Think before you cut! Is surgery about ‘doing’ or about ‘thinking’?

Abstract

Is surgery about ‘doing’ or about ‘thinking’? The question is pertinent, because only if we know what we are trying to achieve can we hope to use the right educational method to reach our goal! It could be argued that surgery is an inextricable combination of doing, thinking and interacting with others. Educational theory teaches us that there are three main models of teaching: behaviourism (learning by ‘doing’), cognitivism (learning by ‘thinking’) or social constructivism (learning by ‘interacting’). Furthermore, most education systems advocate the models to be used in that order, with behaviourist techniques for the novice and constructivism reserved for the expert. Yet on reflection, today's medical students start their learning in a lecture theatre, spend core training years revising for exams and only the last few years of training actually ‘doing’ surgery – quite the opposite of what educational theory mandates. If the expert surgeon ‘does’ while the novice only ‘knows’, then is it not time to start teaching in reverse? Rather than surgical training beginning with a period of ‘thinking’ in isolation, an integrated curriculum incorporating ‘doing’ from the outset should allow trainee surgeons to reach their goal of ‘doing’ more efficiently and effectively.