Peak — Review for Academic Medicine

November 26, 2025 · Travis Osterman · Book Reviews

The Myth of the Natural

Every department has one. The attending who seems effortlessly brilliant on rounds. The researcher whose grants land on the first submission. The surgeon whose hands just know what to do. We look at these people and reach for the most comforting explanation available: they are naturals. They were born with something the rest of us were not.

Anders Ericsson spent his entire career dismantling that story. His book Peak: Secrets from the New Science of Expertise, co-authored with Robert Pool, is the definitive peak Anders Ericsson review of what actually builds expert performance — and it is not innate talent. It is deliberate practice. For physicians in academic medicine, this distinction is not just interesting. It changes how you think about your own development and how you develop the people you train.

What Deliberate Practice Actually Means

Ericsson is the psychologist behind the research that Malcolm Gladwell popularized as the "10,000 hour rule." But Gladwell got it wrong, and Ericsson spends a good portion of Peak correcting the record. Hours alone are not enough. What matters is the quality and structure of those hours.

Deliberate practice has specific characteristics:

• It targets a well-defined goal. Not "get better at teaching" but "improve the clarity of my clinical reasoning explanations during case-based sessions."
• It demands full concentration. You cannot practice deliberately while multitasking. This is focused, effortful work.
• It involves immediate feedback. Without knowing what you did right or wrong, repetition just reinforces existing habits — good and bad.
• It pushes beyond the comfort zone. If you are performing at a level that feels easy, you are maintaining, not improving.
• It builds and refines mental representations. Experts do not just know more facts. They organize knowledge differently, recognizing patterns that novices cannot see.

That last point is critical. Ericsson argues that the real product of deliberate practice is not muscle memory or rote knowledge. It is increasingly sophisticated mental models that allow experts to perceive, decide, and act at a level that looks like intuition but is actually the result of structured development.

Why This Matters for Deliberate Practice in Academic Medicine

Most physician development after training is not deliberate. It is experiential. You see patients. You write grants. You give lectures. You accumulate hours. And Ericsson would say that accumulation without structure leads to a plateau that can last an entire career.

Think about clinical practice. A 2005 meta-analysis by Choudhry and colleagues in Annals of Internal Medicine found that physician performance and clinical knowledge actually declined with years of experience. More time in practice did not mean better care. It often meant the opposite. Ericsson would not be surprised. Without deliberate effort to identify gaps, seek feedback, and push past comfortable routines, experience alone does not produce expertise. It produces autopilot.

This has implications across every domain of faculty life:

• Clinical skills plateau once attendings reach a baseline level of competence unless they deliberately seek feedback on specific procedures, diagnostic reasoning, or communication.
• Teaching often relies on whatever approach worked well enough the first time, repeated for years without systematic refinement.
• Scholarship stalls when a faculty member submits the same style of grant or manuscript without analyzing why previous attempts failed and what specifically needs to change.
• Leadership is treated as a personality trait rather than a set of skills that can be deliberately developed through practice, feedback, and coaching.

The Coach Problem

One of Ericsson's most important arguments is that deliberate practice usually requires a coach or teacher. Not because the practitioner lacks motivation, but because an outside perspective can identify weaknesses that are invisible from the inside.

This is where academic medicine has a structural gap. We assign mentors, but mentoring and coaching are not the same thing. A mentor shares wisdom from their own experience. A coach observes your performance, identifies specific areas for improvement, and designs practice activities to close those gaps.

How many faculty members have someone who regularly observes them teach and gives specific, actionable feedback? How many have a colleague who reviews their grant aims page with the same rigor a pitching coach brings to a pitcher's mechanics? The answer, in most departments, is very few.

Ericsson would say this is not a luxury. It is a requirement for continued development. Without it, even highly motivated physicians will plateau because they cannot see what they cannot see.

Purposeful Practice as a Starting Point

Ericsson distinguishes between deliberate practice and what he calls "purposeful practice." Deliberate practice, in its purest form, requires an established training methodology and an expert coach — conditions that exist in fields like classical music and chess but are harder to find in academic medicine.

Purposeful practice is more accessible. It means setting specific goals, maintaining focus, getting whatever feedback is available, and consistently pushing beyond your comfort zone. It is not as optimized as true deliberate practice, but it is vastly better than naive repetition.

For a faculty member, purposeful practice might look like this:

• Recording a lecture, reviewing it yourself, and identifying two specific things to change next time
• Submitting a grant to an internal review panel with the explicit request to identify the three weakest elements
• Setting a quarterly goal to develop one specific skill rather than vaguely trying to "improve"

None of these require a world-class coach. They require intentionality and a willingness to treat your professional skills as things that can be developed rather than traits that are fixed.

The Talent Question

Ericsson does not deny that genetic differences exist. But he argues — with decades of research behind him — that in most domains, the differences we attribute to talent are actually differences in the quantity and quality of practice.

This matters for how we develop faculty. If you believe expertise is mostly talent, your job as a leader is selection: find the gifted ones and get out of their way. If you believe expertise is mostly deliberate practice, your job is development: create the conditions, feedback systems, and coaching relationships that help people improve. The junior faculty member struggling with scholarship is not necessarily in the wrong career. They may be missing the structured practice that would close the gap.

The Bottom Line

Peak is not a light read. Ericsson is thorough, sometimes repetitive, and more interested in the research than in packaging it for a popular audience. But the core argument is essential: expertise is built, not born. And the way it is built — through deliberate practice with clear goals, focused effort, expert feedback, and constant discomfort — is largely absent from how we develop physicians after residency.

If you are a faculty member wondering why your skills have plateaued, Ericsson's framework offers a diagnosis and a prescription. Stop accumulating hours. Start practicing deliberately. Get a coach. Seek feedback that is specific enough to act on. And accept that real growth requires spending time doing things you are not yet good at.

That is uncomfortable. It is also how expertise actually works.

Check out the complete list if you're interested in other book recommendations.