Getting from Amateur to Pro in Medical Training: One Key Concept

One of the most challenging gaps to bridge in the healthcare is the gap between textbook knowledge and its application at the patient’s bedside.  The cognitive practice whereby a learner’s mastery of knowledge or skill in one context allows them to apply that knowledge or skill in a different context is known as transfer of knowledge (TOK). Demonstrating transfer of knowledge is the hallmark of learning.  TOK is a ginormous task in healthcare.

In medicine we are faced with nearly 13,000 diagnoses, over 6,000 medications and over 4,000 procedures. The variety of clinical venues and numerous individual patient contexts creates tremendous complexity.  Context is king in making the correct assessment.  Misreading or missing one detail can change everything in the evaluation and treatment of a patient.  The mathematical possibilities when calculated reveal a seemingly infinite combination of conditions that no single clinician can fathom, yet we are called to enter this world and diagnose, treat and heal.  We are called to make time sensitive decisions, frequently with limited information.  We are called to be flawless.   

And yet, much of our education and training hinges on passing standardized tests.   Standardized learning and testing have become a necessity in efforts to ensure that learners in healthcare meet established minimum requirements. No doubt we need some level of standards by which to measure knowledge and qualifications.  The stakes are high and the costs of error in healthcare are beyond a measurement of dollars. Longevity, well-being and life itself are on the line.  We train and train.  We test and test, yet the results are not quite up to snuff.  The loss of life from medical errors is unacceptable and the costs per capita are two times higher than other developed nations for worse outcomes.  So, if we are not systematically asking, what can we do better?  Then we are arguably not thinking critically.  

Sometimes the best way to understand a concept is to emphasize the empty spaces, what it’s not.


o   It’s not about learning for the test. 

o   It’s not about memorization.

o   It’s not just about procedural skill, rather it is procedural skill coupled with skillful judgement.

o   It’s not about silent learning, rather it’s about thinking aloud.

o   It’s not about external validation, but rather learning skills of self-assessment

o   It’s not about a grade but rather it’s about practice, practice, practice

o   It’s not about learning one right way, but rather developing use of tools that go into a toolbox.

o  It’s not just about a standardized scenario, rather it about learning to apply information from a standardized patient to thought provoking modifications of the standard scenario.


·      Communicate goals of transfer clearly and at frequent intervals

·      Clearly communicate performance expectations and types of tasks expected to perform

·      Design using Gradual Release of Responsibility (GRR):  See One, Assist for One, Do One with Assistance, Do One Unassisted (I do, you watch; I do, you help; you do, I help; you do, I watch) 

The concept of TOK applies across all disciplines in healthcare from nursing assistants to surgeons and everything in between.  In a system with escalating complexity all “minds” on deck will be a necessity to make progress against the current headwinds of medical error and improving patient safety.  

About The Writer:  Hector Caraballo, MD is a practicing Board Certified Emergency Physician and Chief Medical Officer at MedCognition.

MedCognition has developed a high-fidelity medical simulation teaching instrument, called PerSim™, that can be a powerful tool for targeting transfer of knowledge using holographic augmented reality technology.