The 10 000-hour rule

“Practice isn’t the thing you do once you’re good. It’s the thing you do that makes you good.” The book “Outliers: The Story of Success” by Malcolm Gladwell¹ was recommended to me by one of my Urology mentors, Dr. Kevin Kwan. The book explores factors that contributed to the high levels of success of some individuals. It dissects the steps of how Bill Gates created the world’s largest PC software company, Microsoft, as well as how Joseph Flom transformed Skadden, Arps, Slate, Meagher & Flom LLP and Affiliates into one of the most powerful law firms in the world.

In the second chapter, Gladwell introduces the concept of the “10 000-Hour Rule” and how it helped the Beatles become world famous musicians by having the opportunity to perform live as a group in Hamburg, Germany over 1200 times between 1960 and 1964. Although they initially started at strip clubs, they accumulated more than 10 000 hours by playing nonstop. Throughout his book, Gladwell repeatedly refers to the “10 000-hour rule,” asserting that the key to achieving true expertise in any skill is simply a matter of practicing, albeit in the correct way, for at least 10 000 hours.

As surgical residents, we spend roughly 70+ hours a week working, learning and breathing Urology. A typical day is spent seeing patients in the clinic or inpatient wards, performing minor procedures, such as vasectomies in the outpatient clinics, treating kidney stones with lasers and shockwaves in the endoscopic suite, or performing open, laparoscopic or robotic surgeries in the main operating rooms. At the end of the day, if not on call, we go home to read journal articles, brainstorm research ideas, or study from our 3753-page bible, Campbell’s Urology. With a 5-year residency program that runs 48 weeks a year, we will each accumulate 16 800 hours of experience – more than the 10 000 hours “necessary” to achieve true expertise. Each of these hours presents us with a new opportunity. Each hour lets us learn something about ourselves. Each hour brings us closer to our future careers as Urologists.

This, however, is an oversimplification. Gladwell later describes how family, culture and friendship are all critical in any individual’s success. Residency is more than simply attaining those 10 000 hours. We take time out of our scheduled lives to be with family and friends. We balance our work lives with various sports and artistic activities that cultivate our determination and creativity. The supportive relationships we build and who we are outside of residency define the future surgeons we will become. These things help us to not only survive those 10 000+ hours of surgical residency, but to also flourish in it.

So, is 10 000 hours really enough?