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Rohrich, Rod J. M.D.

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Plastic and Reconstructive Surgery: August 2010 - Volume 126 - Issue 2 - p 689
doi: 10.1097/PRS.0b013e3181de1a57
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I thank Dr. Luce for his kind words and especially for bringing to my attention the work of both Malcolm Gladwell and especially K. Anders Ericsson. I confess regret that I am not more familiar with the work of Dr. Ericsson but will remedy that deficiency right away.1–5 The figure provided by Dr. Luce is instructive; excellence (perhaps in any endeavor) is gained through long, hard work. The more time and effort a person puts in, the greater their performance will be. If we can objectively spend approximately 2000 hours per year learning a craft (40 hours per week × 50 weeks per year), we will become “experts” in roughly 5 years. Given that life is altogether too short, it seems critical that we carefully narrow down our choices and select our intended fields of excellence at a young age, and then pursue our goals with vigor.

I wonder whether Ericsson has insight on how to “become better,” once a person has become an “expert.” Plateaus are inevitable, but how do we scale to even greater heights once we obtain great skill? Is it a matter of adding additional expert skills to those we have already acquired, or are there new levels of expertise that we cannot even conceive of yet?

Dr. Luce's final point opens up a whole new area of discovery. How does a given level of skill correlate to the desire to practice that skill? Does a stronger desire (or greater enjoyment) in performing an operation correlate directly to the acquisition of greater proficiency at performing that precise operation? I leave that question to you to answer!

Rod J. Rohrich, M.D.


Plastic and Reconstructive Surgery

University of Texas Southwestern Medical Center

5959 Harry Hines Boulevard, POB 1, Suite 300

Dallas, Texas 75390-8820


1. Ericsson KA, Nandagopal K, Roring RW. Toward a science of exceptional achievement: Attaining superior performance through deliberate practice. Ann N Y Acad Sci. 2009;1172:199–217.
2. Williams AM, Ericsson KA. From the guest editors: How do experts learn? J Sport Exerc Psychol. 2008;30:653–662.
3. Ericsson KA. Deliberate practice and acquisition of expert performance: A general overview. Acad Emerg Med. 2008;15:988–994.
4. Ericsson KA. An expert-performance perspective of research on medical expertise: The study of clinical performance. Med Educ. 2007;41:1124–1130.
5. Ericsson KA, Prietula MJ, Cokely ET. The making of an expert. Harv Bus Rev. 2007;85:114–121, 193.

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