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May 13, 2020

Reflections of a Millennial Surgeon: The Changing Face of Medical Education

Author Affiliations
  • 1Department of Neurological Surgery, Mayo Clinic Florida, Jacksonville
JAMA Surg. Published online May 13, 2020. doi:10.1001/jamasurg.2020.0751

“Aren’t there any grown-ups here at all?”

“I don’t think so.”

The fair boy said this solemnly, but then the delight of a realized ambition overcame him.

-Sir William Golding, Lord of the Flies, 19541

Sir William Golding’s 1954 allegorical novel Lord of the Flies emphasizes the dangers of the autonomy of personal will at the expense of wisdom, and underscores the innate human longing for independence from determinate culpability.1 A group of children stranded on an island without oversight or governance is an unsettling premise, not only with respect to the safety of innocence, but also for the potential disastrous consequences of immature executors in impending life-or-death circumstances. Golding’s choice of vehicle to demonstrate this unhindered and undeserved independence through children is a powerful illustration of the growing pains of maturity, when naivety is exposed and the realities of life are recognized. This metaphor can be applied not only to the physical evolution of aging, but also to professional development in performance-based careers. The Dreyfus model of skill acquisition is a well-known scale of assessment of the transitional stages from novice to expert in a particular skill discipline and delineates patterns of behavior during these stages to gauge learner progression. This model has been applied to assessing progress in clinical and procedural skill development in medical education. However, a consideration that is not fully explored in this or other scales is the perceptions and emotional transitions of the learner during the process of stage shifting and how individual intrapersonal factors affect the rate of acceleration from novice to expert. It is not difficult to imagine that these factors are likely widely variable amidst the flux of cultural normality in different generational cohorts, especially with respect to interpersonal relationship standards between learners and teachers on opposing sides of the scale.

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