dreyfus model of skills acquisition (1)

8/2/2019 Dreyfus Model of Skills Acquisition (1)

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Dreyfus Model of Skill Acquisition

Craig McClure, MD

EOSG

University of Arizona

March 2005



“To become competent you mustfeel bad”

Hubert Dreyfus



Activities Studied

Airplane pilots,

Chess players,

Automobile drivers,

Adult learners of a secondlanguage



Five Stages

Novice

Advanced Beginner

Competent

Proficient

Expert



Best Opportunity to ObserveStages

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”

Don’t feel responsible for other thanfollowing the rule



The early medical student is taughtto obtain an EKG for chest pain,

without other modifiers.



Advanced Beginner

New “situational” elements areidentified

Rules begin to be applied to relatedconditions

Decisions still are made by ruleapplication

Does not experience personalresponsibility



The more experienced medicalstudent finds that dyspnea also

might be associated with cardiacischemia and orders an EKG forthat situation as well.



Competence

Numbers of rules becomes excessive

Learn organizing principles or

“perspectives” Perspectives permit assortinginformation by relevance

The experience of responsibility arisesfrom active decision-making



The competent physician realizesthe multitude of factors influencing

the likelihood that a singlesymptom represents ischemia andhas a decision tree to allocateprobabilities balancing a number of

factors in deciding when to orderan EKG or other diagnosticmodalities 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” ishappening

Conscious decision-making and rules used toformulate plan



The proficient physician realizes“this is an infarction” and then

applies rules to decide aboutthrombolysis.



Expertise

Don’t make decisions

Don’t solve problems

Do what works

No decomposition of situation intodiscrete elements

Pattern recognition extends to planas well as diagnosis



“This is an infarction and weshould implement the following

diagnostic and therapeuticinterventions.”



When Expertise Fails

The expert uses rules and explicitdecision-making.



Novice

Novice: follows rules and does notfollows rules and does not

feel responsible for outcomes.feel responsible for outcomes.



Advanced BeginnerAdvanced Beginner

recognizes new situations in whichrecognizes new situations in which

the rules may be applied. Still doesthe rules may be applied. Still does

not feel responsible.not feel responsible.



CompetentCompetent

Follows rules, applies an organizingFollows rules, applies an organizing

“perspective” to determine what“perspective” to determine what

elements of the problem areelements of the problem arerelevant and feels accountablerelevant and feels accountable

because of decision-makingbecause of decision-making



ProficiencyProficiency

The proficient learner uses pattern The proficient learner uses pattern

recognition arising from extensiverecognition arising from extensive

experience to identify the problemexperience to identify the problem(“what” is happening”) and rules(“what” is happening”) and rules

and analysis in formulating theand 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.



ExpertiseExpertise

immediately sees “what” isimmediately sees “what” is

happening and “how” to approachhappening and “how” to approach

the situation. Pattern recognitionthe situation. Pattern recognitionextends to management plan asextends to management plan as

well as diagnosis.well as diagnosis.



Dreyfus Model of SkillDreyfus Model of Skill

AcquisitionAcquisition

The utility of the concept of skill The utility of the concept of skill

acquisition lies in helping theacquisition lies in helping the

teacher understand how to assistteacher understand how to assistthe learner in advancing to thethe learner in advancing to the

next level.next level.

dreyfus model of skills acquisition (1)

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