This doesn’t mean that the number of repetitions tells the whole story; it’s entirely possible, for instance, that less-talented surgeons make more errors as novices and, as a result, are given less opportunities to operate over the long haul.2 Similarly, even among very experienced surgeons, we sometimes see large individual differences in performance that can’t be explained just by the number of procedures performed. Still, the general principle holds: practice makes perfect — or, at least, competent.3

It’s not just quantity, though; quality also matters. Mindless repetition without the benefit of instructive feedback won’t yield the desired results. Dan got around this problem by submitting every swing for near continuous feedback by accomplished golf instructors and seeking the input of performance science experts.4 In the same vein, cutting-edge medical educators insist that video of residents and junior surgeons in the operating room be evaluated by master instructors who are able to reliably point out the skills that require improvement and should be drilled in a simulator. 

Modern simulators, in turn, are providing increasingly accurate facsimiles of the operating room; surgeons can finally play like we practice and practice like we play. Much as musicians devote countless hours to mastering the challenging portions of a piece, simulators give growing surgeons the opportunity to isolate and correct mistakes and to repeatedly perform difficult maneuvers without putting patients at risk or incurring astronomical costs. The benefits of simulating operations in the lab have been shown, again and again, for all sorts of procedures and for all levels of experience.5 We’re talking about practice, man.      

***

Gleeful accounts of the Dan Plan’s supposed demise completely ignore or at least gloss over one critical fact: at the peak of his performance, about 2 years after he started playing competitive rounds, Dan achieved a handicap — the most reliable measure of golfing ability — that put him in the 94th percentile of all players.6 That’s an incredible monument to the power of consistent, focused, and deliberate practice. Any surgical intern in the country would give his or her favorite loupes in a heartbeat to achieve a performance like that. Dan’s heavy workload and eventual injury may well tell us something about the risk of burnout with such intensive pursuits, but his stunning success reinforces the playbook that guides us from a novice resident to a great, safe surgeon.

So, what’s the best way to get to the operating room? The same way Dan became an elite golfer, and the same way you get to Carnegie Hall: practice, practice, practice.

References

  1. Schrag D, Panageas KS, Riedel E, et al. Hospital and surgeon procedure volume as proctors of outcome following rectal cancer resection. Ann Surg. 2002;236:583-592.
  2. Ericsson KA. Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Acad Med. 2004;79(10):S70-S81.
  3. Begg CB, Riedel ER, Bach PB, et al. Variations in morbidity after radical prostatectomy. N Engl J Med. 2002;346:1138-1144.
  4. Phillips S. The average guy who spent 6003 hours trying to be a professional golfer. The Atlantic. Updated August 11, 2017. Available at: www.theatlantic.com/health/archive/2017/08/the-dan-plan/536592/. Accessed August 8, 2017.
  5. Kneebone R. Simulation in surgical training: educational issues and practical applications. Med Educ. 2003;37:267-277.
  6. Men’s Handicap Index® Statistics. USGA. Updated August 16, 2017. Available at: www.usga.org/Handicapping/handicap-index-statistics/mens-handicap-index-statistics-d24e6096.html. Accessed August 8, 2017.

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