Experience Curves as an Organizing Framework for Deliberate Practice in Emergency Medicine Learning

Abstract

Deliberate practice is an important skill-training strategy in emergency medicine (EM) education. Learning curves display the relationship between practice and proficiency. Forgetting curves show the opposite, and demonstrate how skill decays over time when it is not reinforced. Using examples of published studies of deliberate practice in EM we list the properties of learning and forgetting curves and suggest how they can be combined to create experience curves: a longitudinal representation of the relationship between practice, skill acquisition, and decay over time. This framework makes explicit the need to avoid a piecemeal, episodic approach to skill practice and assessment in favor of more emphasis on what can be done to improve durability of competence over time. The authors highlight the implications for both educators and education researchers.ACADEMIC EMERGENCY MEDICINE 2012; 19:1476-1480 by the Society for Academic Emergency Medicine E mergency physicians (EPs) intervene cognitively or physically to ameliorate any of a number of health conditions ranging from simple laceration repairs to managing massive multitrauma disaster situations. One of the fundamental tasks in medical education is the teaching and learning of these cognitive and kinesthetic skills. To gain these skills, novices use a number of instructional strategies, ranging from mental imagery to practicing on high-fidelity simulators. Some of these skills are amenable to deliberate practice, in which the learner repeats the given skill with informative feedback, in the hopes of progressive improvement to a recognized level of mastery.1,2 Once mastery is achieved, issues of skill retention supervene.3 Skills not practiced can degrade at a startling rate.In this article, we present experience curves, which are combinations of learning and forgetting curves that can demonstrate a single, longitudinal representation of knowledge and skill acquisition and decay over time. We will focus on discrete skills that are amenable to deliberate practice as defined by Ericsson.1 Deliberate practice consists of repetition with tailored feedback, is effortful, and is best done over an extended period. Examples could be cognitive (interpreting a radiograph, doing a calculation, applying knowledge to a medical decision, etc.), kinesthetic (performing a cricothyroidotomy), or mixed (leading a resuscitation).Informed by selected research in the medical and general education literatures, we first describe the educational properties of learning curves and forgetting curves. [4][5][6] We then show how these concepts can be united to make up experience curves.7 Our goal in writing this concept article is to promote a longitudinal approach to how these sorts of skills could be practiced in emergency medicine (EM) simulation environments. This framework makes explicit the need to avoid a piecemeal, episodic approach to skill practice and

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