Dreyfus Model of Skill Acquisition

Craig McClure, MDEOSGUniversity of Arizona March 2005

“To become competent you must feel bad”

Hubert Dreyfus

Activities StudiedAirplane pilots, Chess players, Automobile drivers,Adult learners of a second language

Five StagesNoviceAdvanced BeginnerCompetentProficientExpert

Best Opportunity to Observe Stages

Unstructured problemsNumber of potentially relevant facts enormousVariety of solutions extensive

NoviceThe 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 BeginnerNew “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.

CompetenceNumbers 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

ProficiencyIntuitive 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.

ExpertiseDon’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.”

When Expertise FailsThe expert uses rules and explicit

decision-making.

NoviceNovice: follows rules and does not follows rules and does not

feel responsible for outcomes. feel responsible for outcomes.

Advanced BeginnerAdvanced Beginnerrecognizes 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

ProficiencyProficiencyThe proficient learner uses pattern The proficient learner uses pattern recognition arising from extensive recognition arising from extensive experience to identify the problem experience to identify the problem (“what” is happening”) and rules (“what” is happening”) and rules and analysis in formulating the and 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.

ExpertiseExpertiseimmediately 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.