10 years (or) 10,000 hours later…
They say Mozart never needed to practice. That’s what they say. At the same age that his peers were trying to string together words, he was assembling notes of a harpsichord. By age 5, he had composed his first concerto. And by 13, after hearing it only once, he wrote the entire score of Gregorio Allegri’s Miserere from memory. Almost flawlessly. Mozart’s talent to recognize pitch, and to pick apart musical notes, only to string them back together was practically unprecedented. Historians of music say he was born with this skill. Nowadays, you might hear somebody say that you have to practice for 10,000 hours to become an expert, or work for 10 years at something to become proficient at it. But where do these numbers come from? And are they real?
Let’s start by acknowledging that the “10,000-hour” rule is a dramatic oversimplification by people who just read the Cliff Notes to Malcolm Gladwell’s book, Outliers. If you wanted to learn how to effectively dice carrots, you shouldn’t lock yourself in a kitchen with a bagillion vegetables and go to town. You can probably learn how to quickly and effectively dice carrots over a period of a few hours. But, seeing as this is a medical program, let’s pretend you work in the medical field, and maybe you’re a resident physician. You can’t become an expert physician in a matter of hours. But can you do this over 10,000 hours, and does residency training get you to this goal?
If you worked 80 hours a week for 48 weeks a year, you’ll reach the 10,000-hour minimum before the end of year 3. Congratulations to all the neurosurgery residents out there! You can abort residency before you reach the half-way mark! Except, not really. Because during those 12-hour workdays of residency, you’re not striving to become a proficient physician. You’re doing other things in the meantime. During that 12 hours, you’re losing an hour or two to lunch, snacking, and maybe dinner. Probably half an hour to an hour of walking around the hospital, half an hour on the phone—probably on hold or navigating through a prior authorization, about 2 hours listening to patients tell you nothing relevant, another 1-2 hours typing up your notes on a computer, documenting the patient’s mother’s history of high blood pressure and cousin with glaucoma. Then there’s about a half hour or an hour of you presenting your patient to your attending, taking the time to acknowledge his mother’s hypertension and cousin’s vision problems. And then you lose 30 minutes looking up medical record data, 20 minutes finding the right article on UpToDate, 20 minutes with the computer screen freezing on you or restarting, 30 minutes to helping your med student perform all the elements of a thorough physical exam, 15 minutes in the bathroom, 20 minutes texting, 20 minutes reading the highlights from NPR, 15 minutes on reddit, and 5 on bumble. Plus all the remaining time during the day when you are daydreaming about eating, or sleeping. Suddenly your 12-hour workday has become one hour and 5 minutes of dedicated, deliberate clinical skill building. Those 2 and a half years it might have taken you to become an expert in medicine, well, now they’re 3 decades.
UGH. Makes me tired just thinking about it… Wait, is that an ad for a free 365-day trial for comfortable mattresses below?
But is the 10,000-hour rule valid for the medical profession? Acknowledging that there is no legitimate way to test that hypothesis, let’s use chess as an example. Some of the earliest reports on expertise indicate that no single player attained the level of Grandmaster, or International Chess Master, after fewer than 10 years of preparation. Bobby Fischer, the child prodigy, achieved an international reputation just one year shy of this. A 10-year commitment also appears to be the duration necessary to become fluent in another language, or to become an expert musician. This 10-year rule has been repeatedly demonstrated and promoted by American scientists Herbert Simon and William Chase. And the evidence predating Simon and Chase and following their seminal works is pretty compelling. Take for instance a study in 1936 which looked at the 120 top scientists and 123 top poets and authors from the nineteenth century. The average age at which the scientists published their first work was about 25, and for poets or other authors it was 24. For each group, it would be another 10 years before they published their “greatest work”: the scientists were 35 and the writers were 34. But we should acknowledge that for many of these “expert” contributors to science and literature, the preparation for their careers far preceded their first publications in their twenties. They probably started in their mid-teens. And if they were truly child prodigies, as most may be, maybe even younger than that. So 10 years is really just the minimum.
That’s 10 years. Where does the 10,000 hours bit come in? And for this part, we’ll talk a bit about statistics. The original data for the “10,000-hour rule”, now popularized by Malcolm Gladwell from his book, Outliers actually references a nearly 50 page study from 1993 by Ericsson and colleagues. When you read Gladwell’s book, you get the idea that you can become an expert after 10,000 hours of practice for whatever skill it is you want to achieve. But the original 1993 study, involving 40 German violinists, doesn’t support this claim. By the time these violinists turned 20 years old, the average duration of practice for the groups were as follows:
- Most talented violinists: average 10,000 hours of deliberate practice
- “Good” violinists: average 7,800 hours of practice
- Least talented violinists: average 4,600 hours of practice
But that doesn’t mean 10,000 is necessary or sufficient. Statistically, saying the average duration of violin practice to achieve expertise is not the same as the minimum duration of violin practice. An average of 10,000 hours among expert violinists means that half of expert violinists didn’t even reach the 10,000-hour minimum. And among those violinists who only reached “good”, who averaged nearly 8,000 hours of total practice throughout childhood, there are probably a large number of them who committed over 10,000 hours—but did they achieve excellence? No.
So how are you going to achieve proficiency in your skillset?
- Motivation. Probably the most cited prerequisite for optimal learning. Have you ever tried to get a dog to roll over without giving it a treat? No! You’re not an idiot. And neither is the dog. The animal has to be motivated to do the trick. And even with all the motivation in the world, sometimes they still won’t learn the trick. Kingsley still hasn’t yet. My dog. He’s 3. And just as a dog needs a reason to drive him to perform the trick, so does the human violinist preparing for a concerto.
- Reward. Ok, maybe not reward. But certainly feedback. In the absence of feedback, of knowing that you are doing something correct or accurately, there is no guarantee for improvement. You cannot tell that you are getting closer to your goal or that there could be a way to improve your performance without a third-party bystander. Imagine placing 1,000 arterial catheters, and during every procedure you happen to be cannulating a vein. Not the artery. Unless someone’s beside you telling you, “hey, that’s not an artery”, you will never become an expert at placing an a-line. You’ll be an expert at placing peripheral IVs, but only by accident.
- Repetition. You’ve heard “practice makes perfect.” Practice doesn’t make perfect. Practice makes performance. You only perform as well as you practice, and you only practice well when it’s deliberate, and your practice will only improve when you’re given feedback. So if you keep on practicing deliberately, with concentrated effort and focus, and you do this over and over again, then maybe, one day, you’ll become an expert. Maybe.
Unfortunately, achievement is not an exact science. In a controlled environment, in the lab where humans are treated like mice, even putting subjects through extended training where they meet these 3 criteria (motivation, feedback, repetition), the highest level of performance is not guaranteed. In fact, according to a 2016 meta-analysis of 88 studies on deliberate practice across multiple modalities, only 12% of the variance in a subject’s performance was the result of deliberate practice. 88% of the variance in talent remained unexplained. And in studies which evaluated the effect of deliberate practice on educational achievement, deliberate practice only accounted for 4% of the variability in performance. The remaining 96% probably had to do with things like, your genetic makeup, being born Mozart, learning to snow ski at the same time you are learning to walk, and eating all your veggies.
There is no single formula for perfection. But utilizing these 3 factors to build your proficiency is a great starting place. Some people have a natural ability. They might hear numbers (or for Mozart, music), and they can remember them. (Remember Good Will Hunting?) Others, a.k.a. “normal people” need cues, hints, or work-arounds. In med school, this is simplified by mnemonics, which take up as much space in your First Aid as more useful educational content. But even more useful than mnemonics are memory palaces. And that’s what we spend the rest of the episode talking about. So tune in, and see if this technique is helpful to you when you’re trying to learn a new memory. Or acquire a new skill. Then practice it. Because practice makes performance.
You can also find this TedTalk from 2012 that highlights the extremes of memory performance using a memory palace. In it, Joshua Foer, winner of the US Memory Championship—yes there is a thing, check out the link—describes what he did to memorize the order of cards in a 52-card deck. In 2 minutes.
The BrainWaves podcast and audio content are intended for medical education and entertainment purposes only. The featured image associated with this blog entry is from https://www.flickr.com/photos/free_for_commercial_use/14169066157 under a CC license.
- Macnamara BN, Hambrick DZ and Oswald FL. Deliberate practice and performance in music, games, sports, education, and professions: a meta-analysis. Psychol Sci. 2014;25:1608-18.
- Ericsson KA, Krampe RT and Teschromer C. The Role of Deliberate Practice in the Acquisition of Expert Performance. Psychol Rev. 1993;100:363-406.
- Raskin E. Comparison of scientific and literary ability: A biographical study of eminent scientists and letters of the nineteenth century. Journal of Abnormal & Social Psychology. 1936;31:20-35.