- You weren’t born with a fixed potential. Your potential is exponentially expandable, and it’s shaped by what you do every day. You already have everything you need to be successful within you—you just need to learn how to develop the right habits.
- Physicians working at the expert level have immediate access to much of the medical knowledge of their specialty, and many of the mental processes that go on in their minds become automated with time, even complex problem solving.
- Attaining expertise in a medical specialty is a gradual process that involves a lot of practice. “Getting reps in” is the key to building expertise. Good, productive practice always leads to improved results.
- There is a “sweet spot” in difficulty that allows the brain to achieve peak motivation—it’s when you’re working on something that’s just above your capabilities. In fact, your brain encodes information better when you struggle.
- Look back at your performance in specific areas and think about what you need to do differently next time. Using hindsight to adjust future performance can be powerful.
Becoming an expert is extremely hard work. It’s not about the perfect morning routine or meditation—although those things can help you along your journey. You can optimize what you put in every day to get to expertise faster.
We’ve all heard of Malcolm Gladwell’s “ten-thousand-hour rule” that says anyone can become an expert at something if they devote the necessary time to study and practice it. But his hard-and-fast rule isn’t exactly true (it’s more of an average), and it doesn’t account for skill versus expertise.
Take medical school, for example. Doing some back-of-the-napkin math, if you are in class or clinicals for 8 hours per day, and you study for an additional 5 hours, you will spend about 13,000 hours studying and practicing medicine throughout your 4 years (assuming you take 10 holiday days per year). But are you an expert doctor immediately upon graduation? Not even close.
So what makes you an expert in your field? As you learn and repeatedly recall medical facts, concepts, processes, and relationships, you eventually obtain a level of access to those memories that is immediate. All the associated thinking is fluid and quick—not delayed by looking information up or attempting to recall it.
How do you get to the end-goal of expertise? Here are seven rituals to think about adding into your daily routine to build towards expertise in medicine.
1. Commit for the long haul
You weren’t born with a fixed potential. Your potential is exponentially expandable, and it’s shaped by what you do every day. You already have everything you need to be a successful doctor within you—you just need to learn how to develop the right habits to truly reach expertise.
Studying and practicing medicine for those 13,000 hours in medical school will most likely result in you graduating and passing your exams—after all, 95% of medical students will match into residency. So what makes an expert doctor? Deep practice.
When you commit to a goal for the long-haul, that makes all the difference in whether or not you reach the goal. What’s your goal? Physicians working at the expert level have immediate access to much of the medical knowledge of their specialty, and many of the mental processes that go on in their minds become automated with time, even complex problem solving. This is called “automated thinking.” These mental processes are mostly nonverbal.
The expert tends to think in patterns and bases decisions on where the current patient presentation fits in with matching patterns. Hence, an expert physician’s care becomes quick and accurate, no matter how complicated the case. So it’s crucial to understand what you’re aiming for (expertise in your field), and commit to whatever is going to get you there (lots of repetition/practice).
2. Practice often
Practice is a key theme in this article, because practice and “getting reps in” is the key to building expertise. Good, productive practice always leads to improved results. Always. In medicine, things are always changing. Without regular practice, you won’t know if you’re still improving or what you should work on next.
After you do enough repetitions (ahem, spaced repetition), you obtain a quick, fluid recall of that concept. At this point you have achieved “expertise” in that area. Attaining expertise in a medical specialty is a gradual process that involves a lot of practice. You first learn the facts, concepts, and connections that are most common in your field and those that are very dangerous to the patient if you don’t fully understand them. Next, you master the less common ones. Finally, you learn the relatively rare ones.
Regular practice and feedback on your medical knowledge will absolutely eventually lead to expertise. You can practice your clinical knowledge with Qbanks, get a mentor and ask for feedback on competencies, and use practice exams like the ITE.
3. Look for desirable difficulty
There is a “sweet spot” in difficulty that allows the brain to achieve peak motivation—it’s when you’re working on something that’s just above your capabilities. In fact, your brain encodes information better when you struggle. There is a desired level of difficulty—or else everyone would be a doctor!
This is absolutely true in learning medicine as well. Working your way through a complicated concept helps you learn it the best. When you struggle through something, you’re becoming smarter for it. Challenges keep you engaged in the material, and even help you get in the zone.
There should also be a level of difficulty applied to how you study medicine. Fluency illusion tells us that reviewing material again and again is one of the least effective ways to learn something. When it comes to how you study, students often fall into the trap of getting short-term results—study this question, answer it incorrectly, review the material until I know the answer, then move on. The short-term result is that you know the answer, but long-term you don't learn the material. Spacing out your study material (practicing spaced repetition) is more difficult to do, but teaches you the information for the long-haul.
4. Double-down on what works
The majority of people do pass the boards. How? They study focused materials, take advice from physicians who’ve passed the exam before and allow learning science to influence their study habits. Doctors who pass the boards aren’t very different from you. They know how to expand on good results.
Do you know what evidence-based learning techniques are working best for doctors who are studying medicine? You probably know what materials they’re using to prepare for exams and maintain competence. Many physicians share their tips on reddit boards for Step 1 advice, Student Doctor Network, and more. Research what’s worked in the past, and use elements to build your study plan.
You can also expand on your own good results. Try out an evidence-based learning technique, like effortful recall, and see how it affects your study progress. If it works for you, keep doing it! When you have a good result from your efforts, think about what got you there and try to replicate it in the future.
5. Practice in an environment similar to the real thing
Expertise is built by repetition. If you want your clinical knowledge expertise to be readily available when you’re in an exam or treating patients, you need to practice in a similar environment.
If you’re studying using a qbank you should make sure the interface replicates the exam and you do some sessions timed. Challenge yourself to practice recalling information in a timed, realistic condition to train your brain to recall everything about that concept quickly.
6. Don’t let history repeat itself
Expertise can also be built by being a “Monday night quarterback." Look back at your performance in specific areas and think about what you need to do differently next time. Using hindsight to adjust future performance can be powerful.
Here’s an example: According to this study, 22% of Internal Medicine residents correctly assess heart sounds in patients and only 30% of Pediatric residents auscultate and diagnose accurately. And that number declines the longer a physician is in practice—it turns out for the majority of doctors, heart sound skills diminish after medical school.
You can “Monday night quarterback” your heart sounds skills by using a Heart Sounds simulator tool to practice over 40 audio recordings of normal heart sounds and murmurs, and even self-test your knowledge of heart sounds. We have a free trial of that product available for 24 hours—why don’t you hop in and test yourself on them now?
Everybody has expertise in some areas. Think of driving a car. You do this almost without conscious thought, even though the process is full of fast, complex calculations and judgments with life and death consequences. Similarly, all docs have some level of expertise in some area of medicine. The level of expertise may be only 20% for a resident. It is probably 60% or higher if you’re in practice.
Learning in your training years doesn’t mean you’ve fully met your potential—it means you’ve developed it. You leave residency with the tools, knowledge, and skills to become an expert doctor. You will enter into a career-long effort to maintain the knowledge you’ve built during your training, and that deep practice requires passion and commitment. You’re not an expert yet—but your potential to become one is absolutely there.
With hard work and dedication, you can absolutely become an expert in your field. Try adding in some of these tips to your daily routine to build expertise that you can use with patients and on exams.