What separates the best surgeons from average surgeons?

[CaptainSSO]

Is it a matter of technical proficiency? Or is it a matter of intelligence?

Would someone at the top of their class probably make a better surgeon than, say, someone who was average?

I guess what I'm asking is it a matter of medical knowledge, or technical skill?

Edit: Assuming one is not grossly deficient in one or the other.

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[OveractiveBrain]

Is it a matter of technical proficiency? Or is it a matter of intelligence?

Would someone at the top of their class probably make a better surgeon than, say, someone who was average?

I guess what I'm asking is it a matter of medical knowledge, or technical skill?

Edit: Assuming one is not grossly deficient in one or the other.

Surgery is ever more becoming a technician field. You get better outcomes with surgeons who do the same surgery. Surgery takes less time. Complications are lower. The number of cases that can be done goes up. Outside of the academic world, it is technical proficiency and MAYBE the ability to acquire new skills that separates the good from the great. Hospitalist groups are set up to do pre and post op care.

Now, jump into academic and all of sudden things change. Volume isn't important. Pride is. No program director is going to call medicine to manage potassium (a vital source of revenue from the private medicine docs). Here, knowledge and gestalt will endure over technicaly proficiency. Knowing when to cut, and when not to, knowing how to diagnosis a disease, when to order a test, or when to sit back and relax... these are the things of great minds. If those great minds happen to have decent hands, then they are often more revered (by other academics and trainees).

When you are paid to do procedures, the better surgeons are those who do them better, faster, and cheaper (private). When you aren't paid to do more procedures, the skill is knowing when to do them and when you aren't (academics).

I guess what I'm asking is it a matter of medical knowledge, or technical skill?

So... both, and one is more important depending on his station.

I

Would someone at the top of their class probably make a better surgeon than, say, someone who was average?

To specifically answer this question:

I often believe the memory machines who score top of their class are likely to be memory machines for the rest of their life. This is not a universal, and it certainly doesn't mean that YOU (who are junior AOA and reading this) are incapable, but in general, I have found people in the mid to top of their class superior physicians. These are the ones who communicate, act as a team, know enough to get the job done and the modesty to admit (and look up) what they don't know. All qualities that make a truly great physician.... until you have the upper eschelon who actually know everything.

 

[mimelim]

I got yelled at 2 weeks ago for not getting a patient admitted to medicine for issues as limited as potassium management. Oh ya, and that was by the program director. It is just more work to do admissions rather than perform surgery as a consultant and back off when finished, especially on dialysis patients.

In my limited exposure, the 'best' students rarely make the best physicians, surgery especially. Raw ability to memorize correlates poorly with being a good doctor.

 

[Bancrofti]

I remember asking a chief of GS this when he came to talk to my student group in college... he completely sidestepped the question, I guess as if not to step on anyones toes. However, he did say that academic history does not correlate at all with how competent or good you will be as a physician. Said one of the "dumbest" residents he had ever worked with graduated from Hopkins and one of the best residents he had ever worked with was a female resident from a no name school.

 

[Freakfarm0]

Is it a matter of technical proficiency? Or is it a matter of intelligence?

Would someone at the top of their class probably make a better surgeon than, say, someone who was average?

I guess what I'm asking is it a matter of medical knowledge, or technical skill?

Edit: Assuming one is not grossly deficient in one or the other.

I've been told by a couple of different sources (one a program director and the other an private practice surgeon) that most people can become a good surgeon with time and practice.

The interesting thing that the program director told me was that once every 10-20 years they will get someone who is extraordinarily gifted. "Really just born to do it," he told me. He told me that he did not think it correlated well with class rank.

 

[OveractiveBrain]

I've been told by a couple of different sources (one a program director and the other an private practice surgeon) that most people can become a good surgeon with time and practice.

The interesting thing that the program director told me was that once every 10-20 years they will get someone who is extraordinarily gifted. "Really just born to do it," he told me. He told me that he did not think it correlated well with class rank.

No one is "born to do it." It is the great fallacy of reason. In order to be in the NBA you have to be over 7 feet. Ok, not everyone can be in the NBA.

But the way you get extraordinary at something is by spending time doing it. That's the 10,000 hour rule. it existed before Malcolm Gladwell, but he codified it in his book Outliers.

What I think he meant was every 10-20 years there is someone who has had the experience enough to develop a talent beyond their peers, and a dedication to the craft where that person is willing to put more time into the practice and art of surgery than into the art or practice of his life.

 

[Valadi]

I think there needs to be some clarification of what is meant by 'surgical technique' here for this discussion to be meaningful. It's not just skill at cutting and stitching, but includes everything from the extent of undermining, to the type of suture used or method of closure. No combination of these things, I would say, could make a surgeon "great."

I think the most superior surgeons are the ones who are consistently able to decide upon the best surgical plan for the patient, including the type of surgery to be performed (that is, variations upon similar surgeries for the same end). For this I think that academic knowledge, experience, and mentoring from a number of masters in the field are invaluable prerequisites.

It happens that I asked this question to two "masters" in a surgical subspecialty (ie, international reknown) and they both had the same response: constant evaluation of their results and modification of their indications, procedure, and technique.

 

[Winged Scapula]

I've been told by a couple of different sources (one a program director and the other an private practice surgeon) that most people can become a good surgeon with time and practice.

The interesting thing that the program director told me was that once every 10-20 years they will get someone who is extraordinarily gifted. "Really just born to do it," he told me. He told me that he did not think it correlated well with class rank.

No one is "born to do it." It is the great fallacy of reason. In order to be in the NBA you have to be over 7 feet. Ok, not everyone can be in the NBA.

But the way you get extraordinary at something is by spending time doing it. That's the 10,000 hour rule. it existed before Malcolm Gladwell, but he codified it in his book Outliers.

What I think he meant was every 10-20 years there is someone who has had the experience enough to develop a talent beyond their peers, and a dedication to the craft where that person is willing to put more time into the practice and art of surgery than into the art or practice of his life.

I would tend to disagree with your interpretation of the meaning of the PD in the OP's post; this is a common observation in surgery.

Every few years someone comes along who is technically far more gifted than his peers. Naturally. Not because of practice or being willing to put more time into the practice and art of surgery.

They just seem to get it and be able to do it easier. Whether its more dexterity, a higher level of sensitivity in their hands, or better ability to discern surgical illness requiring an operation, no one knows. We just know it when we see it. The 10,000 hour rule wasn't meant to define "extraordinariness" but rather the amount of time it takes to really learn a skill well.

The resident in my program who was regarded as one of those "every 10 years or so" is now a Surgical Oncologist at Hopkins and one of my favorite senior residents (because he was a cool guy, great teacher and always had my back).

Otherwise, I think defining what a great surgeon is, is up for debate. Its as much technical, as it is knowledge base, confidence, judgement, and relationships with patients/colleagues. IMHO it also includes the ability to learn, modify techniques and approaches based on patient presentation.

OR staff will label someone a great surgeon who is nice to them, who doesn't seem to have any disasters and who remains calm under fire. That person may not technically be a great surgeon or may have horrible relationships with his/her peers. I'm not sure most of us would have the same definition as the OR staff.

 

[45408]

I would say good judgment. I've never seen a good surgeon without it or a bad surgeon with it. Technical proficiency is always a good thing, but it can't get you out of some jams that good judgment would have prevented. You have to know what to do, when to do it, and to whom.

But the way you get extraordinary at something is by spending time doing it. That's the 10,000 hour rule. it existed before Malcolm Gladwell, but he codified it in his book Outliers.

10,000 hours will get you to your PGY-3 year in a 5 year surgery residency.

OR staff will label someone a great surgeon who is nice to them, who doesn't seem to have any disasters and who remains calm under fire. That person may not technically be a great surgeon or may have horrible relationships with his/her peers. I'm not sure most of us would have the same definition as the OR staff.

Yeah, they don't really get it a lot of the time. They can usually spot the awful surgeons though...

 

[jdh71]

10,000 hours will get you to your PGY-3 year in a 5 year surgery residency.

10,000 hours in the building isn't 10,000 hours DOING an operation or even making clutch medical decisions.

 

[OveractiveBrain]

10,000 hours in the building isn't 10,000 hours DOING an operation or even making clutch medical decisions.

This