I am constantly talking to my externs about endeavoring to be experts. But what does that mean? When they are in practice, do they want to be the best or second-best contact lens prescriber?

It is not easy. In Malcolm Gladwell’s book Outliers: The Story of Success, he talks about the “10,000 Hour Rule.” Mr. Gladwell believes that 10,000 hours of practice are what it takes to become elite at something. There is research to back it up.

While this axiom is key, it is much more involved than that. That practice has to be purposeful. If you practice a skill that emphasizes the wrong technique, then you will become an expert at doing the skill wrongly. In Teacher to Teacher Mentality, Caroline Crawford, PhD, and Sandra Hardy, PhD, talk about the importance of purposeful practice. Purposeful practice demands a concrete goal based on best practices and a deliberate method of practice and results recording to get where you are going.

Purposeful practice also requires situational adaptation. If you are trying to become an expert at playing the violin, there are only a few patterns to perfect. This is not the case with eye care. Like sailboat racing, in eye care, there are myriad patterns to recognize, and that is the hallmark of an expert—pattern recognition. The ability to sort through differential diagnoses sets experts apart from novices.

Traits of Experts

In Mind over Machine, Hubert and Stuart Dreyfus articulate many of the traits of an expert compared to a novice. Experts are context-free in their application of rules and experience. Experts are neither analytical nor detached. They are intuitive and involved. However, while they are involved, they are not invested.

Experts do not base their self-worth on the outcome, so they are not afraid to make mistakes. They are the ones who want the ball at crunch time or who make the crazy cross-court return when facing match point against; they are free to do so, because they never invest in the outcome.

The experts admit that they might be wrong. They say things like, “I’m either right or I’m wrong, but my instinct tells me that your problem is corneal ectasia.” A novice would never say something like that.

Experts make quantum leaps to the outcome without going through an analytically linear sequence of decisions. Experts seem more observant of even the most subtle things—not because they are more observant, but rather because the pattern recognition tells the experts what to look for.

Experts are involved and not detached. They have an inner coach continually asking questions, such as “What am I looking at?” “What do I see?” “What is the pattern?” “What are the possibilities?” or “What is the next move?” This involvement in the process—while being non-invested—keeps experts laser-focused despite many distractions. Anyone who has watched tennis star Rafael Nadal during a match as compared to his post-match interviews knows that he is two completely different people. Experts are like that.

Become a Contact Lens Expert

So, how do we become contact lens experts? We practice identifying and perfecting the patterns of haptic alignment, aspheric optics, microbial keratitis, limbal stem cell deficiencies, and lid wiper epitheliopathies. We become experts in the best practices of contact lens alignment and power parameters. We learn the patterns of contact lens intolerance and multifocal prescribing. We become involved in the clinical applications of didactic knowledge.

As Steven Covey says in The Seven Habits of Highly Effective People, we begin at the beginning. CLS