Surgical experts: Born or made?

Abstract

The concept of surgical expertise and the processes involved in its development are topical, and there is a constant drive to identify reliable measures of expert performance in surgery. This review explores the notion of whether surgical experts are "born" or "made", with reference to educational theory and pertinent literature. Peer-reviewed publications, books, and online resources on surgical education, expertise and training were reviewed. Important themes and aspects of expertise acquisition were identified in order to better understand the concept of a surgical expert. The definition of surgical expertise and several important aspects of its development are highlighted. Innate talent plays an important role, but is insufficient on its own to produce a surgical expert. Multiple theories that explore motor skill acquisition and memory are relevant, and Ericsson's theory of the development of competence followed by deliberate self-practice has been especially influential. Psychomotor and non-technical skills are necessary for progression in the current climate in light of our training curricula; surgical experts are adaptive experts who excel in these. The literature suggests that surgical expertise is reached through practice; surgical experts are made, not born. A deeper understanding of the nature of expert performance and its development will ensure that surgical education training programmes are of the highest possible quality. Surgical educators should aim to develop an expertise-based approach, with expert performance as the benchmark.

Declining interest in general surgical training – Challenging misconceptions and improving access at undergraduate level

“…Surgical training increasingly relies on trainees being comfortable with various techniques to achieve their full potential [26]. Events such as simulation training provide an opportunity for students to familiarise themselves with basic surgical procedures and techniques in a safe environment allowing graduating doctors to develop basic surgical competency.…”

Influence of medical student career aims on ophthalmic surgical simulator performance (part of the international forum for ophthalmic simulation studies)

“…A long-standing debate exists over whether surgeons are ‘born’ or ‘made’, as discussed by Sadideen et al 18 This thorough evaluation of the literature suggests that surgical expertise is reached through practice, that is, surgeons are made, not born. It does, however, acknowledge the fact that the surgical expert should possess a strong set of ‘non-technical skills’, including depth of knowledge, communication skills and decision making, along with the acquisition of ‘technical’ psychomotor skills.…”

An Instrumented Glove to Assess Manual Dexterity in Simulation-Based Neurosurgical Education

“…However, some authors have explored the possibility of using this type of NTs to assess dexterity in surgeons [7]. Researchers have found that there is a significant relationship between scores on NTs that evaluate FMS and the performance of trainees in surgical procedures [65,66,67]. Moreover, Kyle et al [68] suggest that NTs may be used to identify those novice trainees with lower FMS scores, who might require additional support for their learning of some specific technical tasks.…”

“…Even if the “ideal” amount of movements is unknown, it is also possible to make comparisons with the amount of movements required by a very skilled individual. On surgical simulators, a parameter called movement economy is used; it is calculated as a ratio between the average of movements required by skilled surgeons (taken as a gold standard) and the average of movements performed by a trainee [65]. …”