Expertise in medicine: using the expert performance approach to improve simulation training

Context We critically review how medical education can benefit from systematic use of the expert performance approach as a framework for measuring and enhancing clinical practice. We discuss how the expert performance approach can be used to better understand the mechanisms underpinning superior performance among health care providers and how the framework can be applied to create simulated learning environments that present increased opportunities to engage in deliberate practice. Expert Performance Approach The expert performance approach is a systematic, evidence-based framework for measuring and analysing superior performance. It has been applied in a variety of domains, but has so far been relatively neglected in medicine and health care. Here we outline the framework and demonstrate how it can be effectively applied to medical education. Deliberate Practice Deliberate practice is defined as a structured and reflective activity, which is designed to develop a critical aspect of performance. Deliberate practice provides an opportunity for error detection and correction, repetition, access to feedback and requires maximal effort, complete concentration and full attention. We provide guidance on how to structure simulated learning environments to encourage the accumulation of deliberate practice. Conclusions We highlight the role of simulation-based training in conjunction with deliberate practice activities such as reflection, rehearsal, trial-and-error learning and feedback in improving the quality of patient care. We argue that the development of expertise in health care is directly related to the systematic identification and improvement of quantifiable performance metrics. In order to optimise the training of expert health care providers, advances in simulation technology need to be coupled with effective instructional systems design, with the latter being strongly guided by empirical research from the learning and cognitive sciences

Shared and disorder-specific task-positive and default mode network dysfunctions during sustained attention in paediatric Attention-Deficit/Hyperactivity Disorder and obsessive/compulsive disorder

Patients with Attention-Deficit/Hyperactivity Disorder (ADHD) and obsessive/compulsive disorder (OCD) share problems with sustained attention, and are proposed to share deficits in switching between default mode and task positive networks. The aim of this study was to investigate shared and disorder-specific brain activation abnormalities during sustained attention in the two disorders. Twenty boys with ADHD, 20 boys with OCD and 20 age-matched healthy controls aged between 12 and 18 years completed a functional magnetic resonance imaging (fMRI) version of a parametrically modulated sustained attention task with a progressively increasing sustained attention load. Performance and brain activation were compared between groups. Only ADHD patients were impaired in performance. Group by sustained attention load interaction effects showed that OCD patients had disorder-specific middle anterior cingulate underactivation relative to controls and ADHD patients, while ADHD patients showed disorder-specific underactivation in left dorsolateral prefrontal cortex/dorsal inferior frontal gyrus (IFG). ADHD and OCD patients shared left insula/ventral IFG underactivation and increased activation in posterior default mode network relative to controls, but had disorder-specific overactivation in anterior default mode regions, in dorsal anterior cingulate for ADHD and in anterior ventromedial prefrontal cortex for OCD. In sum, ADHD and OCD patients showed mostly disorder-specific patterns of brain abnormalities in both task positive salience/ventral attention networks with lateral frontal deficits in ADHD and middle ACC deficits in OCD, as well as in their deactivation patterns in medial frontal DMN regions. The findings suggest that attention performance in the two disorders is underpinned by disorder-specific activation patterns

Reorganisation der Arbeitsmarktpolitik Weiterbildung fuer Arbeitslose in Deutschland

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