Leveraging Low-Repetition Practice

How to work toward mastery when chances to practice are limited.

Progress in almost any discipline requires deliberate repetitions with feedback loops. Experts across disciplines talk about building constant and never ending improvement into your daily routine, or about the value of marginal gains compounded over time.

This is excellent advice when we have long times to practice and can repeatedly train in stable environments, but what about when there's not enough time on target available to *really* tune your algorithms well?

For example, if you are an emergency provider and your attempts to place a breathing tube during a crisis are unsuccessful, you may need to cut into your patients neck to access their airway. This technique, called a cricothyrotomy but usually abbreviated to "cric", is a critical tool that has to be completed in a matter of seconds. It is also extremely rare, and many emergency providers go their entire career without actually performing one.

So, how do you develop mastery at the kind of skill which you may or may not ever perform but absolutely have to be fluent at when needed? How do we improve in environments were we only get a few chances to practice, or when practice comes at great cost?

Here are three ideas from the world of emergency medicine that you can use to drive toward mastery and make the most out of whatever training you do get access to.

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1// Study the work of experts.

If it is hard to get access to the true environment yourself, go find someone who has been there. Ask them deep questions about how they perform and leverage their experiences. Learn vicariously through their mistakes and the time they have spent in the dirt.

What mistakes have they made that you don't have to? Are there drills they recommend that you can perform outside of your normal routine to prepare? Skills you need to hone, theories to master?

Sometimes, the knowledge they can offer will be easy to access and all it takes is asking, "hey, when you did a cric, how did it go?" Other times, the knowledge may be more hidden. They might be unaware of how they perform differently due to their experience, or their mental models may be so advanced compared to yours that it is difficult for them to translate. (Imagine asking a chess master how she uses a bishop - the answer would eclipse the scope of your question).

One great way to start this type of conversation is to an expert what "basic" skills they do differently now then when they started & why? For every idea that comes up, try to make a training plan to train whatever part of those basic skills you have access to.

2// Make the most of your limited reps

For whatever time on target you do get, make the most out of your experiences by being an active participant. Instead of just working your way through in the same manner you approach areas where you have unlimited training, try to prepare and design your environment to maximize the utility of each repetition.

If you know you will get time to train--say on a simulator or other scarce resource--review all relevant material you have access to in order to optimize your experience. Make sure that you have mastered whatever theory you can before hand. Study adjacent techniques, and visualize yourself performing the skill flawlessly multiple times.

For example, if you have time on a cric trainer, make sure you review the relevant anatomy and memorize the steps of the procedure before your session starts. Mentally rehearse the procedure to either (A) identify any sticking points that you need to especially concentrate on and (B) front load the steps for easy recall.

During the actual training (or ASAP afterward if parallel processing is impossible), take notes on what you were thinking and feeling. What did the room smell like? What did the tools feel like in your hands? Record as much rich detail as possible for use in future mental simulations.

3// Improve your post hoc analysis by putting other people in your shoes.

An often unexpectedly powerful way to learn more from limited repetitions is to turn your experiences into case or simulation and have other people run through them. If you get one attempt to perform a cric, for example, break the situation down into a table-top "adventure" and ask other operators to step through and say what they would have done.

This technique especially for rare or dangerous situations, where you can access nearly infinitely more reps in "sim land" than in reality, but can be performed for any type of technique or experience. To get the most out of the exercise, try to run individuals of varying levels of experience through the event.

Pay particular attention to how more experienced operators would have behaved. If their actions differ from what you did, ask follow up questions and try to understand why. Looking for diversity of action among sets of peers is also very useful.

Importantly, for this to work well you need to take care not to say what you did until after you get their opinion. If not, you might anchor them toward your actions and lose access to alternitive route of thought. Decision making expert Anne Duke talked about this idea extensively in Episode 28 of The Emergency Mind Podcast. See for example, this clip:

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While more repetitions and turns of the feedback loop are clearly better, performing under pressure mandates that we do the best with what we have. These three ideas can help you make the most out of situations where repetitions are limited and improve your performance for rare events.

How else do you train to master skills in the setting of limited available time on target or insufficient repetitions of feedback loops?

I'd love to hear your ideas.