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"More on Lifelong Learning"

Martin McKneally
Martin McKneally

"I’ve been a surgeon for eight years. For the past couple of them, my performance in the operating room has reached a plateau. I’d like to think it’s a good thing - I’ve arrived at my professional peak. But mainly it seems as if I’ve just stopped getting better."

Atul Gawande

Terry Axelrod’s conviction that we should all participate in lifelong learning fits perfectly with his role as director of Continuing Education for our department. Few surgeons would accept the notion that we are not learning as we practice. But surgeon Atul Gawande writes convincingly about the attenuation of the learning process: Read his New Yorker article and you will recognize the logic of Terry’s position. As he explored the problem, Gawande learned that professional athletes and musicians, even at the level of violinist Itzhak Perlman and soprano Renee Fleming have coaches. So he hired a coach and started learning how to get off the plateau. The story is a page -turner that ends with a great anecdote.

Surgeons concerned about retirement from active practice sometimes ask my advice, as a neogeezer, on how to think about the transition. I usually begin with the story about our Bigelow lecturer, the television personality Mehmet Oz, and sexologist Dr. Ruth:

Mehmet: "Dr. Ruth, you’re about to be 86. When are you going to retire?"

Dr. Ruth: "Sonny, the word is rewire!"

Then I roll out my analogy - about how the book of surgical life comes in 3 volumes. In volume one you prepare yourself for what you’ll do - school, training, start a family, locate your practice. It takes about 3 decades. In volume two, you DO it - applying what you’ve learned for 3 or 4 decades. Volume three contains the more reflective and rewarding chapters,

where you can think, write, teach, and explore new challenges while controlling your own schedule. (That’s why the Spotlight publication schedule is a little irregular.) In volume three, you can also start paying back - with precision-targeted philanthropy, sharing insights learned from past mistakes, and helping young surgeons. All analogies limp, and the hitch in this one is what Terry and Atul are saying. Active learning shouldn’t be confined to volume one; we need to be learning and teaching throughout our lives. Active practitioners today are challenged to master new skills at a rate unimaginable in the past (1).

I am learning a lot about new technology in my volume three days, as I interview members of our department who are pushing and breaking boundaries. I’ve also learned not to say "I’m retired". Self-identified retirees can be deluged with ideas for how they might fill their days doing other people’s projects. It is safer, and more fun to be able to say "I’m working part-time".

Terry Axelrod and Hans Kreder have developed a transition plan for senior orthopedic surgeons at Sunnybrook. They share operating room time and practice volume with new recruits to the division - a 15% reduction in resource use at age 66 progresses to 30% at 67, then 50% at 68, 80% at 69, and finally 100% over 5 years. This sequence can begin earlier than 65, allowing the experienced surgeon to begin volume three sooner and enjoy it longer. The plan fits well with the retirement advice of the great financier and thinker Bernard Baruch: "Don’t retire your experience; it can achieve so much without expending much of your energy or time." You can save your protégés’ time and energy because you have already invested both earlier in life, and learned from the outcome of your investment. And you can always rewire.


(1) Rosenberg, L. Twenty-first Century Surgery: Have we entered uncharted waters? Bull Am Col Surg.,2010, Jul: 6-11

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