The other day, a nurse at Florida State University in Tallahassee responded to an alarm in a hospital room where a patient named Stan D. Ardman lay gravely ill. Ardman's blood pressure had dropped precipitously, and when the nurse came in, Ardman wheezed and said, "I'm very nauseous and dizzy ... Having trouble breathing."
"O.K.," the nurse responded. "I'm Thomas. I'll be taking care of you." (Thomas is a pseudonym for a nurse in his mid-20s.) Then, in a tone of uncertainty, Thomas said under his breath, "Nauseous and dizzy?"
Ardman moaned, and his heart monitor squalled urgently.
Thomas looked at Ardman's chart, riffled through a book describing prescription drugs, searched a couple of drawers and accidentally dropped something on the floor. Ardman was already receiving a drip of dopamine, a compound that treats low blood pressure. Merely increasing the dosage of dopamine would almost certainly raise Ardman's blood pressure, relieve his nausea and dizziness, and bring him out of crisis.
But Thomas missed that simple solution. Instead, he asked Ardman if he had chest pain. "I'm just nauseous and dizzy," the patient replied. Just then, the monitor made an ominous noise indicating that Ardman's pressure was plummeting further. Thomas vacillated.
"Think out loud," another nurse pleaded to Thomas.
"Uh," Thomas mumbled. "Not sure."
And then he made a fatal mistake. He decided to give Ardman epinephrine, a drug that would certainly raise the patient's blood pressure but that, in combination with the dopamine Ardman had already received, would also spike his heart rate and possibly kill him. Sure enough, after epinephrine was administered, the patient lost consciousness and drifted toward death although just before he died, the simulation ended.
Stan D. Ardman isn't a real person but a robot simulator ("standard man") used to train medical personnel. Thomas, who is just out of nursing school, was participating in a Florida State study designed to compare the performance of novice nurses like him against that of more experienced ones. The results were surprising. After Thomas left, I watched a nurse with more than 25 years' experience go through the same simulation. At first, when the monitor indicated a drop in blood pressure, Monica (also a pseudonym) coolheadedly began to identify possible treatments. Within seconds she noticed Ardman's dopamine drip, and she knew it was the answer. "She's so fast," said James Whyte IV, an assistant professor at Florida State's School of Nursing who was controlling the robot from a hidden room where we sat watching.
Still, Monica didn't know the robot's weight, which she would need to measure the dopamine increase. She moved to pick up Ardman's chart, which listed his weight, but just then the simulator's blood pressure dropped radically, prompting Monica to make the same error that Thomas had made: she went for epinephrine. After the drug sent Ardman into ventricular tachycardia, Monica was fast enough to shock him with the defibrillator. But this time poor Mr. Ardman died before the experiment ended. The expert had killed Ardman even faster than the novice had.
In making the case that she would be a better President than Barack Obama, Hillary Rodham Clinton never forgets to summon the argument that she has more experience. But as the Florida State simulations show, experience doesn't always help. In fact, three decades of research into expert performance has shown that experience itself the raw amount of time you spend pursuing any particular activity, from brain surgery to skiing can actually hinder your ability to deliver reproducibly superior performance.
How can that be? It is widely accepted that mastering most complex human endeavors requires a minimum of 10 years' experience. The 10-year rule was posited as long ago as 1899, when Psychological Review ran a paper saying it takes at least that long to become expert in telegraphy. The modern study of expert performance began in 1973, when American Scientist published an influential article by researchers Herbert Simon and William Chase saying chess enthusiasts had to play for at least 10 years before they could win international tournaments. (Bobby Fischer was an exception; he played for nine years before becoming a grand master at 16.)
The 10-year rule explains, in an obvious and intuitive way, why the novice nurse Thomas failed his simulation: he had completed only two years of training, and he got rattled. "It's funny the things that anxiety can do to people," Whyte, the nursing professor, said, as Thomas ignored the drip. Monica, by contrast, instinctively looked up to see what medications were on the line. But then she made the same error as her inexperienced counterpart. Why?