Memphis, TN 9/15/2011 - I was speaking to the new residents at a program in a large Midwestern city last week. The Program Director had asked me to do so because the residents just hate the time it takes to complete these Challenger assignments. They didn’t object to the quality of the materials – just the amount of time and the difficulty of the testing. Could I offer some new ideas?

It wasn’t hard to provide some illustrations of how the Challenger service could be stimulating. I described the “Challenger Rounds” at the St. Vincent (Toledo) EM residency and the Carolinas Medical Center FM (Cabarrus), where materials are displayed on-screen for discussion. Then, there were the programs using our new audio response system (ARS) to poll users during instruction. Qualified residents, under faculty supervision, could even acquire peer reviewed publications by writing for Challenger, updating Q and A, or providing reference revisions.

In the end, however, I had to come to the main point of my discourse – becoming an expert at anything is not easy and is largely a function of time spent “in practice.” Would this young crowd believe me? Although I have many years of experience as an instructor, public speaker, and business executive, it was somewhat intimidating to look out at these young professionals, half my age, and try to imagine how to connect with them. Where to begin?

I commended them for their commitment to medicine and to what would be a rigorous and demanding “call” on their life resources of time, money, and energy. On their road to becoming experts in their specialty, if they had not already realized it, there were a few common principles. These principles apply to any competency where one aspires to expertise.

1. It takes anywhere from 5,000 to 10,000 hours to acquire expertise in a skill or competency, and there are no real shortcuts. Whether a pilot, physician, martial artist, scientist, expert card player, chess master…you have to put in the time to become a master.
2. Challenger can help you with this daunting adventure, but it was not easy either!

Tests that do not challenge learners to get better are fairly useless. For example, a Colorado company, Knowledge Factor, founded by a world renowned learning psychologist, believes that content should be a blend of tools with a common theme, but a varying medium – didactic and case studies, image interpretation and lectures, Q and A response and video etc. So, to teach for learning of cardiopulmonary issues, blend and alternate these things.

Effective learning uses front loaded questions and answers. Learners do better trying to find out why they got an answer wrong than they do trying to recall the answer after reading about a topic. This is not my opinion. You can look up the research by Nobelist Eric Kandel to check it out!

Some significant minority of any question and answer routine should include items with multiple right or wrong answers. Knowledge Factor, once again, gets the credit for this finding.

I hit on these points because each of them is characteristic, at least in part, of the Challenger service.

It seemed the residents were listening, but perhaps a personal perspective would lend weight to my comments. So, I then turned to my own personal competencies – tournament bridge play and aikido, a Japanese martial art. At the former, I would be considered a master, and hold the Gold Lifemaster rank from the American Contract Bridge League, with over 40 years of experience. In the latter, I am a 5th kyu, or mid-level practitioner, with two years of experience – I guess you could call me a PGY 2 in martial arts. However, my goal is to secure a black belt in the next 3-5 years. Not easy whatsoever!

One can learn the playing rules for bridge in two hours; to become an excellent player requires ten years or perhaps 10,000 hands played against good players. Aikido is not as simple to pick up, but one can become fairly proficient by practicing twice a week for a few hours each for a year or so. Mastery requires thousands of hours of practice in “combat” with skillful and very fit opponents.

Was I connecting with these residents? I’m not sure. Would they pay the price? Or had the modern world with its social media, texting, and impulse for immediate gratification created for them a false sense of entitlement or rapid rewards? I did not know then, and still don't.

I did, however, make a commitment to these residents. If they used Challenger faithfully, they had a more than 95% likelihood of passing their in-service and initial boards exam tests. As Yogi Berra said, "you can look it up!" There are several formal research studies conducted under the aegis of our Physician Review Board, and over ten thousand end user resident results to back this claim up!

I also cited several examples of programs where residents have come to not only accept, but demand, the Challenger Program for Residencies after 3-4 years. Why? Simple – word about the dramatically increased graduation pass rates gets around like a virus to incoming residents. Challenger works.

But it is not easy, nor intended to be. When I or anyone else goes to see a physician, we want confidence that the man or woman behind the white coat has spent the thousands of hours to become an expert. That is still as true today as it was 1,000 years ago in Japan when the martial art of aikido was invented!