Surgeons as Educators A Guide for Academic Development and Teaching Excellence

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valuable information about surgical culture—the values, beliefs, and behaviors that
must be adopted to become a recognized member of the professional community
[ 8 , 32 , 40 ]. Importantly, technology also plays a role in how surgeons see their
patients, their work, and their own capabilities; trainees must learn how to manipu-
late these tools and, in turn, are manipulated by them [ 9 , 55 ]. Essential learning that
does not resemble deliberate practice therefore emerges from social interactions [ 8 ,
32 ] and is shaped by the learning environment [ 9 , 61 ]. Beyond being an approach to
practicing technical skills, then, intense involvement reflects deepening learner
participation in the personal, social, and technological context of surgical work.
Consider Fig. 1.1, which depicts the surgical learning context as a “community
of clinical practice” in which a trainee’s progress toward expertise is reflected in
movement from the periphery of the community toward its center [ 15 , 20 , 32 ].
Shown at the center of the community is the independent practitioner, a person
identifiable by her role, that is, the community’s expectations for her knowledge,
attitudes, values, and behavior as professional surgeon, her autonomy to manage
uncertainty by exercising judgment and making decisions to mitigate risk, the lan-
guage she uses to communicate with members of the community—which is distinct
from the language she uses outside the community—her use of specialized tools
and technology to perform her work, and her self-identification as a full community
member.
Our independent practitioner arrived at the center of her community after starting
out on the periphery as a medical student and gradually deepening her participation
over the course of her training [ 32 ]. Throughout this process, characteristics of the
surgical learning context served as a gateway to her progress. Professional culture

Independent

Practitioner

Fellow

Resident

Student

• Role


• Autonomy


• Language


• Technology use


• Identity

Care Team Supervisors, Peers

Members

Patients

Culture, Regulations

Intense Involvement

Fig. 1.1 Moving inward within a community of clinical practice

1 “See One, Do One, Teach One?” A Story of How Surgeons Learn