Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains
Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains
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DOI：
10.1097/00001888-200410001-00022
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发表时间：
2004-10-01
影响因子：
7.4
通讯作者：
Ericsson, KA
中科院分区：
文献类型：
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作者：
Ericsson, KA
导致职业成就的巨大个体差异的因素只是部分地被理解。没有经验就不能成为杰出的专业人士，但是丰富的经验并不一定能使人成为专家。当个人在完成教育后第一次被介绍到一个专业领域时，他们往往不知所措，依靠别人的帮助来完成自己的责任。经过数月或数年的经验，他们达到了可接受的熟练程度，并能够独立工作。尽管在给定领域中的每个人都倾向于最初随着经验的提高而提高，但有些人比其他人发展得更快，并在随后的几年里继续提高。这些人最终被认为是专家和大师。相比之下，大多数专业人士在相对较短的时间内达到稳定的平均水平，并在其职业生涯的其余时间内保持这种平庸状态。个体差异的本质导致了所达到的性能的巨大差异，这一问题仍然存在争议。最常见的解释是，某一特定领域的成就受到先天因素的限制，不能通过经验和训练来改变；因此，可以达到的表现的极限是由一个人的基本禀赋决定的，比如能力、心智能力和天生的才能。持这种广泛接受的专业发展观点的教育工作者把重点放在识别和选择那些拥有必要的天生才能的学生上，这些天赋能使他们在有足够经验的情况下达到专家水平。因此，最好的学校和专业组织几乎总是依靠广泛的测试和面试来寻找最有才华的申请人。这种普遍观点还解释了与年龄有关的职业成就下降，因为一般能力和能力不可避免地会下降，这被认为是衰老的结果。在这篇文章中，我提出了另一种框架来解释个人在获得专业发展方面的差异，以及与年龄相关的衰退的许多方面。这个框架是基于这样的假设：获得专家表现需要参与刻意练习，而持续的刻意练习对于维持多种类型的专业表现是必要的。为了将这一替代框架与传统观点进行对比，我首先描述了基于天赋的说法。然后，我简要回顾了在几个表现领域（包括音乐、国际象棋和体育）获得专家表现的刻意练习的证据。最后，我回顾证据从获得和维持专家的表现在医学和检查故意练习在这一领域的作用。
The factors that cause large individual differences in professional achievement are only partially understood. Nobody becomes an outstanding professional without experience, but extensive experience does not invariably lead people to become experts. When individuals are first introduced to a professional domain after completing their education, they are often overwhelmed and rely on help from others to accomplish their responsibilities. After months or years of experience, they attain an acceptable level of proficiency and are able to work independently. Although everyone in a given domain tends to improve with experience initially, some develop faster than others and continue to improve during ensuing years. These individuals are eventually recognized as experts and masters. In contrast, most professionals reach a stable, average level of performance within a relatively short time frame and maintain this mediocre status for the rest of their careers. The nature of the individual differences that cause the large variability in attained performance is still debated. The most common explanation is that achievement in a given domain is limited by innate factors that cannot be changed through experience and training; hence, limits of attainable performance are determined by one’s basic endowments, such as abilities, mental capacities, and innate talents. Educators with this widely held view of professional development have focused on identifying and selecting students who possess the necessary innate talents that would allow them to reach expert levels with adequate experience. Therefore, the best schools and professional organizations nearly always rely on extensive testing and interviews to find the most talented applicants. This general view also explains age-related declines in professional achievement in terms of the inevitable reductions in general abilities and capacities believed to result from aging. In this article, I propose an alternative framework to account for individual differences in attained professional development, as well as many aspects of age-related decline. This framework is based on the assumption that acquisition of expert performance requires engagement in deliberate practice and that continued deliberate practice is necessary for maintenance of many types of professional performance. In order to contrast this alternative framework with the traditional view, I first describe the account based on innate talent. I then provide a brief review of the evidence on deliberate practice in the acquisition of expert performance in several performance domains, including music, chess, and sports. Finally, I review evidence from the acquisition and maintenance of expert performance in medicine and examine the role of deliberate practice in this domain.