Error-Proofing for Healthcare Professionals

By Bonnie Hutchinson

Quick. Think of something you’re really good at.

Maybe cycling or rock climbing or playing a musical instrument.

Maybe reading or solving math puzzles or the game of chess.

Your body does what it’s supposed to do – the right motions at the right time at the optimum pace – without you having to think about it. Your mind does that too. Almost instantly, you adjust your actions based on all you can see and hear, or you see the best game move, without having to think it through step by step.

If someone asked you to explain how you did that, you might not be able to identify all the mental and physical steps you took.

Chances are, for activities you are really good at, you’ve experienced the benefits of overlearning.

Not just learning but overlearning

According to the American Heritage Dictionary, to overlearn is “to continue studying or practicing [something] after initial proficiency has been achieved so as to reinforce or ingrain the learned material or skill.”

Take reading for example. If you’re a skilled reader, you’re performing multiple cognitive functions at once.

Most obviously, you’re seeing visual squiggles or symbols and mentally translating them into words. That’s the obvious. But then you’re attaching meaning to each word, and – yet another function – grasping the larger meaning of the combined words.

Depending on what you’re reading, you may also be imagining the sights and sounds of what you’re reading about – even when there are no images or sounds in what you’re reading.

You may be interpreting what you’re reading in the context of other knowledge you possess. You may be assessing the accuracy or significance of what you’re reading, related to your work or personal life. You may even be mentally applying what you’re reading to a specific situation.

So – reading involves a complex cluster of sophisticated cognitive functions. But if you’re a skilled reader, you’re not even aware of performing all those functions. You’re so good at it that you’re “unconsciously competent.”

Reading is a skill you have overlearned.

How your brain changes during overlearning

Ever learn something new? Of course! Every moment since you were born.

Ever learn something new, think you have it nailed, and the next day realize you can’t remember it? Probably. Here’s why.

When you’re learning something new, the new learning is unstable at first. It takes a while before the new learning is embedded in your brain pathways so securely that it cannot be disrupted by new learning or any other brain stimulation. Brain researchers call that embedded stage “passive stabilization.”

Research shows that over-learning can change the pattern of new learning being unstable for a while. To quote one of the studies:

…overlearning in humans abruptly changes neurochemical processing, to hyper-stabilize and protect trained perceptual learning from subsequent new learning.
Usually, learning immediately after training is so unstable that it can be disrupted by subsequent new learning until after passive stabilization occurs hours later. However, overlearning rapidly and strongly stabilizes the learning state so that it not only becomes resilient against, but also disrupts, subsequent new learning.[1]

In other words, if you keep practicing beyond the time of initial learning, there’s a point at which you can perform the skill without consciously thinking about it, even when there are external distractions.

A goal of overlearning: automaticity

Automaticity is “the ability to do things without occupying the mind with the low-level details required, allowing it to become an automatic response pattern or habit. It is usually the result of learning, repetition, and practice.” [Wikipedia]

Examples of automaticity are activities such as walking, speaking, cycling, assembly-line work or driving. After an activity is practiced often enough, you can focus your mind on other activities or thoughts while performing the automatized activity. For example, you can talk while walking or driving.

Based on over a decade of research, John Bargh (1994),[2]suggested that four characteristics usually accompany automatic behavior:

  • Awareness: A person may be unaware of the mental process that is occurring;
  • Intentionality: A person may not be involved with the initiation of a mental process (that is, you just start doing it without even “deciding”);
  • Efficiency: Automatic mental processes tend to have a low cognitive load, requiring relatively low mental resources;
  • Controllability: A person may not have the ability to stop or alter a process after initiation.

If you think about something you’re really good at, you may recognize these four characteristics. You can do it without consciously thinking about how to do it. You find yourself starting to do it without a conscious decision. You don’t need to use a lot of mental energy to do it. Sometimes, once you’ve started, you can’t make yourself stop the process in the middle.

As a health practitioner…

Now, think of a typical paramedic scenario. A paramedic team arrives at a scene after a fast-moving and possibly hazardous drive. Within minutes or even seconds of scanning the patient and the environment, the paramedic grasps the immediate medical needs of the patient, and how to provide for those needs within that (possibly chaotic) environment.

There’s no time for a “checklist” approach. The paramedics need to “get it all” instantly.

The ability to do that is the result of overlearning. The paramedics have reached automaticity.

Can you train for automaticity?

Navy SEALS say, “You don’t ever rise to the occasion. You sink to the level of your training.” And then they train for every imaginable scenario.[3]

For paramedics and other health practitioners who practice outside of controlled medical facilities, the need to be capable of “automaticity” is essential. But every health practitioner in any setting can be confronted with medical emergencies – times when they need to “get it all” and act immediately.

So yes, whether they’re consciously aware of it or not (or whether they’ve ever heard the word before!), health practitioners can and do train to the point of automaticity.

Hone simulation training modules can help over-learning

Hone Virtual Education’s mission is “to help practitioners perform at peak levels, capable of rapidly and correctly identifying diagnostic cues, enabling correct clinical decisions.” The over-arching mission is to save lives.

Hone combines mastery learning psychology with augmented reality technology to create virtual simulation training modules you can download to your augmented reality smartphone or tablet.

The initial training modules are focussed on diagnostic cue recognition in the first few minutes of patient contact. Each module allows you to practice specific observations and skills again and again. Once your accuracy is assured, the modules increase the speed with which cues are presented, so you learn to make assessments and decisions more quickly.

For you as a learner, this taps into the cognitive processes that foster overlearning or automaticity.

Find out more

The first Hone Cue Recognition modules will soon be released. In the meantime, check out

  • Learn more about Hone Cue Recognition simulation training;
  • Be notified of updates and launch dates;
  • Apply to be a beta tester as new modules are developed for health practitioners in high-pressure environments.



Bonnie Hutchinson is a writer and lifelong learner with degrees in Education and Whole Systems Design. She also has extensive training and experience in adult learning and teaching. She’s author of bestselling Transitions: Pathways to the Life and World Your Soul Desires.


[1] Kazuhisa Shibata et al (2017), “Overlearning hyperstabilizes a skill by rapidly making neurochemical processing inhibitory dominant,” referenced in Victoria Sayo Turner (2017), “The Power of Overlearning,” Scientific American,

[2]    John A Bargh. “The Four Horsemen of Automaticity: Awareness, lntention, Efficiency, and Control in Social Cognition” (PDF). New York University. Archived from the original (PDF) on February 22, 2014. Retrieved 2014-02-16. (NOTE: Missing pages 24-25.). Referenced in Wikipedia.

[3] Quoted in Steven Kotler and Jamie Wheal (2017), Stealing Fire: How Silicon Valley, the Navy SEALS and Maverick Scientists are Revolutionizing the Way We Live and Work, Harper Collins.

Hone CUE Recognition on the App Store

The Hone CUE Recognition App will soon be available on the App Store for early adopters. When it is available - you will be able to download it via the link below.