Newly-Acquired Complex Performance Competence and Medical Errors
Increasingly, the acquisition of competence is defined using learning progressions . For conceptual bodies of knowledge, such progressions are reasonably straightforward. They state stages of understanding and capability that people pass through on the path to expertise. Generally, once each stage is fully mastered, performance at that stage is relatively less demanding of cognitive processing resources, leaving some capacity free to notice cues for routine required actions. In mission critical areas, including many areas of medicine, competence includes not only knowing how to deal with situations but also being reliable, while exercising that expertise, in carrying out critical routines (e.g., hand washing) even when overloaded when complex problems that must be solved. This chapter considers the circumstances during the course of progressing to expertise under which there is a danger of routine but critical actions being omitted and then discusses possible ways to minimize the likelihood of critical omissions.
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