Model of Skill acquisition I found over internet, useful

1. Dreyfus Model of Skill
Acquisition
Craig McClure, MD
EOSG
University of Arizona
March 2005

2. “To become competent you must feel
bad”
Hubert Dreyfus

3. Activities Studied
Airplane pilots,
Chess players,
Automobile drivers,
Adult learners of a second language

4. Five Stages
Novice
Advanced Beginner
Competent
Proficient
Expert

5. Best Opportunity to Observe
Stages
Unstructured problems
Number of potentially relevant facts
enormous
Variety of solutions extensive

6. Novice
The novice follows rules
Specific rules for specific circumstances
No modifiers
“Context free”
Don’t feel responsible for other than
following the rule

7. The early medical student is taught
to obtain an EKG for chest pain,
without other modifiers.

8. Advanced Beginner
New “situational” elements are identified
Rules begin to be applied to related
conditions
Decisions still are made by rule
application
Does not experience personal
responsibility

9. The more experienced medical
student finds that dyspnea also
might be associated with cardiac
ischemia and orders an EKG for
that situation as well.

10. Competence
Numbers of rules becomes excessive
Learn organizing principles or
“perspectives”
Perspectives permit assorting
information by relevance
The experience of responsibility arises
from active decision-making

11. The competent physician realizes
the multitude of factors influencing
the likelihood that a single
symptom represents ischemia and
has a decision tree to allocate
probabilities balancing a number of
factors in deciding when to order an
EKG or other diagnostic modalities
and begin treatment

12. Proficiency
Intuitive diagnosis
Approach to problem molded by perspective
arising from multiple real world experiences
“Holistic similarity recognition”
Learner uses intuition to realize “what” is
happening
Conscious decision-making and rules used to
formulate plan

13. The proficient physician realizes
“this is an infarction” and then
applies rules to decide about
thrombolysis.

14. Expertise
Don’t make decisions
Don’t solve problems
Do what works
No decomposition of situation into
discrete elements
Pattern recognition extends to plan
as well as diagnosis

15. “This is an infarction and we should
implement the following diagnostic
and therapeutic interventions.”

16. When Expertise Fails
The expert uses rules and explicit
decision-making.

17. Novice
Novice: follows rules and does notfollows rules and does not
feel responsible for outcomes.feel responsible for outcomes.

18. Advanced BeginnerAdvanced Beginner
recognizes new situations in whichrecognizes new situations in which
the rules may be applied. Still doesthe rules may be applied. Still does
not feel responsible.not feel responsible.

19. CompetentCompetent
Follows rules, applies an organizingFollows rules, applies an organizing
“perspective” to determine what“perspective” to determine what
elements of the problem areelements of the problem are
relevant and feels accountablerelevant and feels accountable
because of decision-makingbecause of decision-making

20. ProficiencyProficiency
The proficient learner uses patternThe proficient learner uses pattern
recognition arising from extensiverecognition arising from extensive
experience to identify the problemexperience to identify the problem
(“what” is happening”) and rules(“what” is happening”) and rules
and analysis in formulating theand analysis in formulating the
“how” of the solution. A sense of“how” of the solution. A sense of
responsibility follows the decision-responsibility follows the decision-
making.making.

21. ExpertiseExpertise
immediately sees “what” isimmediately sees “what” is
happening and “how” to approachhappening and “how” to approach
the situation. Pattern recognitionthe situation. Pattern recognition
extends to management plan as wellextends to management plan as well
as diagnosis.as diagnosis.

22. Dreyfus Model of SkillDreyfus Model of Skill
AcquisitionAcquisition
The utility of the concept of skillThe utility of the concept of skill
acquisition lies in helping theacquisition lies in helping the
teacher understand how to assistteacher understand how to assist
the learner in advancing to the nextthe learner in advancing to the next
level.level.