The Epidemic of Good Enough

Deliberate practice takes effort, feedback, recalibration and ….. more effort

When is the last time that you have engaged in perfect practice?

  • Medicine vs Sports or Musicians

  • High stakes in medicine

The scope of the problem

  • When we learn a new skill, learn just enough to be competent; brains switch to autopilot

  • 10 years of experience - Did you experience the same 1 year ten times?

    • We are all really bad drivers at first (some of us still bad drivers); through deliberate practice and thousands of hours driving, we got better. We gained expert feedback (for better or worse), studied for test, demonstrated competence, and are now only marginally better at driving today

The “Good Enough” In Medicine

  • Medical education has done a great job at creating competent providers; there is a period of time in school and postgraduate training programs. In these you have forced deliberate practice of basic, core skills

  • Through deliberate practice and thousands of hours studying with expert feedback beyond the way, we got better and were deemed ready for clinical practice

No matter your clinical role: Nurse, RT, PA, MD

  • Is competence your target?

  • Or are you shooting for expertise?

  • What’s your plan to get there? Do you have a plan at all?

Why is this?

  1. Unrealistic views of experts - “smart, lucky, talented” not true, while “dedicated, consistent, hungry” much more true

    1. Not really a big difference between experts and non experts

    2. EXCEPT for small, every-day decisions

    3. Making this fake distinction makes us feel better - as if we shouldn’t become experts ourselves

  2. Hardwired to avoid the unpleasant

    1. Including seeking out negative feedback from others

    2. Self-reflection - overly positive

    3. Example: “difficult” central line - maybe I should have stuck at a different angle, or maybe if my technique of needle stabilization was a little better

    4. Other example: interpersonal communication; sure someone didn’t do what you asked but maybe you didn’t communicate it well

  3. Time and effort

    1. Priorities - bandwith

    2. 80-20 rule

  4. Social proof; values, who you surround yourself with

    1. “The five most dangerous words in business are: ‘Everybody else is doing it.'”

    2. The road to expertise - Scott Weingart calls the path to insanity; lonely road

Practical tips

  1. Change your target from competence to expertise

  2. Galilean Relativity

  3. Metacognition

  4. Seek out feedback (mentors, outcomes, peers); shadowboxing

  5. Actual practice - simulation, mental rehearsal


“Fading Prospects”, “Repose”, “Afterglow”, “Dramamine”, “Fluorescence”, “Program Reverie”, “Crunk in the Trunk”, “Spring Comes Early”, and “Wisp” by Podington Bear is licensed under CC BY-NC 3.0 / Songs have been cropped in length from original form

“Late Night Tales" by Lee Rosevere is licensed under CC BY-NC 4.0 / Song has been cropped in length from original form