Dreyfus Model of Skill Acquisition

Craig McClure, MD EOSG University of Arizona March 2005

To become competent you must feel bad Hubert Dreyfus

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

Five Stages
Novice Advanced Beginner Competent Proficient Expert

Best Opportunity to Observe Stages

Unstructured problems Number of potentially relevant facts enormous Variety of solutions extensive

Novice
The novice follows rules Specific rules for specific circumstances No modifiers Context free Dont 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 identified Rules begin to be applied to related conditions Decisions still are made by rule application Does 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 excessive Learn organizing principles or perspectives Perspectives permit assorting information by relevance The 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 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

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

Expertise
Dont make decisions Dont solve problems Do what works No decomposition of situation into discrete elements Pattern recognition extends to plan as well as diagnosis

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

When Expertise Fails

The expert uses rules and explicit decision-making.

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

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

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

Proficiency
The proficient learner uses pattern recognition arising from extensive experience to identify the problem (what is happening) and rules and analysis in formulating the how of the solution. A sense of responsibility follows the decisionmaking.

Expertise
immediately sees what is happening and how to approach the situation. Pattern recognition extends to management plan as well as diagnosis.

Dreyfus Model of Skill Acquisition

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