Repetition

At basketball camp growing up, one of the sayings that was imprinted in every campers’ head was “repetition, the mother of all learning”. At that stage, it was just something that was repeated, rote memorization for the sake of avoiding being yelled at or having to run extra sets of lines. At that time it was difficult to appreciate the importance of repetition, of muscle memory, of getting enough rounds in that one began to see the natural variations and contingencies involved with the exercise at hand. The goal is not to do it right once, to have a Dude Perfect trick-shot moment, but to be able to do the job correctly on command. Again. And Again. And Again. 

Do it until you get it right, keep doing it until you cannot do it wrong. The importance of repetition in every area of life is critical. Repetition is experience, and experience determines outcome. The goal of the new automobile driver is to change lanes without crashing, to park without hitting the curb. The experienced driver does not even have to think about either of those actions, they are little more than muscle memory after hundreds and thousands of repetitions. During medical training, there is a critical mass of patients that must be seen in order to gain proficiency. One of the criticisms of duty-hour limitations (i.e. limiting duty hours to 80 hours per week in the hospital) has been that this limits the number of repetitions seen during medical training. These repetitions are critical as each patient, each iteration is slightly different, and some are truly unique such that the presentation is only encountered a handful of times across a whole career. Training means getting these repetitions in, yet the end of training does not mean that there is an end to these repetitions, rather these repetitions repeat throughout the months and years and decades of a career, making medical practice, truly a practice. 

Repetitions are especially important for the critical aspects of any job. The more codes that one runs, the more experience one gains. Each code is different and requires both medical knowledge as well as team and resource management. Likewise, medical procedures may require as few as five repetitions until one is certified to perform the procedure independently. Yet it is often after the 20th, 50th, or 100th repetition when one is beginning to gain true mastery over the nuances of the technique and appreciates the variation between the anatomy of each individual as well as the clinical context in which one is appearing. 

Repetitions are not passively obtained but rather must be actively earned. Stepping up and volunteering, making sure that one is in the right place at the right time, making sure that others know that one is hungry and willing to get reps is critical to earning more reps. Repetitions can be earned in any capacity, perhaps as the learner, perhaps as the practitioner, perhaps as the instructor, or even as the assistant. There is a privilege to being in the room, to being allowed to participate in the repetition that must be earned. The snowball of experience allows those who start gaining repetitions to continue to gain repetitions as their experience is valued, they begin to know where to look for additional repetitions, and anticipate the way in which they can prove useful. Repetition begets experiences; experience begets the outcome. Put in the reps.