I picked up two key learning strategies as an NCC cadet during the pre-university course: deconstruction and deliberate practice. Daily running with a 12 kg backpack and a .303 rifle with a bayonet in hand, drenched in sweat in chilly winter, in hilly terrain, was worth the lessons learnt. However, I never imagined the life surviving skills learnt during that short stint would help me master a wide variety of surgical skills in a short time. 

One exercise I fondly remember is dismantling, cleaning and re-assembling the .303 British WW-II Lee Enfield rifle, which has nearly 70 individual parts. A senior instructor Mr. Balwinder Singh, a retired Sikh army officer, taught us the art of deconstruction and deliberate practice to handle the rifle. Later, when I started my medical training, I applied the same principle to learning new surgeries.  

Deconstruction is the easiest way to master any surgery quickly. Deoncstruction means breaking down a complex operation into smaller constituent steps or parts. In other words, all surgical procedures are bundles of many minor sub-unit skills performed in different combinations. Next, we can further break down these sub-skills into their minute components to figure out which sub-skills we already know or don’t know and exactly what we need to learn, which are essential. Then, we can focus all our energy and resources on what we don’t know and are crucial.  

Once we deconstruct a complex procedure, we can apply the 80/20 principle to polish our surgical skills to learn what we don’t know. Earlier, I had written a blog on Pareto’s 80/20 principle named “A lesson of two Italians” to learn more about Pareto’s principle at this link: https://tinyurl.com/3c3tejy4. One of my favourite and prolific author, Tim Ferris of “The 4-Hour Chef” fame, has framed a DiSSS method to learn any skill from a language to dance.   DiSSS stands for Deconstruction, Selection, Sequencing and Stakes. The key concept is to simplify and remove unnecessary hurdles and improve any skill as quickly as possible.

Selection is to identify and practice the core sub-skills you need to learn. Then, you can improve faster by taking the most crucial parts of your skill and learning them exceptionally well. Our objective is to use the 80/20 principle (Pareto) to identify the 20% to give you 80% of results.

Sequencing is the order of learning. It is like a recipe in cooking. It is wise to learn the essential skills first and learn them well. Critical skills are those we perform most often and impact our performance if we know how to execute them. If we haven’t mastered the basics well, it won’t matter if we have learnt a rarely used skill. If we want to progress faster, it’s crucial to improve those skills that matter most.

Stakes are to create real consequences and guarantee to ensure we train.  

We can add positive incentives by rewarding ourselves when we reach our goal. Or holding ourselves accountable if we do not practice. The main goal is to pick the stakes that are most likely to help us achieve our goals. Rising stakes is one of the ways to keep up with our commitment to learning.  

With best regards,

Prof. Dr. Prahlada N.B
01 January 2022

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