The next step in attaining mastery, after breaking a task down into component pieces is to have students practice each component piece with feedback. They need to repeat it until they get it right. Each time they get it wrong, it’s our job to tell them how they got it wrong and how they can correct course.
This seems it may require too many iterations than can be realistically done in the classroom, given that we meet four times only. There really isn’t the time to internalize big things. But perhaps some of this can be offloaded online. (Can deliberate practice be done online with automated feedback? I’d think not.)
The feedback may come in the form of a rubric. Looking at the example from the previous post, we had broken the task of “assess an undifferentiated patient” into the following component pieces:
- Identify the chief complaint
- Create a differential diagnosis based on that complaint
- Create an illness script for each disease on that differential
- Use the illness scripts to perform a history and physical
- Determine how closely your patient fits your illness scripts, this is your pretest probability
Can students grade themselves on this rubric? I don’t think so, they don’t have the insight to answer, but this could form a good shift evaluation.
[✓] Identified chief complaint correctly
[✓] Differential diagnosis included all life threats
[✖] Able to create an effective illness script for each Dx on DDx
[✖] Focused history and physical
[✖] Assigns appropriate pretest probability
Practice can come with the patients they see and feedback from the physicians to whom they present. The evaluators would need to be trained on this sort of evaluation system, but I think it is more concrete. It is easier to grasp and easier to provide feedback (instead of the vague “how did I do?”).
It would be great if they were graded this way on each patient. Whenever the student got an “✖” they could ask why and get feedback. If they successfully completed a component piece, the positive feedback (✓) would encourage more of the same behavior. Goal-directed feedback should incorporate WHAT they are doing incorrectly, WHERE their performance is going well or poorly and HOW they can improve it.