Challenges for educationalists

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Abstract
Make practical training more effective Many of the developments and research in medical education have focused on the undergraduate curriculum, especially the theoretical parts. Clinical attachments and postgraduate training have not received nearly as much attention. This is unfortunate because not only are these practical aspects largely unstructured but they also waste too much time on non-educational activities and rely on learning by doing.1 2 Changes in society have made this approach inadequate. Firstly, patients' growing awareness about quality of care makes them understandably reluctant to act as learning tools for medical students or registrars. Secondly, the European Working Time Directive, which limits the number of hours a registrar is allowed to work to 58 a week, has implications for training. The directive is a good thing for individual patient care, as working long hours increases the risk of medical errors,3 4 but there is a downside. The evidence from cognitive psychological research on expertise shows that to become an expert you need many hours of practice.5 The challenges are thus to find ways to allow registrars to practise without using patients as learning objects and to optimise the educational effectiveness of learning in practice. Dummies and (computer) simulation tools are likely to have only minor value. Most of the things doctors have to learn cannot be taught on dummies or with simulations.6 The use of simulated patients can be helpful, but they too can train students in only certain areas. The main emphasis, therefore, should be on implementing what is already known about effective learning practice. Cognitive psychological research has shown that deliberate practice is a far better method to acquire expertise than simple unstructured practice.7 Deliberate practice in simple terms is the combination of acquiring expertise with activities that help learners to become more conscious of their learning. Key elements in deliberate practice are: Supervision and detailed feedback Well defined tasks to improve certain aspects of performance Ample opportunity to improve performance gradually by performing tasks repeatedly. Top athletes and musicians apply a similar approach. It is not just practice that makes perfect; it is deliberate practice. View larger version: In this window In a new window Simulation has limited applications Credit: KEITH SRAKOKIC/AP