to improve (rather than a simple grade to close out the lesson). This is very different from repeatedly performing a skill or exhibiting a behavior, either in the classroom or in professional practice, over and over again.

When using deliberate practice, educators and students will exert more effort as they focus on performance improvement with each cycle. Simple practice—the blind repetition of a skill or behavior—requires far less effort. However, simple practice is not only far less likely to result in tangible improvement; it is also more likely that errors will creep in and become deeply ingrained in the healthcare provider’s performance.

The exact way educators can include deliberate practice will change depending on the desired outcome, available resources, and students themselves. However, the three core components that define deliberate practice should always be included.

Clear Objective

Avoid overly general goals such as “improve at CPR” or “deliver adequate compressions.” Educators should specify the four critical components of any learning objective. These are:

• Audience: the specific person being evaluated;
• Behavior: the specific knowledge, skills, or attitude being evaluated;
• Condition: the specific circumstances under which students will be performing; and
• Degree: the exact measurements that will define performance failure, competency, or excellence.

These are the ABCDs of specific performance objectives. While they don’t have to be written as a formal lesson plan, they should be clear to educators and students alike. Learn how to avoid performance objective pitfalls in this earlier column. 

Immediate Actionable Feedback

As students practice they may seek feedback from a subject matter expert instructor, a competent skills evaluator, or another student, or they may observe themselves through a video recording or other performance-measurement device. They should seek feedback shortly after the skill is practiced and be given adequate time to process it.

Feedback must be presented so the student will be able to build on their successes or correct their deficiencies. “You passed” or “do better next time” is not actionable. “You need to align your shoulders, elbows, and wrists over the patient’s sternum to make your compressions more efficient” is an example of actionable feedback. The person delivering feedback should focus on what the student can change to improve performance. Feedback should help the student get closer to what they should do, not simply tell them what they did incorrectly.³Tools like “plus/delta” can help them get there.⁴

Opportunity to Improve

Actionable feedback does little good if a student does not have the opportunity to implement the recommendations, moving closer to mastery. Giving basic feedback to students and then sending them on their way does little to improve their chances for a better performance during the next round of practice. Following the 6 Rs of feedback—readiness, realism, recording, review, reflection, and rules—can help.⁵ Students should have the opportunity to implement the actionable feedback they receive. When it is not practical to do this due to time or resource constraints, students should be told where, when, and how they can next use deliberate practice to improve.

Conclusion

Deliberate practice is not just a method to help students prepare for a National Registry psychomotor skills evaluation. It is a method anyone can use for continued performance improvement in any field. The benefits of deliberate practice improve performance not only in classroom exams but in real-world resuscitations, along with outcomes for real patients.²

It takes an upfront investment of time and effort and, like any new technique, can feel awkward when it is first introduced. However, the benefits of skills mastery, real-world performance, and long-term retention are more than worth the effort for those truly committed to performance improvement.

References

1. Cheng A, Nadkarni VM, Mancini MB, et al. Resuscitation Education Science: Educational Strategies to Improve Outcomes From Cardiac Arrest: A Scientific Statement From the American Heart Association. Circulation, 2018; 138: e82–e122.

2. Donoghue A, Navarro K, Diederich E, Auerbach M, Cheng A. Deliberate practice and mastery learning in resuscitation education: A scoping review. Resuscitation Plus, 2021; 6: 100137.

3. Tuma F, Nassar AK. Feedback in Medical Education. StatPearls [Internet], 2021; https://pubmed.ncbi.nlm.nih.gov/31335031/.

4. Duckworth RL. Duckworth on Education: The Plus/Delta Feedback Tool. EMS World, 2019; www.hmpgloballearningnetwork.com/site/emsworld/article/1223328/duckworth-education-plusdelta-feedback-tool.

5. Duckworth RL. Duckworth on Education: The 6 Rs of Feedback. EMS World, 2019; www.hmpgloballearningnetwork.com/site/emsworld/article/1223204/duckworth-education-6-rs-feedback.

Rommie L. Duckworth, LP, is a dedicated emergency responder and award-winning educator with more than 25 years working in career and volunteer fire departments, hospital healthcare systems, and public and private emergency medical services. He is currently a career fire captain and paramedic EMS coordinator.