Chapter 1
Lifelong learning
Complex phenomena, such as the transitions that surgeons make from stage to stage throughout their career and the impact of these transitions on lifelong learning, can only be understood through a process that involves in-depth exploration—in this case, studying actual experiences of real surgeons as to how their careers progress and their reflections on how learning and education play a role. Such a study gives an understanding of actual processes and suggests potential directions to target focused change. This study was developed with the idea that by understanding over 100 surgical careers in-depth, we could present a representation of the pathways that are characteristic of orthopedic surgeons as they progress through the stages and transitions that characterize their career. We could understand how these changes affect their learning processes and the activities they engage in to improve surgical care. Such an in-depth exploration using rigorous interview procedures should reveal and portray accurately the stages surgeons experience and the transitions that accompany those stages as they move through their career.
1.2
Lifelong learning models
The idea of moving through a developmental process is neither new nor revolutionary. Humans advance through different phases of life—it is an intuitive journey. We have always described children as moving through stages, and even Shakespeare in As You Like It described seven stages of life. In fact there is an historical body of literature about how adults progress through stages of development. These investigations provide a framework for approaching the question of how and why surgeons pass through different stages and transitions on their career pathway.
1.2.1 Levinson’s six stages
The first formal account of the various stages in adult development dates from 1977 with the publication of a book by Daniel Levinson entitled the Seasons of a Man’s Life [7]. Levinson’s description was groundbreaking because it was the first theory to describe development that occurs throughout the adult years, as opposed to childhood. Levinson based his model on biographical interviews with 40 American men aged between 35 and 45. They worked either as biology professors, novelists, business executives, or industrial laborers. The model therefore resonates most strongly with men in the developed world and has less relevance to non-western and developing societies. It should also be noted that the model does not apply to women. Levinson published a second book called Seasons of a Woman’s Life nearly 20 years later [8]. Each subject was interviewed between 6 and 10 times and each interview lasted between 1 or 2 hours. Levinson described certain stages in adult life and differentiated two types of stages—stable and transitional periods. A stable period is defined as the time
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