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Oversight, ownership, and the development of expertise

Part 2: Deliberate Supervision

As faculty, we want residents to graduate as clinical experts who are prepared to handle any emergency thrown their way. Getting there requires that they spend every shift engaged in deliberate practice. Just showing up and seeing patients isn’t enough – that’s a recipe for arrested development.  
Deliberate practice requires harmonization of both teacher and learner effort. The teacher must establish an environment where deliberate practice can occur (shown in the diagram as team-based care, a state of high learner ownership of patient care and high supervision by the teacher) while the learner must engage in deliberateness and make meaningful adjustments to his or her performance as a result of feedback.  

So how do you supervise deliberately, balancing a resident’s need for independence and ownership of patients with the supervision and feedback that facilitates deliberate practice? The answers will be slightly different for each of us.


Pay attention to your own supervisory style. Are you a laissez-faire supervisor who prefers to get involved only when absolutely necessary? For you, optimizing this balance may mean increasing the amount of time and effort you spend directly observing and providing feedback on patient management as well as resident interactions with patients and families, nurses, techs, and consultants. On the other hand, if you run a pretty tight ship and have a tendency towards micromanagement, allowing the resident more ownership of their patients will best facilitate them reaching 


Augment your reflections with feedback from residents. In the following sections, we’ll start discussing techniques to optimize what we’re calling Deliberate Supervision. Understanding your current preferences will help you optimally integrate these techniques.

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Biondi EA, Varade WS, Garfunkel LC, et al. Discordance Between Resident and Faculty Perceptions of Resident Autonomy. Academic Medicine 2015;90(4):462–71.

Ericsson KA. (2016). Peak: Secrets from the New Science of Expertise. Boston : Houghton Mifflin Harcourt.

Ericsson KA. (2004). Deliberate Practice and the Acquisition and Maintenance of Expert Performance in Medicine and Related Domains. Academic Medicine, 79(10), S70–S81.

Ericsson KA, Krampe RT,  Tesch-Römer, C. (1993). The role of deliberate practice in the acquisition of expert performance. Psychological Review, 100(3), 363–406.

Ericsson, KA. (2009). Development of professional expertise: toward measurement of expert performance and design of optimal learning environments. New York, Cambridge University Press. 

Gladwell, M. (2008). Outliers: The story of success.

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