Intended for healthcare professionals

Rapid response to:

Letters Training surgeons

EWTD in the European capital

BMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b5141 (Published 01 December 2009) Cite this as: BMJ 2009;339:b5141

Rapid Response:

Hours to train Physicians

Michael Sherratt's reminder to consider Physicians as well as
Surgeons is welcome. Much of the debate about hours refers back to
seminal work by Ericsson and others with the figure of 10,000 hours to
master a complex skill. The relevance of this and subsequent research is
that, even with motivation and optimum conditions, it takes much longer
than most people would guess to produce experts. Whether it's 10,000 or
the odd thousand hours more or less is not as important as the recognition
that practice needs to be not only lengthy but also deliberate, ie
focussed very specifically on technique and result (whether of manual
skill or judgement) and that errors have to be recognised and corrected
early. Mere repetitive practice without feedback and evaluation will not
produce the desired results; the expertise may end up in faulty practice.

It is not possible for all 'trainees' to spend long enough practicing
to achieve routinely the wide levels of expertise the public may expect.
Even if we were better at assessing when someone is 'good enough' the
problem remains that competence assessed in training is very different to
the performance we need in the more turbulent world of real-life medical
practice. Many things can perturb skills acquired under more controlled
conditions.

Perhaps one answer is to be more realistic about the level and
breadth of expertise that can be attained at the end of a relatively short
period as a junior trainee. Much longer will be spent as a Consultant than
as a junior and the aim must be to enable all practitioners to maintain
effective habits of learning and improvement over a working lifetime. With
a few exceptions consultants will learn far more after accreditation that
before. Perhaps habits of consulting colleagues more commonly are needed
but learning and insight must be upwards as well as downwards.

The transition from junior to Consultant is perhaps seen too much as
a final step instead of one other transition point. Let me make it clear
that I am not advocating anything called, or seen as, 'subconsultants',
simply that we revisit ideas of lifelong learning, see ourselves all as
trainees and support the collegiate approach that is needed to make this
work.

Competing interests:
None declared

Competing interests: No competing interests

19 December 2009
David Levine
Retired Physician
Sennen, Cornwall TR19 7AX