title: The role of deliberate practice in the acquisition of clinical skills.
abstract: BACKGROUND
  The role of deliberate practice in medical students' development from novice to expert was examined for preclinical skill training.
  
  
  METHODS
  Students in years 1-3 completed 34 Likert type items, adapted from a questionnaire about the use of deliberate practice in cognitive learning. Exploratory factor analysis and reliability analysis were used to validate the questionnaire. Analysis of variance examined differences between years and regression analysis the relationship between deliberate practice and skill test results.
  
  
  RESULTS
  875 students participated (90%). Factor analysis yielded four factors: planning, concentration/dedication, repetition/revision, study style/self reflection. Student scores on 'Planning' increased over time, score on sub-scale 'repetition/revision' decreased. Student results on the clinical skill test correlated positively with scores on subscales 'planning' and 'concentration/dedication' in years 1 and 3, and with scores on subscale 'repetition/revision' in year 1.
  
  
  CONCLUSIONS
  The positive effects on test results suggest that the role of deliberate practice in medical education merits further study. The cross-sectional design is a limitation, the large representative sample a strength of the study. The vanishing effect of repetition/revision may be attributable to inadequate feedback. Deliberate practice advocates sustained practice to address weaknesses, identified by (self-)assessment and stimulated by feedback. Further studies should use a longitudinal prospective design and extend the scope to expertise development during residency and beyond.
authors.affiliation: Skillslab, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands. r.duvivier@maastrichtuniversity.nl
authors.forename: Robbert J
authors.initials: RJ
authors.lastname: Duvivier
authors.forename: Jan
authors.initials: J
authors.lastname: van Dalen
authors.forename: Arno M
authors.initials: AM
authors.lastname: Muijtjens
authors.forename: Véronique R M P
authors.initials: VR
authors.lastname: Moulaert
authors.forename: Cees P M
authors.initials: CP
authors.lastname: van der Vleuten
authors.forename: Albert J J A
authors.initials: AJ
authors.lastname: Scherpbier
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000592:standards*; D003162:Competency-Based Education / Q000379:methods*; D003430:Cross-Sectional Studies; D004504:Education, Medical, Undergraduate / Q000379:methods*; D004521:Educational Measurement / Q000592:standards; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D009042:Motivation; D011214:Practice, Psychological; D012577:Schools, Medical / Q000458:organization & administration; D013337:Students, Medical / Q000523:psychology / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D055815:Young Adult