Dreyfus Model of Skill Acquisition

Craig McClure, MDEOSGUniversity of Arizona March 2005

Five Stages

NoviceAdvanced BeginnerCompetentProficientExpert

Novice

The novice follows rulesSpecific rules for specific circumstancesNo modifiers“Context free”Don’t feel responsible for other than following the rule

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

Advanced Beginner

New “situational” elements are identifiedRules begin to be applied to related conditionsDecisions still are made by rule applicationDoes not experience personal responsibility

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

Competence

Numbers of rules becomes excessiveLearn organizing principles or “perspectives”Perspectives permit assorting information by relevanceThe experience of responsibility arises from active decision-making

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

Proficiency

Intuitive diagnosisApproach to problem molded by perspective arising from multiple real world experiences“Holistic similarity recognition”Learner uses intuition to realize “what” is happeningConscious decision-making and rules used to formulate plan

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

Expertise

Don’t make decisionsDon’t solve problemsDo what worksNo decomposition of situation into discrete elementsPattern recognition extends to plan as well as diagnosis

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

Novice

Follows rules and does not feel ollows rules and does not feel responsible for outcomes. responsible for outcomes.

Advanced BeginnerAdvanced Beginner

Recognizes new situations in which Recognizes new situations in which the rules may be applied. Still does the rules may be applied. Still does not feel responsible.not feel responsible.

CompetentCompetent

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

ProficiencyProficiency

Uses pattern recognition arising Uses pattern recognition arising from extensive experience, to from extensive experience, to identify the problem (“what” is identify the problem (“what” is happening”) and rules and analysis happening”) and rules and analysis in formulating the “how” of the in formulating the “how” of the solution. A sense of responsibility solution. A sense of responsibility follows the decision-making.follows the decision-making.

ExpertiseExpertise

Immediately sees “what” is Immediately sees “what” is happening and “how” to approach happening and “how” to approach the situation. Pattern recognition the situation. Pattern recognition extends to management plan as extends to management plan as well as diagnosis. well as diagnosis.

Dreyfus Model of Skill Dreyfus Model of Skill AcquisitionAcquisition

The utility of the concept of skill The utility of the concept of skill acquisition lies in helping the acquisition lies in helping the teacher understand how to assist teacher understand how to assist the learner in advancing to the the learner in advancing to the next level.next level.