The recent editorial (Plast Reconstr Surg. 2009;125:1719) by Dr. Rod Rohrich was well written and timely. He did not cite the work of a well-respected investigator and academician, and we probably should do so.
The best-selling book published last year by Malcolm Gladwell entitled Outliers1 contains a chapter entitled “The Ten Thousand Hour Rule.” In that chapter, Gladwell refers to the work of K. Anders Ericsson, a professor of psychology at Florida State. Because of my interest in the aging surgeon, I have reviewed some of Ericsson's work and publications in the past. Ericsson has written extensively on the subject of acquisition of expertise, including a contribution as an invited address at proceedings in 2004 entitled “Research in Medical Education” published in Academic Medicine.2 In that article, he reproduced the graph (Fig. 1)3 used in other articles authored by Ericsson of the relationship between hours of “deliberate practice” and level of expertise required, but applied that concept more specifically and discussed his views on integration of his theories into the practice of medicine. That discussion would be of interest to the readers of Plastic and Reconstructive Surgery involved in graduate medical education.
Ericsson postulated that the level of expertise obtained was dictated by the willingness of the individual to engage in those activities specific to their sport, art, or profession and to continue to do so on a sustained basis. The stratification of amateur to professional to world class (a sports designation but analogous to surgery) occurs because an individual accepts a given level of expertise obtained and plateaus in performance ability at that point. A broader discussion on this topic is his book The Road to Excellence,4 a compilation of presentations at a 1995 symposium, “The Acquisition of Expert Performance.”
My interest is as follows: does a relationship or strongly positive correlation exist between plastic surgical skills at the top stratum of the Ericsson curve and the desire to practice forever? However, that authorship will have to await another day.
Edward A. Luce, M.D.
80 Humphreys Drive, Suite 100
Memphis, Tenn. 38120
1. Gladwell M. Outliers: The Story of Success
. New York: Little, Brown; 2008.
2. Ericsson KA. Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Acad Med.
3. Ericsson KA, Krampe RT, Tesch-Romer C. The role of deliberate practice and the acquisition of expert performance. Psychol Rev.
4. Ericsson KA. The Road to Excellence: The Acquisition of Expert Performance in the Arts and Sciences, Sports and Games.
Mahwah, NJ: Lawrence Erlbaum; 1996.
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