May 1, 2001
by Marco F. Caminiti DDS, MEd, FRCD(C), Dip OMFS
What separates truly exceptional individuals from the rest of us in athletics, arts, music, science or any activity we endeavour in? What creates a virtuoso or are virtuosi created? Was Wayne Gretzy great from the beginning or did practise and coaching make him great?
After many years I finally found the courage to register for hockey lessons. I bought all the equipment took an hour to get dressed and when I finally got on the ice, of course I fall. Now I’ve learned from expert coaching and repetitive practice to use the boards to stop! Some of the beginners are now awesome and some still struggle. Where and why has this variation occurred?
Remember your first amalgam preparation. Most of you reading this now can zip through a restoration in seconds. How did you develop this skill? The development of expert performance is an area of great interest and research. It is also the muse of a centuries old debate – nature versus nurture. Expert performance to us means clinical competency and in general takes on about five elements: 1. Knowledge, 2. Clinical Skills, 3. Interpersonal Skills, 4. Problem Solving, and 5. Technical Skills.
The study of virtuosi and their performance has shed some interesting information as to how and where these developments occur. Studies looking at young children in music have demonstrated enormous talent at a very young age. Ironically, these “amazing” kids do not, generally, continue this level of performance into adulthood. The mythical ingenuity of idiot savants as popularized by the movie “Rainman” have unfortunately revealed a great number of unsubstantiated and irreproducible extremes in performance that are also restricted to a very small range. The “mathematical wonders” are an example. The ability to compute elaborate formulae is impressive but short cuts to multiplication methods exist and with practice, most individuals can accomplish the same tasks. So, it seems that exceptional abilities in these individuals are acquired often under optimal environmental conditions with little evidence of innate talent or “giftedness”.
Athletes are also an enigma. Watching a group of sprinters lined up for the 100-meter dash is exciting, indeed qualifying for that race represents a lifetime of daily training. Every aspect of their lives from diet to relationships all becomes focussed on this single event and the one who wins does so as a result of exhaustive practice, expert coaching, superior mental attitude and funky genes.
What does it take to become an expert? Many studies show that it takes up to 10 years of deliberate practice to achieve expert performance. Analysis of captured superior performance reveals that extended training alters the cognitive and physiologic processes of experts to a greater degree than is commonly believed possible.
Like athletes, we do focus our entire lives towards our skill (whether aware of it or not). Our technical ability becomes automatic very early on in our training. Maintenance of this ability then becomes a matter of regular practice, mental fortitude and self-awareness. The concept of metacognition is when you become aware of how you have learned something. It is that great feeling, that spark, when you suddenly understood something. It is the moment you recognize the “feel” of a handpiece, or when stopping on skates became thoughtless. This concept is not limited to technical ability only, it’s the mastery of obtaining patient data and information while producing a suitable treatment plan without difficulty. We must strive for expert performance everyday for all our patients. Remaining an expert practitioner requires skill, heart and self-awareness. The debate is now no longer nature or nurture – but our abilities in life and practice are a product of nature AND nurture. You need to keep those sparks flying.