In Praise of Healthcare “Technicians”

By Bonnie Hutchinson

In the world of academia, cognitive knowledge is rightfully prized. But “cognitive” is not the only kind of knowledge – as every healthcare practitioner knows.

Of course you need to know how the human body functions. Of course you need to know time-tested protocols.

But ultimately, all that knowing is in service of DOING – providing care to patients who need your help.

Healthcare practitioners as “technicians” – THE PERFORMERS OR DOERS

In essence, all health care practitioners are “technicians.” Really!

Google definitions of “technician” include:

  • an expert in the practical application of a science.
  • a person skilled in the technique of an art or craft.
  • a person employed to look after technical equipment or do practical work in a laboratory.

Healthcare practitioners take information from many sources and do the “practical application.” Healthcare practitioners are the doers, the performers, the ones who put information to use in service of others.

Doing things, performing actions, is “any activity or gathering of reactions which leads to an outcome or has an impact on the surroundings.”[1] In other words, performing is doing and getting results. That sums up what healthcare practitioners do.

TAKES INCREDIBLE BRAIN POWER

Performance or “doing and getting results” is sometimes thought of as less impressive compared to academic knowledge. However, high levels of performance take as much or more brainpower as academic pursuits.

To use an example from sports, Jonah Lehrer, a neuroscientist turned journalist, says this about quarterbacks.

“Finding the open man involves a very different set of decision-making skills than solving an algebra problem. If you look at it from the perspective of decision-making – what they have to take in and decide in 3.5 seconds — it’s mind-boggling. Their brains have to function at an incredibly high and efficient level.”[2]

The sports example is less impressive than what healthcare practitioners do every day. For example, Dr. Scott Weingart has said this of emergency physicians.

“A good EM doc knows from the first three minutes of encountering the patient whether they need to be admitted or discharged.”[3]

Dr. Scott Weingart is an emergency physician who works in an Emergency Department intensive care unit. He’s also one of the founders of the Free Open-Access Medical education movement known as FOAM.

He’s passionate about making the best information available in a form that healthcare practitioners can use. His motto is “Attempting to Bring Upstairs Care Downstairs, One Podcast at a Time.” He says this.

“…What I think my bent is, is trying to figure out is how to take the research and actually make it usable on a clinical ship or in the trenches of the ICU or an ED….

“I care about taking evidence, and if there’s no evidence out there then taking the best physiology and applications of clinical experience and trying to make sense of what to do on an actual patient encounter. [4]

He’s helping healthcare practitioners become the best “technicians” they can be – the best able to transform research or clinical data into “doing and getting results.”

But. The process of moving from “understanding” to “doing and getting results” is not simple.

FROM CONCEPT TO ACTION: PERFORMANCE PSYCHOLOGY

Performance psychology grew out of sports psychology. The intent was to help athletes perform at their best. The American Psychological Association defines performance psychology this way.

“…the systematic application of psychological principles and techniques to performance, particularly when there is a time element and one must perform on demand. The goal is helping the psychologist’s clients build on and broaden their skills and learn new habits to help perform consistently at high levels in pressure situations. The model and principles are applicable to all contexts where an individual must perform under pressure. These include elite athletes, performing artists, business persons, and individuals dealing with life and death situations such as those encountered in medicine, the military, and law enforcement.”[5]

FROM UNDERSTANDING TO PEAK PERFORMANCE

The most quoted name in the study of performance is Swedish psychologist K. Anders Ericsson. Dr. Ericsson may be the world’s foremost expert on acquiring and maintaining skills and expertise. In 2004, he wrote, “Deliberate practice and maintenance of expert performance in medicine and related domains.”[6] The paper is so influential that it’s one of only 36 works referenced in the American Heart Association’s 2015 ECC Highlights. Dr. Ericsson’s work directly influenced the American Heart Association’s 2015 Core Educational Concepts.[7]

He explains the process of moving from “understanding” to being able to apply information to specific skills.

“If you teach a student facts, concepts, and rules, those things go into long-term memory as individual pieces. If a student then wishes to do something with them—use them to solve a problem, reason with them to answer a question, or organize and analyze them to come up with a theme or a hypothesis—the limitations of attention and short-term memory kick in. The student must keep all of these different, unconnected pieces in mind while working with them toward a solution.

“However, if this information is assimilated as part of building mental representations aimed at doing something, the individual pieces become part of an interconnected pattern that provides context and meaning to the information, making it easier to work with. As we saw in chapter 3, you don’t build mental representations by thinking about something; you build them by trying to do something, failing, revising, and trying again, over and over. When you’re done, not only have you developed an effective mental representation for the skill you were developing, but you have also absorbed a great deal of information connected with that skill.”[8]

Dr. Ericsson used the phrase “deliberate practice” to describe this process of “building mental representations by trying, failing, revising and trying again.” It is based on two main sources. One source is the practice methods of elite and world class performers. Another source is an analysis of factors the most skilled people in the world have in common.[9]  It’s the process that allows healthcare practitioners to become so expert at what they do.

You might like to hear Dr. Scott Weingart’s interview with Dr. Anders Ericsson on Weingart’s EMcrit podcast in October 2017.[10]

HEALTHCARE PRACTITIONERS AND DELIBERATE PRACTICE

So – healthcare practitioners as technicians or performers, the people who turn knowledge into action in service of their patients. Healthcare practitioners using deliberate practice to achieve ever more mastery. Impressive. Except…

Healthcare practitioners may find it hard to use deliberate practice. It would be unethical and dangerous to “practice” on live patients. Simulation training may not be easily available.

Hone Virtual Education has created a resource to make possible deliberate practice of a sub-set of skills crucial to all healthcare practitioners. The focus is diagnostic skill during the first few minutes of patient contact. Hone Cue Recognition virtual training is a series of training modules that you can download to your augmented-reality smartphone or tablet. You can deliberately practice diagnostic skills as often as you wish, whenever you wish, until you achieve mastery.

Find out more

At www.honevirtualeducation.com you can…

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.

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Bonnie Hutchinson is a writer and lifelong learner with degrees in Education and Whole Systems Design as well as extensive training and experience in adult learning and teaching. As an organizational and evaluation consultant, she’s worked with many healthcare and healthcare practitioner organizations. She’s bestselling author of Transitions: Pathways to the Life and World Your Soul Desires.

[1] Pam Nugent (June 29, 2015), “What is Performance? Definition of Performance,” retrieved from https://psychologydictionary.org/performance

[2]  B. Marshall (January 6, 2010), “Brain power secret to Drew Brees’ success,” http://www.nola.com/saints/index.ssf/2010/01/brain_power_secret_to_drew_bre.html

[3] Dr. Joshua Landy of Figure1 interview with Dr. Scott Weingart of EMCrit, (date unknown), “Dr. Scott Weingart of EMCrit on burnout, FOAM, beef jerky, and why emergency medicine is broken,” https://figure1.com/blog/scott-weingart/

[4] Dr. Joshua Landy interview with Dr. Scott Weingart, op. cit.

[5] American Psychological Association (date unknown), “Performance Psychology,” http://www.apa.org/pubs/videos/4310854.aspx

[6] Dr. K. Anders Ericsson (October 2004), “Deliberate Practice and the Acquisition and Maintenance of Expert Performance in Medicine and Related Domains,” Academic Medicine 70-81

[7] American Heart Association (2015), “Highlights of the 2015 American Heart Association Guidelines Update for CPR and ECC,” https://eccguidelines.heart.org/wp-content/uploads/2015/10/2015-AHA-Guidelines-Highlights-English.pdf

[8]  Dr. K. Anders Ericsson (2016), Peak: Secrets from the new science of expertise, Eamon Dolan/Houghton Mifflin, Harcourt, CT, USA.

[9] Dr. K. Anders Ericsson (2016), op. cit.

[10] Dr. Scott Weingart (October 30, 2017), “Expertise with Anders Ericsson.” EMCrit Podcast 211, https://emcrit.org/emcrit/expertise-ericsson/

Hone CUE Recognition on the App Store

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