Editor's Column

Martin McKneally

In his recent Robert Stone lecture to the Department of Surgery, the distinguished research psychologist Anders Ericsson discussed an interesting and important aspect of performance at the expert level. Ericsson's research is the original source of the maxim popularized by Malcom Gladwell that 10.000 hours of practice are needed to achieve expertise (see also Surgical Spotlight Summer 2009). In addition to deliberate practice, masters in skilled occupations have unique cognitive representations of the tasks they undertake. World class soccer players that Anders has studied know where every player is on the field, in the way that Wayne Gretzky knew where every hockey player was on the ice. In addition, there is a fourth dimension - the time dimension, projected forward. Gretzky knew not just where the puck was going, but where the players were going as well. Master chess players know what their opponents will do in response to certain moves, how they will counter them, and how their counter moves will change the board. This cognitive representation is so rich that it allows making predictive judgments many moves in advance.

Some analysts relate Tirone David's surgical expertise to his ability to "see surgical problems in three dimensions". This is an insufficient explanation. Ericsson's analysis focuses on the fourth dimension, providing a better insight. At a cognitive level, David sees what is coming far enough in advance that he anticipates rather than encounters problems. There is also a fifth dimension - seeing beyond the present reality to what might be ideal. That is the creative intuition that leads to advances beyond our current understanding, equipment, devices, and techniques.

Richard Reznick's cognitive representations of surgical education have allowed him to bring our department to a remarkable level of expertise. Like the outliers I have described in sports, chess, and surgery, Richard's synoptic view of what we are doing, what we should do in the future, and what ideal we can aspire to has been applied at all levels. Medical students are engaged in deliberate practice in the skills lab, surgical residents are perfecting their techniques through multiple iterations with expert feedback. Some of our residents are embarking on a new Competency Based Pathway of surgical training. Our 200 fellows have been reorganized under David Latter's guidance into a program of scholarship and skill building at a level that will bring even greater credit to our reputation for advanced training in surgery.

I came to a better understanding of this gift of cognitive vision combined with the ability to bring it into reality during my interview with Richard for this issue. He is a realizateur as well as a visionary. We have been enriched by this combination of extraordinary talents. We are sad to see him leave, and proud to see him go to a position of wider scope and greater impact. And we are resolute in our determination to have him come back often to enjoy and encourage the programs he has developed so well.

Our colleague David Latter has proven his ability to adapt and enrich the programs of the Department of Surgery. His willingness to take on the significant responsibility of interim chair is encouraging, comforting and greatly appreciated by the Department.

M.M.