4 tips to conquer the 'OK Plateau'

Practice does not make perfect; instead EMS expertise comes from studying failure and greatness


How many words per minute can you type?

Most of us have a rough idea how many words we can enter into a keyboard in a minute while maintaining some degree of accuracy. This might be a more telling question though. Can you type any faster than you could one year ago? How about five years ago?

For most of us the answer is no. Even though you likely type on a keyboard every day and your skill level is likely nowhere near as fast as it could be, most of us maintain a consistent typing speed. We “practice” typing every day. Many of us spend hours each day performing the skill of typing. And yet we remain at the same skill level.

The same is true for many of our skills.

Driving is another good example. Most of the human beings on the road get some amount of daily practice at the art of driving a car. Yet few of us ever really develop any level of mastery. In fact, it’s tough to take a drive through rush hour traffic and not conclude that most of us are relatively bad at driving, despite our years of experience behind the wheel.

Doesn’t this fly in the face of most of what we’ve learned about skill acquisition? Wasn’t practice supposed to make us perfect? Wasn’t repetition the mother of skill? Why aren’t we all typing 100 words a minute and driving like skilled professionals? When do we start getting really good at these things?

The OK Plateau

Joshua Foer coined a name for this phenomenon, 'the OK Plateau' while he was studying human skill acquisition for a story on memory champions. OK plateaus exist in every field of human endeavor. It exists in the field of human memory. It exists in sports, music, science and technology. And as you might imagine, it exists in emergency medicine.

The OK plateau tells us that experience is not the road to becoming better. Don’t misunderstand me; if you’re consciously trying to get better, experience is necessary. But if you aren’t making an effort to improve, experience means nothing. Once the OK plateau kicks in, we unconsciously decide that we are good enough at what we’re doing and we turn off the conscious analysis that allows us to learn and improve.

We pay a lot of lip service to experience in emergency services. Yet, with all of our talk about the value of experience and respect for seniority, it’s important to remember that it’s entirely possible to run one thousand 911 calls and be no better than you were before you began. If you aren’t in a learning mode, even the most valuable learning experiences will go unheeded and unnoticed.

So how do you keep your brain from switching into default mode and break through the OK plateau? How can we keep improving from each call each day? Here are a few tips for making a year’s worth of experience actually feel like five years on the street.

1. Consciously get off autopilot

Your brain wants to push routine tasks to the background. It’s designed to do this. You don’t want to have to think about how to turn on the coffee pot or back your car out of the garage. Once you feel comfortable with a certain skill set, you’ll unconsciously quit trying to get better.

When you feel like you’ve learned your job to the extent that you are competent and comfortable, it’s time to intentionally push yourself out of your comfort zone.

Do you see an easy IV stick? Maybe try for a harder one first. Do you know the etiology and pathology of each disease process in the patient’s medical history? Pick one and look it up with your phone. Learn something new about COPD or Crohn’s Disease. The same goes for that medication list. Pick one and spend 10 minutes learning about it.

In the information age, there is no excuse for not knowing. Just because it wasn’t in your EMT textbook doesn’t mean that it isn’t worth knowing. But you have to decide that you want to know.

2. Study your failures

On every call there are failures. We fail to establish a quality patient rapport. We fail to perform a skill to the standard of our ability. We fail to direct the team as well as we might have. Failure is uncomfortable. It’s convenient and comfortable to overlook and downplay our failures.

Individuals who master their chosen discipline do so by rigorously examining their failures. They identify and dissect moments of failure to discover how to perform better. You can consciously do the same thing. Spend some each shift asking yourself, “How could I have done that better?”

Very few of us take the time to do that kind of self-analysis. If nobody else is evaluating us, we typically stop evaluating ourselves. Turn your evaluation mode back on.

3. Study and emulate greatness

I’m not a big fan of mentors. I rarely see these relationships develop well and benefit the individuals involved. I am, however, a huge fan of emulation. When you see someone who you feel is really good at their job, find what you like best about their style and copy it.

Every great athlete spent time emulating the moves and techniques of a star that they admired. The person you choose to emulate doesn’t have to be great at everything. Just find the one thing they are great at and focus on it. What makes them do that particular thing well? How could you incorporate their technique into your own care?

I always feel humble about the skills and experience that I have gained over the years because I’m well aware that just about everything I know about running an emergency I copied from someone else at some point. I may bring my own flair to the job, but I copied just about everything I do on an emergency scene.

4. Seek feedback, even when it might be uncomfortable

There seems to be nothing we fear more in emergency service than performance feedback. I’ve never completely understood it. I’ve worked shoulder to shoulder with some incredibly brave men and women over the years. And yet, once the QA /QI person calls on the phone or sends them an email they turn into withering children.

During these moments, I often feel like Despereaux, the mouse, imploring people. “Try being brave!”

I know it can be hard. And it’s harder at some places than others, particularly if your organization subscribes to the idea that the best way to improve performance is to punish mistakes. Yet, even in the worst circumstances, I find that our fear of quality oversight is, at best, exaggerated.

Instead of trying to document around your mistakes and praying that your quality assurance manager overlooks you, invite the scrutiny and coaching of knowledgeable providers. Be willing to bring up challenging cases and difficult clinical decisions.

Be honest with your coworkers about what you were thinking and where you think you could have done better. Your honesty and willingness to seek feedback will likely be seen as a refreshing change to the fear-based bravado and performance feedback avoidance that frequently dominate our organizational cultures.

Are your EMS knowledge and skills stuck in an OK plateau? Try using some of these tricks to break through and launch yourself to the next level of learning. I look forward to hearing how it goes.

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