10,000 hours to becoming an expert doctor?

This week I want to talk about something a little different – expertise.

Now as a junior doctor I am constantly and acutely aware of how much I have to learn…and indeed how little I actually know. One of the goals of going into work each day, whether it be in the intensive care unit or medical wards, is not only to care for patients but to learn. This learning is critical to my daily life as a junior doctor for without I simply won’t progress – I won’t become an expert doctor. Now I don’t care what people tell you – everyone wishes to be good at their jobs for it not only makes their lives better and more rewarding but it also makes life easier. I, for example, watch with envy as the senior registrars and consultants on the intensive care unit diagnose and manage acutely unwell patients with multiple organ failures and on the brink of death with such calm and ease.

Yes, I am sure the cogs are turning but they are turning in a well-oiled, slick, calm and experienced head!

That is how I would like to be. That is what I am working towards every day. As such, I consider that no experience – irrespective of the trauma it causes me – as a doctor – is a bad one. As long as I learn from it, I will be better for it.

Life is the same.

Which brings me to the book I am reading at the moment – The Sports Gene. This is a book that tries to unravel the evidence as to what makes an elite athlete, well, an elite athlete. Is it nature? Is it nuture? Well, in this regard it holds its hands up early on and says it is obviously both (we all know that) but how much of one versus the other? It is a great read and has already set my mind in over drive at some of the statements it has made, because I wonder – does it apply to medicine?

Let me explain two of the key points. Firstly there is this idea of innate ‘hardware’ versus learned ‘software’. The innate hardware is our genes – the nature part of the equation if you like – and the very framework of our biological basis. The learned software is our learned skills – the nuture part of the equation. Now comes the interesting part. There was an article published in 1993 in the journal Psychological Review called “The Role of Deliberate Practice in the Acquisition of Expert Performance”. The takeaway message was that despite innate hardware within us all, that it the learned software that produces expertise. Now, very (I mean VERY) loosely the number of 10,000 hours of deliberate practice to yield expertise was quoted and has since formed the basis of the concept:

It takes 10,000 hours of practice to become an expert.

Hello…..!

So this got me thinking. Does after 10,000 hours of studying medical theory and being on the hospital wards, launch me into the realm of being an expert? How long will it take before I am able to say this…Interestingly, and please do bear in mind this has very little scientific rigor (apart from a scrap of paper and a pen whose ink ran out half way through my calculation), the book and the journal article say these 10,000 hours of deliberate practice spread out roughly over a 10 year period i.e. 1,000 hours of deliberate practice per year. And….

….from the medical school to consultant level is also roughly 10 years.

Perhaps, without even realising it the very pathway that I am on as a junior doctor, has coincidently aligned itself with what researchers are proposing. Personally I like this theory as I can very confidently tell you that my innate hardware is nothing exciting – I have a brain that forgets a lot of things and struggles at maths big time, a body that has kept me healthy and active but by no means a super athlete! – and  you know,  I am happy with this arrangement. The software in me though, what I have learned over the years, is what is making me a safe doctor – and hopefully too one day, an expert.

Well, I say one day…I mean 7 years…

Better put the kettle on then! As Robert Hasting suggested in his poem ‘The Station’, it is afterall, all about the journey…

See you next week.

Dr Nick

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