surgery performance: innate ability or acquired?

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chef

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how much of being a great surgeon dependent upon your "innate" godgiven talent vs acquired skills through repetition and learning?

i'm curious if surgery is something where there's an established protocol for every surgery (like a cookbook), and then surgeons practice this procedure, and at the end all surgeons pretty much get the same result b/c surgery in itself isnt such a challenge in dexterity and natural ability.

or is surgery something you are just good at, b/c of godgiven talent? for example, are there ever residents who decide to give up on their neuro or ent or vascular career b/c they realize they just arent good enough w their hands and completing their cases?

i havent applied to residencies but i've never heard of programs evaluating an applicant's dexterity or surgical skills, so programs must not think that natural ability is so important...

any comments welcome.

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For most people, it's definitely acquired. Practicing the procedure over and over again allows for perfecting one's techniques.
 
Frank Vertosick, in his book "When the Air Hits Your Brain" mentions the ideal neuro residency interview:

No words...A game of Operation on the desk. Remove the wishbone without setting off the buzzer, and the job is yours. Set off the buzzer, and you arent good enough. In 10 seconds, you can test dexterity, intestinal fortitude, and composure under duress.
 
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8 year olds will get hired and chairmans will get fired!;)
 
i think most of it is being able to think visually. if you have this down, technique becomes easy to learn and master through repetition and just thinking about the tool and how your going to use it on the anatomy. and i think visual thinking has some innate component.

surgeons rule.:horns:
 
Program directors like to claim that becoming a surgeon is an
acquired skill- yet how can one "acquire" the stamina and courage to perform a long procedure under time restraints
and the watchful eyes of your staff? This has got to be in you
from the beginning or never.

Any other thoughts?
 
I've always felt that medicine, being so wide open, has room for people with all sorts of gifts to find a specialty that fits them. As for gifts, surgical skills are no different from playing the piano or shooting hoops - if you do it enough, you can be technically good, or great, but, if you don't have an innate skill that can be honed, it is that much more difficult. That difficulty can be so much, that some people won't transcend it.

However, asking surgery residents and attendings throughout the years if they've ever seen anyone who was completely 'all thumbs' has never yielded a positive, so I think there's a LOT of self-selection. When I was in college, one of the other guys cutting on the dogfish shark would say "oops" it seemed like once or twice a minute. He applied to 5 med schools, got into 4, and is now a nephrologist.

That is something I've thought about - there's nothing sadder than someone who wants to do it, puts their heart in it, but just isn't getting it done, and nothing irritates me more than someone who has the gift, can do it effortlessly, but goes for "good enough" or "pass" instead of going for "great". That's not advocating gunning, but building on one's gifts, instead of riding the wave.
 
Originally posted by Minimalist M
For most people, it's definitely acquired. Practicing the procedure over and over again allows for perfecting one's techniques.

Agree--you can't be a klutz, but if you are reasonably dexterous and practice you will acquire the necessary skills.
 
You can teach a monkey to do an operation. The goal is to learn who needs an operation, how to do good preoperative and postoperative care, and how to recognize when the shtuff is hitting the fan and how to deal with it. Most of it is learned, but being able to face the development of these complications in a timely fashion without letting one's ego get in the way probably has some inate components.
 
Hi there,
The technical skills that I use in the OR on a daily basis are pretty simple. By practicing them over and over, you eventually develop the technical proficiency that you need to perform the most complex cases. The difficult part of surgery is learning when to use your skills and when not to use your skills. Surgical judgement takes years to learn and some folks never develop enough insight to become a great surgeon. They may have super technical skills but mis-use them and they kill the patient or worse, the patient has to live with their mistakes. I am finding surgery one of the most difficult disciplines that I have ever encountered but one of the most fun. It's living on the edge most of the time. When things go great, you are on top of the world but things can go bad very quickly. In the bad situations, the gifted surgeon steps up and get the problems taken care of. This takes insight and experience. Right now, I am thankful for the attending surgeon standing across the table from me.

njbmd
 
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