1. Dreyfus Model of Skill Acquisition
Craig McClure, MD
EOSG
University of Arizona
March 2005

2. “To become competent you must feel bad”
Hubert Dreyfus
The quotation suggests that we change behavior because we are not content with existing behavior.

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

4. Five Stages
Novice
Advanced Beginner
Competent
Proficient
Expert

5. Best Opportunity to Observe Stages
Unstructured problems
Number of potentially relevant facts enormous
Variety of solutions extensive

6. Novice The novice follows rules
Specific rules for specific circumstances
No modifiers
“Context free”
Don’t feel responsible for other than following the rule

7. The early medical student is taught to obtain an EKG for chest pain, without other modifiers.

8. 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

9. The more experienced medical student finds that dyspnea also might be associated with cardiac ischemia and orders an EKG for that situation as well.

10. 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

11. 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

12. 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

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

14. Expertise Don’t make decisions Don’t solve problems Do what works
No decomposition of situation into discrete elements
Pattern recognition extends to plan as well as diagnosis

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

16. When Expertise Fails
The expert uses rules and explicit decision-making.

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

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

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

20. 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 decision-making.

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

22. 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.