10,000 hours

[Pembleton]

I was watching Charlie Rose interview Malcolm Gladwell about his book, "Outliers". Since I'm a busy M2 I haven't read the book, but during the interview, he mentions a magical number of hours in which people achieve expertise in their field. Gladwell suggested 10,000 hours of doing whatever is you do will make you an expert. This made me think about non-trads starting medschool. Assuming your 10,000 hours begin after residency, do you think you'll hit this magical number? And if not, will you be comfortable with not being the best you can be?

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[Lindindite]

I was watching Charlie Rose interview Malcolm Gladwell about his book, "Outliers". Since I'm a busy M2 I haven't read the book, but during the interview, he mentions a magical number of hours in which people achieve expertise in their field. Gladwell suggested 10,000 hours of doing whatever is you do will make you an expert. This made me think about non-trads starting medschool. Assuming your 10,000 hours begin after residency, do you think you'll hit this magical number? And if not, will you be comfortable with not being the best you can be?

Say we work 40 hrs/wk for 42 weeks/yr. (This hypothetical gives us a hefty 10 wks off for long vacations and holidays.) That means we work 1,680 hrs/yr. After 6 years, we'd have 10,080 hrs under our belts.

So, in my case, I'll be 40 when I graduate, and let's say, 45 when I'm done with my residency/fellowship. (I'm not certain what I'll be specializing in yet.) That means, by 51, I'll be an expert in my field. Sounds good to me.

 

[EastWestN2grt]

I was watching Charlie Rose interview Malcolm Gladwell about his book, "Outliers". Since I'm a busy M2 I haven't read the book, but during the interview, he mentions a magical number of hours in which people achieve expertise in their field. Gladwell suggested 10,000 hours of doing whatever is you do will make you an expert. This made me think about non-trads starting medschool. Assuming your 10,000 hours begin after residency, do you think you'll hit this magical number? And if not, will you be comfortable with not being the best you can be?

Im also a MSII (1 week from MSIII--yesss!!!!!), and I read this book a few weeks ago during Spring break. It was so interesting i finished it in 2 days. I think the 10,000 hrs begins when you take the first step towards medicine--including pre-med, medical school, and then residency. So medical school is on average 4000 hrs, residency is 80 hrs/week at 52 weeks a year = 4160 hrs, 4 yr residency x 4160 = 16640 + 4000 = 20,640. Definetely beyond the 10,000 hr mark. But the most important point in "Outliers" is that even with the 10,000 hrs every single outlier in society, the most successful in society( including Bill Gates, and others) all needed a right set of circumstances, the right timing, and outside help to reach their success. No one reaches the pinnacle of achievement as an island or through "individual" achievement.

 

[Scottish Chap]

I was watching Charlie Rose interview Malcolm Gladwell about his book, "Outliers". Since I'm a busy M2 I haven't read the book, but during the interview, he mentions a magical number of hours in which people achieve expertise in their field. Gladwell suggested 10,000 hours of doing whatever is you do will make you an expert. This made me think about non-trads starting medschool. Assuming your 10,000 hours begin after residency, do you think you'll hit this magical number? And if not, will you be comfortable with not being the best you can be?

When I saw the thread title, I just knew it was Gladwell's book, Outliers. When I was interviewing for residency, a faculty member called me an outlier and suggested I read this book. I would recommend it to non-traditional medical school applicants or students because some of us definitely are outliers, and many of us fulfilled the "10,000 hour rule" in our past career. For fun, I calculated how long my Ph.D. took based on the average number of hour in lab each day - it came to 10,400 hours. Interesting (or depressing...depending on how you roll). I just finished "Blink", also by Gladwell. I wouldn't recommend it. It was disappointing and dull.

 

[Pembleton]

Say we work 40 hrs/wk for 42 weeks/yr. (This hypothetical gives us a hefty 10 wks off for long vacations and holidays.) That means we work 1,680 hrs/yr. After 6 years, we'd have 10,080 hrs under our belts.

So, in my case, I'll be 40 when I graduate, and let's say, 45 when I'm done with my residency/fellowship. (I'm not certain what I'll be specializing in yet.) That means, by 51, I'll be an expert in my field. Sounds good to me.

I admire your optimism.

Im also a MSII (1 week from MSIII--yesss!!!!!), and I read this book a few weeks ago during Spring break. It was so interesting i finished it in 2 days. I think the 10,000 hrs begins when you take the first step towards medicine--including pre-med, medical school, and then residency. So medical school is on average 4000 hrs, residency is 80 hrs/week at 52 weeks a year = 4160 hrs, 4 yr residency x 4160 = 16640 + 4000 = 20,640. Definetely beyond the 10,000 hr mark. But the most important point in "Outliers" is that even with the 10,000 hrs every single outlier in society, the most successful in society( including Bill Gates, and others) all needed a right set of circumstances, the right timing, and outside help to reach their success. No one reaches the pinnacle of achievement as an island or through "individual" achievement.

Obviously you know more about Gladwell's ideas than I do. (I'll try reading the book after Step1 in June). However, I wonder if it is really appropriate to start counting your hours with pre-med classes. I doubt those classes really contribute to my becoming a great clinician. Maybe I'm wrong, but those classes seemed far removed from the actual practice of medicine.

I neglected to mention Gladwell's main point. So thanks for bringing that up. He elaborated on that on Charlie Rose. Perhaps I neglected to mention it because, those factors (the right timing, circumstances, etc.) that he mentions seem to be only apparent on hindsight.

 

[nlax30]

Interesting.... may have to look into it when I get some time. Especially since it seems to be based off some research/ideas put out by one of my old professors at FSU, Dr. Anders Ericsson: http://www.psy.fsu.edu/faculty/ericsson.dp.html

He teaches Cognitive Psych among other things, but I remember he was one of the leading guys looking at expert performance and such. Here's an excerpt from his Expert Performance and Deliberate Practice.

 

[DrMidlife]

I heard Gladwell talk on NPR a few weeks ago, and his "wet rice farming" theory completely blew my mind. Basically there's profound evidence that there's no such thing as being "bad" at math; it's all about work ethic. And the societies that grew up around insanely labor intensive agriculture (such as wet rice farming) have correspondingly insane work ethics, which persist after urbanization, resulting in persistent insanely high math test scores. Soon to be our overlords, no doubt.

As for the 10,000 hours vs. starting med school over 40, I've been more or less worrying about this from the start. Lots of subfields and side projects look really interesting, but I assume they're off the table. My heroes are Gawande and Verghese and Farmer and Hamlin, and the polio eradication folks, and family docs who treat generations. But I'm too old to be much of an idealist (I'd like to work with and/or for these folks; I don't get to be one). Furthermore, I think it's naive to start a medical career without awareness of, and willingness to serve, obese diabetic smokers who make you want to hang yourself with your stethoscope. Point being that if I want to have any expertise, and maintain enthusiasm, I need to aim kinda low, budget for distractions and suckage, and keep self-awareness very, very high.

To that end, I'd like to not be too big for my britches, and I'm not planning on having residency directors clap for joy when I show up, and I'm hoping to be pretty close to accurate in picking a specialty with which I can stay fascinated and obsessed. As much as I'd like to do surgery, I'm assuming the barriers to entry will be profound. I can't pick a body part like the liver - that's a 100,000 hour organ. Frankly I think EM is the most practical way to go.

Not that this has made me any less prone to get excited about subfields. For the last couple weeks it's been pelvic reconstruction. Hmm, do I want to take the uro, colorectal, or ob/gyn path?

If I had kids, which I don't, I think I'd be quite a bit more fearful about expertise. I'd live in fear of sucking as a parent as well as sucking as a physician. Hats off to the parental nontrads.

 

[dragonfly99]

Furthermore, I think it's naive to start a medical career without awareness of, and willingness to serve, obese diabetic smokers who make you want to hang yourself with your stethoscope.
.

You're going to make a great resident. I love it.
Do IM.

 

[Lindindite]

When I saw the thread title, I just knew it was Gladwell's book, Outliers. When I was interviewing for residency, a faculty member called me an outlier and suggested I read this book. I would recommend it to non-traditional medical school applicants or students because some of us definitely are outliers, and many of us fulfilled the "10,000 hour rule" in our past career. For fun, I calculated how long my Ph.D. took based on the average number of hour in lab each day - it came to 10,400 hours. Interesting (or depressing...depending on how you roll). I just finished "Blink", also by Gladwell. I wouldn't recommend it. It was disappointing and dull.

Hey, Scottish Chap! After reading Blink and The Tipping Point, I felt a bit jipped and that both were just books of examples; all I really needed to do was read the prologue and/or first chapter to get Gladwell's point. I read the prologue of Outliers and thought, okay, got it. But maybe I'll read it all now after reading your post.

 

[doctor712]

This is a fun topic to discuss, because I think there is a lot of grey area in here. And that's even IF you buy into the 10000 hour rule. First off, why would the clock only start ticking after residency? By the time you are done as a resident, you have already practiced medicine (be it, under guidance, for 4 years). Saying this defeats the whole purpose of what you're looking at: i.e. training for expertise. It begins Wayyyyyyy before end of residency.

I mean, it's all opinion of course. But for example, a pilot, flight hours, do you only start counting hours once you are flying 747s from LA to LHR? I would think NOT. Does a police officer only count expertise AFTER his first year or two "on the job?" If you are doing something, whether taking a H&P or blood pressure, or inserting a catheter, or intubating a patient, why would doing 84 intubations as a 2nd year or 3rd year anesthesia resident NOT be counted toward the expertise clock?

Also, 40 the OP mentioned 40 hours per week? This seems very far off from ANY residency program I know of, or any resident I've spoken to. Let's assume 60-80 hours.

When I watch fellows do valvuloplasties at work, they are ready to do this on their own in private practice. They have done 7 PGY years after med school. I'm not saying they are an expert like an attending who has been an academic for 20 years, BUT, they certainly have many hours toward that clock.

Anyway, that's just my opinion to spark further discussion.

Best to all,
D712

 

[sumstorm]

Part of what Gladwell talks about is the development of experts in the sense that an individual who develops even a little 'extra' knowledge in a field becoms the 'go to' person, who then explores and develops more expertise in the field as he finds solutions to the problems that others bring to him/her.

My husband is an excellent example of this. His education is structural engineering. When he was in school, mainframes were the big thing. At his first job after school/army, they had 1 personal computer down in the basement, unused. Typewriters and hand designed charts were still the norm. He heard from a college buddy that the buddy was trying to figure out how to do charts on one... which aroused his curiosity, so he spent time after hours down in that basement. He learned to make charts. The charts were impressive to upper level management. They wanted more charts. People in other departments wanted charts. He was the only one who knew how to do charts. It took hours to get the base knowledge in, but once he did, he was fast and efficient. All of sudden, everyone wanted to use the computer (similar to 'tipping point' by Gladwell) but he had a huge advantage. He is still a computer expert, decades later (and draws a 6 figure salary for it.) His expertise did NOT begin with the day he had a job dealing with computers, but the day he decided to tinker with the machine to help a buddy (who worked at a different company.)

So, your expertise starts before your residency. It starts when you are reading about being a doctor and sharing what you learn. Or when you start helping other students learn the basic skills like chemistry. Or when you spend hours as a hospital volunteer. It starts then because you are developing the knowledge base that gives you an edge above and beyond the average population. That doens't mean you can't be an expert in multiple things, just that you start on paths far earlier than we tend to think.

 

[EkramVahsedi86]

I consider myself almost a half outlier. One quote I'd like to share is the following which makes perfect sense to me:

If you give it everything you got, you will do your best; if you don't you won't.

 

[QofQuimica]

This is a fun topic to discuss, because I think there is a lot of grey area in here. And that's even IF you buy into the 10000 hour rule. First off, why would the clock only start ticking after residency? By the time you are done as a resident, you have already practiced medicine (be it, under guidance, for 4 years). Saying this defeats the whole purpose of what you're looking at: i.e. training for expertise. It begins Wayyyyyyy before end of residency.

I mean, it's all opinion of course. But for example, a pilot, flight hours, do you only start counting hours once you are flying 747s from LA to LHR? I would think NOT. Does a police officer only count expertise AFTER his first year or two "on the job?" If you are doing something, whether taking a H&P or blood pressure, or inserting a catheter, or intubating a patient, why would doing 84 intubations as a 2nd year or 3rd year anesthesia resident NOT be counted toward the expertise clock?

Also, 40 the OP mentioned 40 hours per week? This seems very far off from ANY residency program I know of, or any resident I've spoken to. Let's assume 60-80 hours.

When I watch fellows do valvuloplasties at work, they are ready to do this on their own in private practice. They have done 7 PGY years after med school. I'm not saying they are an expert like an attending who has been an academic for 20 years, BUT, they certainly have many hours toward that clock.

Anyway, that's just my opinion to spark further discussion.

Best to all,
D712

FWIW, I agree with you. We could estimate that residents work ~48 weeks per year and maybe average 60 hour work weeks overall. (That is probably lowballing in many cases. But we have to round broadly, because weekly hours are highly variable depending upon specialty, hospital, and how many inpatient rotations w/ call vs. outpatient rotations are required.) That comes out to nearly 3000 hours per year. Then if we consider that residencies for most specialties last 4+ years, it seems realistic that most people will easily surpass 10,000 hours of training before the end of residency. Wow, way to make me feel depressed before I've even started.

 

[Krisss17]

I consider myself almost a half outlier. One quote I'd like to share is the following which makes perfect sense to me:

If you give it everything you got, you will do your best; if you don't you won't.

I like that quote very much! Thanks!