Letters Training surgeons

The 10 000 hour rule

BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b5138 (Published 01 December 2009) Cite this as: BMJ 2009;339:b5138
  1. Donald MacDonald, specialist registrar in urological surgery1,
  2. Kieran Jefferson, consultant urological surgeon1
  1. 1University Hospital of Coventry and Warwickshire, Coventry CV2 2DX
  1. donaldmacdonald{at}nhs.net

    We welcome Purcell Jackson and Tarpley’s stand on surgical training and wish to add two further points.1 Historically, surgical apprenticeship in the UK has not been of fixed duration but instead ended when trainers felt that an appropriate level of surgical expertise had been reached. Trainees would typically attend two full day operating lists a week for about 40 weeks a year (720 hours). Is it a coincidence that the average trainee was appointed 14 years (10 000 hours in theatre) after registration?

    Secondly, the 10 000 hour rule is not a guarantee of expertise. Ericsson et al’s original study of German violinists relates to hours spent in “deliberate practice”—repetition of a task designed to improve a specific aspect of performance with immediate detailed feedback on performance—mere attendance in theatre is not the route to surgical expertise.2


    Cite this as: BMJ 2009;339:b5138


    • Competing interests: None declared.


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