1.1 Why investigate surgeon lifelong learning?

Suboptimal care has been part of medicine since its inception and remains an issue for surgeons and patients alike. Traditional professional attitudes which led to hiding or denying mistakes have completely altered in the last 30 years. Health care systems and professionals are now focused on reducing errors. The problem has been addressed by a variety of approaches such as critical incident reporting, systems analysis and audit as well as postgraduate medical education. Unfortunately, each approach has met with limited success [3–6].

Part of the explanation for the failure of some postgraduate medical education to improve patients outcomes may lie in the lack of understanding of how surgeon’s needs may vary with their age and experience. Everyone who wishes to help surgeons change their behavior through education needs to know how surgeons as “learned professionals” are using learning over the course of their practicing lives. What experiences do surgeons have and how do these relate to the different ways that learning may occur? What are the surgeons’ responses to the transitions and transformations they experience in their lifelong commitment to quality care?

In order to grasp the complexities and challenges surgeons experience as they move through their careers, we need to understand and explain how and why changes occur. We need to be able to understand the ways that surgeons manage these changes. We also need to know how learning contributes to the different stages of a surgical career. Finally and most importantly we need to know what educators can do to help surgeons grow more competent and less likely to make errors that impact their patients.

The criteria laid down by major specialty societies, professional regulatory bodies for reaccreditation, professional organizations, and medical colleges focus on lifelong learning. Yet these organizations have little real evidence as to the stages of development that medical professionals pass through or the implications of those developmental stages for lifelong processes of education. This knowledge gap is most profound in terms of surgeons and their careers. In order for educators to provide appropriate services and to be able to assist in the learning process, what is needed is an understanding, not only where we ought to be in terms of lifelong learning opportunities, but also where we are today.

One way to understand how and why learning changes over the career of the surgeon is to engage in traditional research that looks at stages of development, such as conducting surveys or mining demographic data related to the learning activities of physicians and surgeons at different stages of their career. The problem with this approach is that such quantitative methods only work when you have a deep understanding of the processes to be studied enabling the researcher to assign numbers and to measure accurately the differences that exist among surgeons at different stages of their career. A high level of precision is needed so that the numbers become meaningful rather than meaningless. Without such a precise understanding there is very little hope that the solutions derived from such a study would be practical and useful.