The common assumption is that the more experience we have, the better we’ll be. But does this theory hold any weight when studied? Or, do we actually get worse as we gain more experience?
It’s a common assumption that in order to be an expert at something, you need to put in hours of practice. Malcolm Gladwell popularized this notion by writing about the 10,000-hour rule – spend ten thousand hours at a given activity and you’ll be an expert.
So, the common assumption is that a doctor practicing for 10 years is better than a doctor practicing for 1 year. Or, a carpenter who has built homes for thirty years is more skilled than his apprentice. Mind you, this doesn’t apply to just careers. Insert any profession/sport/hobby/activity and you’ll likely think that your friend is better at it than you because he’s been doing it longer.
When we turn to the research, this assumption turns out to be completely wrong. In fact, many doctors who have been in practice for a long time are significantly worse than their colleagues that recently graduated. The same can be said of other activities – new drivers are often better than those with lots of driving experience.
Why doesn’t more time spent with an activity result in greater skill or mastery of the activity?
It comes down to how we practice once we’ve learned the basics.
How we learn
I’ll start by drawing a parallel of how we are all used to practicing:
Imagine you want to learn how to play golf. What’s the first step required to fulfill this ambition? Well, you’d start by heading to a sporting goods store to purchase the necessary equipment. After that, you’d likely sign up for a couple of lessons or go out with a friend who has some experience.
From there, you’d practice your drives at the driving range and your putts on the putting green. And, likely throw in a round or two of golf each week. Once you have reached a basic level of proficiency, you might take another lesson or two. By this time, you likely know enough to avoid losing a dozen balls in a round of golf. You may not be very good, but you have enough skill to go out for a round of golf with friends or business associates.
You keep practicing on your own and getting a lesson every now and then. By now, the embarrassing mistakes, like missing the ball completely are a rarity. You’ve reached a level of comfort where you can go out and play a round of golf and have fun. You have become a golfer. That is, you have reached the point where your swings and putts have become automatic and therefore your performance is acceptable without a lot of mental strain. You can now relax and enjoy the game.
You have mastered the easy parts of golf (if there is such a thing). You will (of course) still have weaknesses – everytime the ball lands in a sand trap (which happens all too often due to that wicked slice to the left) it takes you 3 strokes to get back onto the fairway. Yet because this doesn’t happen all the time, you don’t get enough practice to get better at getting out of the sand traps.
The example I’ve just described is called basic practice. It’s what all of us go through when learning a new skill. Be it golf or baking. We all start off with a general idea of what we want to do. Then, we get instruction from someone more competent than ourselves until we reach a competent level on our own. From here, it’s autopilot as the actions no longer require our focused attention – we’ve mastered them.
Think of when you were learning to drive a car. The first lessons consumed all of your consciousness. You had to be incredibly focused as you were learning a new skill. Now, driving happens automatically. At times, we forget what happened in the last kilometer of driving as we were absorbed in thought.
I’m going to repeat that last part one more time as it’s so important. After reaching a basic level of competency in a given endeavor (golf, driving, baking, medicine, etc.) you will have stopped improving.
The common assumption is that the more experience you have, the better at a given task you’ll be. The more driving or golf or whatever the activity you accumulate hours in must equate to being better at it. Instead, the research shows the opposite. Once one has gotten to a place where the skill happens automatically (think of driving), improvement stops. (5,6)
Instead, those who have been doing an activity for a relatively short period of time are generally better than their peers who have been at a given activity for 20+ years. This occurs because the automatic abilities generally decline over time in the absence of the intentional practice required to improve them.
Knowledge vs skill
In traditional education settings, the emphasis is always on knowledge. Teachers or instructors provide information on the right way(s) in which to do something. The student is then required to apply that knowledge (7). Students will apply the knowledge until a basic level of competency is obtained in a certain skill. This is where the learning stops.
All of us who were trained in the professional world were taught to focus on knowledge at the expense of skills (8). This likely occurs because it is far easier to teach knowledge (especially to a large group of people) than it is to have the same individuals practice and receive feedback on skill development.
Take medical professionals, for example, acupuncturists complete a 4-year undergraduate degree followed by a 4-5 year training program.(9) Chiropractors complete a 4-year undergraduate degree followed by a 4-5 year training program. (10) Naturopathic doctors follow the same amount of training. (11) Medical doctors complete a 4-year undergraduate degree, then a 4-year medical school training, followed by 3+ years of residency training. (12)
When any of these professionals graduate, they will have an immense amount of knowledge in how to treat specific conditions but little to no experience in how to translate that knowledge into the skills required to help patients. It is only after working with patients that medical professionals really develop the skills required for their modality.
Does the above training for medical professionals sound a lot like how one sets out learning how to play golf?
It should. Develop enough skill to play the game (or, perform medicine) competently. Then, set aside the intense training that occurred during the original learning period and perform at a competent level. With this in mind, do doctors get better with experience? Or worse?
Do doctors get better with experience?
While the research I’m about to share is specifically on medical doctors and nurses, the information can likely be extended to other healthcare practitioners including naturopaths, acupuncturists, chiropractors, massage therapists, and physical therapists.
In 2005, researchers from the Harvard Medical School found that doctors performance worsened over time. Or, at best, remained the same. (13) A similar study done on the quality of care provided by nurses showed a consistent finding. Experienced nurses do not provide a level of care superior to those only a couple of years out of school. (14)
At the time of this writing, there has not been researching done to indicate why newer doctors provided better care than their experienced colleagues. Perhaps, because the information from medical school was recent, memory recall is easier. Or, perhaps the updated medical information sets the new doctors apart from their older peers.
Do workshops/continuing education courses improve skill?
In 2009 Louise Forsetlund reviewed 49 different studies of continuing education in the context of medical doctors. (15) Her conclusions:
Continuing education can improve a doctors outcomes with patients but the improvements are very small. (16) These improvements only occur in the most basic of things. Complex behaviours that involve many steps, such as diagnosis, could not be changed or improved through the use of workshops. (17)
More importantly, Louise found that the style of the workshop had a dramatic influence on whether the doctors would benefit. Workshops or continuing education classes taught in the common lecture format provided almost no benefit to the doctors. (18) Instead, workshops needed to be interactive.
These workshops are analogous to the amateur golfer watching youtube videos or reading golf magazines. Intellectually, we feel that we are learning and improving. Unfortunately, it does not translate into any benefit to our golf game. This comes about solely through deliberate and direct practice.
How do we continue to improve?
Now you know that it’s far more than an accumulation of hours needed to become an expert in a given field/activity. Instead, you need to continue to push yourself each time you engage in your chosen activity.
A prominent American psychologist, Dr. Thondike, observed that adults perform at a level far from their “best,” even for tasks they frequently carry out. For instance, adults tend to write more slowly and illegibly than they are capable of doing. Likewise, adults (including clerks with many years of frequent daily experience) add numbers far more slowly than they can when they are doing their best. (19)
This occurrence happens because we reach a level of automaticity. Automaticity occurs when the skill can happen without our conscious engagement. We no longer need to improve. We’ve reached a level of competency. Additional speed/skills/training are not required to perform one’s job. When this level is reached, improvement stops.
In order to continue improving, Dr. Anders K. Ericsson’s research suggests we need to engage in what is called deliberate practice. Deliberate practice consists of the following core principles: (20)
- Repetitive performance of an intended skill
- Rigorous skills assessment
- Specific information feedback
- Better skills performance
While engaging in deliberate practice, there are personal skills required to be exhibited. These include:
- Planning (organize work in a structured way)
- Concentration/dedication (higher attention span)
- Repetition/revision (strong tendency to practice)
- Study style/self-reflection (tendency to self-regulate learning)
Deliberate practice is a highly structured activity. The aim of the activity is to improve performance. When applying deliberate practice, the primary aim is to overcome weaknesses. In order for this to occur, performance is carefully monitored to provide cues for ways to improve it further. Deliberate practice requires effort and is not inherently enjoyable.
If you want to better your golf game, you’re going to have to do much more than book additional tee times next season. Instead, assess your current golf skillset – driving, chipping, putting, etc. Once you’ve identified an area of weakness, allocate time to focus on that one area. This needs to occur on a regular basis. Think 1-2 training sessions each week for an amateur golfer.
Next, you’ll need to receive feedback. A golf pro can help analyze your swing. With a proper swing analysis, you should be aware of your potential weaknesses. Now it’s time to focus on improving them. Practice your swing while bringing your full focus to the area(s) needing improvement. Video yourself and analyze it – are you making the proper adjustments?
Repeat. Repeat. Repeat.
This is how we continue to improve.
Now, I want to hear from you!
What are you trying to get better at?
Have you tried adding deliberate practice to your routine? How did it help?
Also published on Medium.