Experience doesn’t always count

March 19, 2008 at 2:00 am 1 comment

Kim photoRemind me not to be at the mercy of these two nurses. A robotic patient at Florida State’s Human Performance Laboratory, lay idly by whilst two nurses, one with solid experience and the other with less nursing experience, handled a medical emergency – the plummeting blood pressure of the patient.

Stan D. Ardman (robotic patient) was in trouble. He was having difficulty breathing and his heart monitor was going berserk. Thomas, a nurse in his mid-20s, rushed in to the hospital room and flipped through the patient’s chart. He was uncertain. The patient reported feeling nauseous and dizzy. The chart told Thomas that Ardman was already receiving a drip of dopamine, a compound that treats low blood pressure. Increasing the dosage of dopamine would raise the blood pressure and relieve the nausea and dizziness. This would have been the solution, but Thomas was unsettled by inexperience and the sounds of the heart monitor squealing, which signalled that blood pressure was plummeting further.

In a state of uncertainty in crisis, Thomas decided to give Ardman epinephrine. This drug would raise the patient’s blood pressure but, in combination with the dopamine, would also spike his heart rate and possibly kill him. Ardman drifted off into unconsciousness and just before dying….the simulation ended. Thomas had killed the patient.

Okay so Thomas was just out of nursing school and didn’t have the medical knowledge or intuition that years of nursing experience can give. So in came Monica with over 25 years’ nursing experience. Same robotic patient; same scenario. As the monitor showed a drop in blood pressure, within seconds Monica spotted the dopamine drip and identified it as a possible answer. Cool, calm and experienced.

But….Monica needed to know Ardman’s weight to administer the right dosage of dopamine. As she picked up his chart to establish his weight, the monitor began squealing dramatically and….. Monica made the same mistake as Thomas, she went for the epinephrine. Ardman went into tachycardia. Monica at least knew to shock him with the defibrillator but too late…..Monica had killed off her patient just as surely and swiftly as Thomas had. Both novice and experienced nurse had made the same error and taken the same decision to act in a certain way in crisis.

Knowledge management is about understanding experience and improving performance through learning from experience. So you would think that Monica would have it over Thomas. According to Anders Ericsson, Professor of Psychology at Florida State University, the number of years of experience a person has does not guarantee success or outstanding performance. Grand masters at chess can recall intricate and complex layouts of 25 pieces from their games but when the chess pieces are randomly arranged, they can recall the positions of about 6 pieces – not much better than a novice chess player.

Expert performers possess experience plus superior skill, which is gained by deliberate practice that involves the risk of failure. In a study of figure skaters and their skating practice habits, elite skaters spent 68% of their time practicing jumps; whilst skaters with similar years’ experience, but considered second tier skaters, spent only 48% of their practice time on jumps. So if we merely practice what is in our “comfort zone” repertoire without stretching our skills through learning and practicing new or complex tasks and receiving accurate feedback, then we may make the same mistake as Monica.

I remember working with a lawyer who had over 20 years’ experience. All “baby” lawyers were in awe and wanted to work with him in order to learn from his experience. But it turned out that vast experience got in his way. He made mistakes that even a baby lawyer would be prone to making. As Ericsson points out, experience often means we execute routine tasks almost unconsciously. We retrieve information but we don’t worry about the rules. The free space that’s left in our minds by knowing how to perform a task may mean that we get distracted by thinking about what’s for dinner. And so experience can lead to smugness or overconfidence. It can lead to a Monica-type decision in a time of crisis.

Source: Time


Entry filed under: Knowledge Management, Medicine, Science.

A gift for Dave There’s a story…

1 Comment Add your own

  • 1. joitske  |  May 31, 2008 at 2:14 pm

    Hi, very nice blogpost. I’ve been thinking for a while about the point in time when we start making mistakes. My daughter learned cycling and for 6 months I watched very anxiously and closely. Then I started relaxing. A few months later, I didn’t pay close attention when she fell behind and a man on a bike bumped into her. The first period of close attention may be a higher quality period!


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