Deliberate Practice, Domain-Specific Expertise, and Implications for Surgical Education in Current Climes

BACKGROUND AND OBJECTIVES: Within surgery, recent years have witnessed increasing focus on patient safety, accountability, and surgical performance. In addition to these factors, increasing subspecialisation and reductions to working hours among junior doctors most notably in the United States of America and Europe mandate the need for surgeons to develop expertise. However, surgical expertise as a concept is poorly defined. The aim of this review is to (i) define surgical expertise, (ii) discuss the literature analyzing how expertise is attained, and (iii) highlight the concept of domain-specific expertise. METHODS: A review was performed of literature pertinent to expertise both within and external to medicine and surgery. Additional literature concerning deliberate practice, simulation, and transfer of learning was also reviewed. RESULTS: A remarkable repertoire of literature demonstrates that in many domains expertise: (i) is developed after 10 years of deliberate practice (defined as repeated practice in motivated individuals receiving feedback) the '10-year rule,' and (ii) is highly domain specific. CONCLUSIONS: Surgical expertise is domain (procedure and context) specific. If the '10-year rule' is true for surgery, restrictions on doctors' working hours will likely delay surgical expertise acquisition. Conversely, the trend to increasing subspecialisation may facilitate surgical expertise acquisition. So, too, may simulation, as long as appropriate transfer of learning to clinical practice occurs. Further work is required to better understand surgical expertise and provide solutions to accelerate expertise acquisition in surgical trainees, with the aim of improving postgraduate training programs and optimizing patient outcomes. (J Surg 70:309-317. (C) 2013 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)