Deliberate practice enhances quality of laparoscopic surgical performance in a randomized controlled trial: from arrested development to expert performance.

BACKGROUND: This study investigated whether deliberate practice leads to an increase in surgical quality in virtual reality (VR) laparoscopic cholecystectomies (LC). Previous research has suggested that sustained DP is effective in surgical training. METHODS: Fourteen residents were randomized into deliberate practice (n = 7) or control training (n = 7). Both groups performed ten sessions of two VR LCs. Each session, the DP group was assigned 30 min of DP activities in between LCs while the control group viewed educational videos or read journal articles. Performance was assessed on speed and dexterity; quality was rated with global (GRS) and procedure-specific (PSRS) rating scales. All participants then performed five porcine LCs. RESULTS: Both groups improved over 20 VR LCs in time, dexterity, and global rating scales (all p < 0.05). After 20 LCs, there were no differences in speed or dexterity between groups. The DP group achieved higher quality of VR surgical performance than control for GRS (26 vs. 20, p = 0.001) and PSRS (18 vs. 15, p = 0.001). For VR cases, DP subjects plateaued at GRS = 25 after ten cases and control group at GRS = 20 after five cases. At completion of VR training, 100 % of the DP group reached target quality of performance (GRS ≥ 21) compared with 30 % in the control group. There were no significant differences for improvements in time or dexterity over five porcine LCs. CONCLUSION: This study suggests that DP leads to higher quality performance in VR LC than standard training alone. Standard training may leave individuals in a state of "arrested development" compared with DP.

Long-term working memory.

To account for the large demands on working memory during text comprehension and expert performance, the traditional models of working memory involving temporary storage must be extended to include working memory based on storage in long-term memory. In the proposed theoretical framework cognitive processes are viewed as a sequence of stable states representing end products of processing. In skilled activities, acquired memory skills allow these end products to be stored in long-term memory and kept directly accessible by means of retrieval cues in short-term memory, as proposed by skilled memory theory. These theoretical claims are supported by a review of evidence on memory in text comprehension and expert performance in such domains as mental calculation, medical diagnosis, and chess.

How experts' adaptations to representative task demands account for the expertise effect in memory recall: comment on Vicente and Wang (1998).

K. A. Ericsson and W. Kintsch's (1995) theoretical framework of long-term working memory (LTWM) accounts for how experts acquire encoding and retrieval mechanisms to adapt to real-time demands of working memory during representative interactions with their natural environments. The transfer of the same LTWM mechanisms is shown to account for the expertise effect in unrepresentative "contrived" memory tests. Therefore, K. J. Vicente and J. H. Wang's (1998) critique of the generalizability of the LTWM framework is rejected. Their proposed refutation of LTWM accounts is found to be based on misrepresented facts. The process-based framework of LTWM is shown to be superior to their product theory because it can explain interactions of the expertise effect in "contrived" recall under several testing conditions differing in presentation rate, instructions, and memory procedures.

Maintaining excellence: deliberate practice and elite performance in young and older pianists.

Two studies investigated the role of deliberate practice in the maintenance of cognitive-motor skills in expert and accomplished amateur pianists. Older expert and amateur pianists showed the normal pattern of large age-related reductions in standard measures of general processing speed. Performance on music-related tasks showed similar age-graded decline for amateur pianists but not for expert pianists, whose average performance level was only slightly below that of young expert pianists. The degree of maintenance of relevant pianistic skills for older expert pianists was predicted by the amount of deliberate practice during later adulthood. The role of deliberate practice in the active maintenance of superior domain-specific performance in spite of general age-related decline is discussed.

The role of mediators in memory retrieval as a function of practice: controlled mediation to direct access.

The role of prior knowledge in retrieval of Spanish-English vocabulary pairs learned using keyword mediators was examined in 4 experiments. Retrieval was tested immediately after learning and after 1-week and 1-month no-practice intervals (Experiment 1), after moderate retrieval practice (Experiment 2), and after extended retrieval practice (Experiments 3 and 4). Using accuracy, latency, and verbal report data, a detailed account of memory retrieval processes was developed. Initial retrieval is an explicit mediation process that involves retrieving keyword mediators into working memory and using them as retrieval cues to access the English equivalents of the Spanish words. After extended vocabulary retrieval practice, this sequential mediation process qualitatively changed to a direct retrieval process in which the English equivalent was accessed in a single working memory step. However, direct retrieval was still influenced by a covert mediation process.

Retention and transfer of morse code reception skill by novices: part-whole training.

The training of composite skills requiring differential responding to a large set of stimuli raises issues about how to break down the whole task into parts and which parts should be trained first. Components of Morse code reception skill were identified, separated, and used to test whether initial training on a difficult part was more effective than initial training on an easy part. Initial training on a difficult subset of stimuli and on a difficult subtask both yielded disadvantages rather than the advantage implied by recent findings with different tasks. Incremental training should begin with the part yielding the most effective strategic skills, which appear to depend on characteristics of the task. In both present experiments, easy initial training led to adoption of an effective unitization strategy for representing codes. The hypothesis that procedural reinstatement at delayed testing leads to better retention was supported and extended.

Expert and exceptional performance: evidence of maximal adaptation to task constraints.

Expert and exceptional performance are shown to be mediated by cognitive and perceptual-motor skills and by domain-specific physiological and anatomical adaptations. The highest levels of human performance in different domains can only be attained after around ten years of extended, daily amounts of deliberate practice activities. Laboratory analyses of expert performance in many domains such as chess, medicine, auditing, computer programming, bridge, physics, sports, typing, juggling, dance, and music reveal maximal adaptations of experts to domain-specific constraints. For example, acquired anticipatory skills circumvent general limits on reaction time, and distinctive memory skills allow a domain-specific expansion of working memory capacity to support planning, reasoning, and evaluation. Many of the mechanisms of superior expert performance serve the dual purpose of mediating experts' current performance and of allowing continued improvement of this performance in response to informative feedback during practice activities.

Can we create gifted people?

Only in the light of specific theoretical frameworks for the development of superior performance can we productively ask to what extent that performance is due to controllable external factors and thus could potentially be engineered or 'created'. The popular view of talent acknowledges that instruction and practice are necessary but not sufficient for the attainment of élite performance. With extensive practice individuals are assumed to achieve all possible modification through learning, so that the ultimate level of performance is a function of the components that cannot be modified and are thus presumably innate. However, recent research shows that improvements in performance are possible even after extensive experience in a domain, and that performance at an international level requires over ten years of intense preparation. Furthermore, research has failed to specify and measure talent factors that predict performance. An alternative framework has been proposed on the basis of the amount of deliberate activities aimed at improving performance. The amount of deliberate practice accumulated during many years of preparation is found to be related closely to performance, even at the highest levels. This framework accounts for expert performance in terms of acquired characteristics and identifies new and different constraints on its attainment.

Toward a model of false recall: experimental manipulation of encoding context and the collection of verbal reports.

The likelihood of false recall in the Deese-Roediger-McDermott (DRM) paradigm was shown to depend on encoding context in two experiments. When fillers had been preselected to decrease the likelihood of encoding the critical lure's semantic features, false recall was virtually eliminated. However, when the same words were presented rearranged in different presentation orders, levels of false recall that were found in earlier DRM studies (Robinson & Roediger, 1997) were replicated. The role of encoding processes in the DRM paradigm was further explored with additional participants completing the experiment while thinking aloud. During encoding of word lists, participants verbalized semantic elaboration of the critical lure while studying the word lists. A path analysis demonstrated that participants' verbalization of critical lures during encoding reliably predicted their level of false recall.