Breaker of Icons

May 16, 2012


learning, medicine


Here a couple of paragraphs from Geoff Norman. Seven years old, but I fear thinking as Geoff does would be risky  (read deviant) for many of our young doctors or medical students.

Competence, whether in surgery, medicine, or music, cannot be captured by checklists, which reward thoroughness, not expertise. The counter-argument is that a checklist remains a valuable mechanism for feedback to learners, but this is predicated on the unproven assumption that the only way to learn is to do it all comprehensively and mindlessly, then learn to take shortcuts. I have heard enough anecdotes about the shotgun behaviour induced by checklists to shift the burden off proof onto the advocates of this strategy.

Two other things depress me. On the one hand, why do we find the idea of general skills so enchanting? As I indicated, we finally buried problem- solving (I think) (Eva, 2003). But there are lots more sacred cows in the skills area just waiting for their comeuppance. If we do manage to get people to reconsider and abandon data-gathering and communication skills, there’s still self-directed learning skills, self-assessment skills (again, lots of evidence to the contrary, none of which seems to change anyone’s mind, e.g. Eva, Cunnington et al. 2004), lifelong learning skills, evidence-based medicine skills, critical appraisal skills, reflective practice, etc. None of these have been shown to be skill-like; indeed, few have been shown to exist. I’ve never figured out what a good self-assessor looks like, or how one could teach it. Yet many bodies pay devout allegiance to these shibboleths.

On the other hand, there is one skill I am prepared to recognize. I really believe that experts in a domain possess ample amounts of judgment.


Post by Jonathan Rees

Clinical academic and skin watcher at the University of Edinburgh

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