The Dreyfus model of clinical problem-solving skills acquisition: a critical perspective

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Dreyfus’ referents	Referents
1. Cognitive processes and skills in terms of implicit knowledge.	1. Cognitive processes and skills in terms of implicit and explicit knowledge.
2. Brain as a spurious referent.	2. Brain as one of the main referents.
Philosophical background: Phenomenology	Philosophical background: Scientific realism
3. Doctrine based on the study of personal experience in which considerations of objective reality are not taken into account.	3. The thesis that there are real things, the world exists independently of the knowing subject.
4. The reality is subject-dependent because a thing is a complex of sensations.	4. The reality can be known objectively and is best explored scientifically.
5. ‘The word is the abode of being,’ ‘things become and are only in the world, in language.’ Reality is constituted in and through discourse.	5. Science distinguishes between words and their referents (atoms, stars, people, societies, etc.). This is why science does not study them semantically or discursively but experimentally.
6. Rhetorical style. No citing of scientific evidence to ground their proposals.	6. Models that are representations of real things must be coherent with scientific evidence.
Dreyfus main postulates	Alternative postulates
7. Skills are automatic ‘dispositions’ stored in our minds.	7. Skills are lasting modifications in an individual's brain apart from habituation or memory that enable its owner to face new experiences.
8. Performance of skills is explained exclusively in terms of implicit knowledge.	8. There is not a pure skill that allows only implicit or explicit knowledge to contribute to performance.
9. There are no references to inverse and ill-defined problems.	9. Any model of clinical skills acquisition must recognize that it faces special kinds of problems: inverse and ill-defined.
10. Acquisition of skills of any kind can be explained with this model.	10. A model should be specific for skills of different natures.
11. The acquisition of a skill is viewed as a gradual transition from rigid adherence to rules, to an intuitive mode of reasoning that relies heavily on deep tacit understanding.	11. The acquisition of skill is viewed as a learning process in two ways: suddenly and gradually. All kind of stimuli is necessary to facilitate the trainee's learning, aside from rigidly following rules.
12. A high degree of performance is attained when the individual works intuitively.	12. A high level of performance is attained when somebody is able to work intuitively, reflectively and analytically

Table

Dreyfus’ model stages propositionsNovice	Alternative propositions
1. A novice follows rules.	1. Novices are not passive learners who just follow ‘rules.’
2. Does not feel responsible for anything other than following the rules.	2. Novices acquire information that allows them to grasp the nature of skills (understanding is a prerequisite to learning).
3. Needs to bring its behavior into conformity with the rules.	3. Novices need freedom.
4. Learning is free of context.Advanced beginner	4. Learning cannot be detached from context.
5. Begins to gain experience in real scenarios.	5&6. Even at the pre-beginner stage, learners gain experience and understanding of context; information, context, and experience cannot be separated.
6. Begins to understand his environment with its contextual features.
7. Learns ‘instructional maxims’ about actions.	7. Maxims are a few explicit ‘prescriptions’ that are learned at any stage.
8. Learning still occurs in a detached analytic frame of mind.	8&9. There is always an emotional attachment to the task even at novice stages; hence there is always an experience of personal responsibility.
9. Does not experience personal responsibility.Competent
10. Develops an emotional attachment to the task.	10. Again, affect is always linked to any cognitive task.
11. Learns ‘guidelines’ (principles formulated by instructors, which dictate actions in real situations).	11. Learns to solve inverse problems, but those cannot be solved following rules, maxims, or guidelines.
12. Competence comes only after considerable experience.Proficient	12. Competence comes after learning to solve inverse problems.
13. Learner uses intuition to realize ‘what’ is happening.	13. A proficient learner, although esteeming its intuition, knows that it is not enough to realize ‘what’ is happening.
14. Uses memorized principles called ‘maxims’ to solve problems and determine the appropriate action.	14. A ‘proficient’ performer tries to solve problems in novel and imaginative ways; he does not use only specific ‘maxims’ because they are just general recommendations.
15. Prior experiences provide patterns for future recognition of similar situations viewed from similar perspectives.Expert and master	15. Humans are ‘pattern seekers and makers’ even at pre-proficient stages.
16. Work intuitively on any problem.	16. Experts esteem intuition but are far from limited to a passive acceptance of it; experts analyze, critique and elaborate ideas.
17. No longer needs principles.	17&18. For an expert, intuition only represents a portion of the problem solving process, which is always analytical besides intuitive. Experts need implicit but also explicit knowledge.
18. Capable of experiencing moments of intense absorption in his work.