Gladwell says just about any college grad could become a cardiac surgeon

"I honestly think that…the overwhelming majority of college grads, given the opportunity, could be better-than-average cardiac surgeons," said pop author Malcolm Gladwell in a discussion with David Epstein. Gladwell qualified his astonishing statement by stipulating that it could only occur with 10,000 hours of deliberate, highly structured practice by very motivated people.

Epstein, author of "The Sports Gene," challenged Gladwell to produce some evidence to support his opinion regarding cardiac surgeons. Instead of evidence, Gladwell replied, "I have a very low opinion of the difficulty of cardiac surgery" and equated the complexity of cardiac surgery with that of driving a car.

If you don't believe me, watch a few minutes of this video, which I have cued to the start of his comments about cardiac surgery.

Both Gladwell and Epstein are somewhat off base. While there is no question that doing operations on the heart requires psychomotor skills, there is much more to it.

Like all procedural specialties, cardiac surgery involves deciding who would benefit from an operation, when should the operation be done, who would be better served without an operation, and what should be done if an unexpected finding or a complication occurs either during surgery or in the postoperative period.

Equating driving a car with performing cardiac surgery is absurd. Most of the time, driving does not require intense concentration. Nearly everyone has had the experience of driving a car on a highway for several miles and realizing that they have no recollection of the scenery or any other vehicles that may have passed going the other way.

Not so with cardiac surgeons, who do not have the luxury of "zoning out."

The "10,000 hours" rule has been challenged by many including David Epstein in his book. If you don't have time to read that book, here is a link to a blog called "The Science of Sport" by Ross Tucker, a PhD in exercise physiology. Do not be put off by the length of the piece, which is worth the few minutes spent reading it. He explains how the original research on the topic of 10,000 hours by psychologist Anders Ericsson was flawed.

And here's an article from Salon called " Ditch the 10,000 hour rule!" that says approaches to learning other than massed practice yield better results.

Finally if hard work and time expended is all it takes to be an expert, my tennis game should be a lot better than it is.

One true statement Gladwell made in the video was, "This is going to offend all medical doctors in the room." But he should have added that it would also offend anyone who is a rational thinker.

This post originally appeared on Physician's Weekly on 11/3/14. It has been revised and updated.

More on whether 10,000 hours makes an expert surgeon

Last week I blogged that I didn’t think 10,000 hours of residency training would make one an expert surgeon [or any other type of physician]. As I explained, and someone who commented on the post explained even more clearly, residency training is not like practicing the piano or swimming. Residency is an amalgam of many skills as well as significant hours of non-productive work that does not approach 10,000 hours of doing only one task.

The concept of the so-called “10,000” hour rule as espoused by Malcolm Gladwell is also open to debate. Another commenter shared a link to a sports science blog that totally debunks Gladwell’s premise, at least as it pertains to athletic ability.

In my previous blog, I pointed out that despite surgical residency training lasting over 19,000 hours, many residents feel the need to take fellowships. The extra year of training not only gives them an edge in the job market, it also helps bolster their confidence.

Three days after that blog was posted, a paper was published in Archives of Surgery confirming what I had suggested. The authors, from Yale University and the American Board of Surgery, surveyed all surgery residents in 2008 and 4136 (77% of all residents) replied, an excellent percentage of response for any survey.

The most interesting finding was that 26% of all respondents were concerned that their operating skills were not appropriate for their level of training and that they would not be confident enough to operate independently upon completion of their residency training.

More residents in university hospitals and those in large programs felt less prepared than residents from community hospital and smaller programs. [Disclosure: I was a community hospital residency program director for 24 years. This paper confirms my longstanding bias that community hospitals produce surgeons with more experience and skills.] Women trainees were somewhat less confident in their abilities than men.

Of course the paper has limitations common to most self-reported surveys. The residents were assured that the survey would be anonymous, but it is possible that the number of residents lacking confidence in their skills may have been under-reported. Confidence is difficult to measure and too much confidence can be as bad or worse than too little. But a distressing finding of the survey was that the residents who were less confident were also less likely to ask an attending surgeon for help in the operating room or when managing a patient.

It is disconcerting to learn that 26% of all surgery residents are uneasy about operating independently.

I hope this paper is read by all surgical program directors and the people who run the American Board of Surgery and the Residency Review Committee for Surgery. I wonder what they will do about it?