Surgical wisdom

Sir,

Becoming wise requires insight and self-reflection. As we state in our conception of surgical wisdom, “rich understanding comes from thinking about things deeply.”  Linda de Cossart and Della Fish advocate the value of reflection and reflective writing, a learning strategy in which they have provided great leadership. We agree that these strategies can have a positive role in clinical practice and in the cultivation of wisdom.

However wisdom requires more that reflection alone. One must first start to practice, as wisdom grows with experience and time, is determined by choice and acquired by habit. Wisdom is much more than reflecting on past performance - it is about making good forward-looking decisions, and the ability to proceed and progress in the face of uncertainty. One won't become wise by navel gazing, wisdom is attained by first being competent and professional, then exhibiting superior judgement, a rich understanding, holding few unjustified beliefs, and having a strong moral compass. This is the pathway we spelled out for becoming wise. There is no formula for actually doing this - it is a long journey and although reflection can provide useful self-monitoring and feedback it is only one aspect of the broad tapestry that constitutes wisdom.

• Commentor: RL Gruen, DAK Watters, MJ Hollands - Alfred and Monash University, Melbourne, Australia
• Date: Feb 28, 2012

Sir,

Gruen et al quote Aristotle’ ideas on ‘practical wisdom’ which teach us that wisdom has an intellectual and moral base and is acquired through guided-experience, time and habit. The striking question raised (but not addressed) in this paper, is how we develop wisdom during our professional life, and perhaps more importantly how we nurture this process in young doctors for whom we have educational responsibility. The technical approach to assessment currently prevalent in postgraduate medical education, falls far short on this matter.

We have, over the last ten years, been developing and using resources for teaching and learning in the clinical setting aimed at cultivating professional wisdom. Our approach, refined with colleagues in real clinical practice, based on Aristotle uses The Invisibles (1,2) and in particular the Clinical Thinking Pathway, as a language and a framework for reflective exploration, both orally and in writing, of a clinician’s clinical reasoning and deliberation.

We have shown that through our process of Clinical Reflective Writing (3) doctors are able to understand themselves and their decision making in greater depth and in a way more meaningful to their everyday practice. Such writing enables them to refine, to record, and store evidence of their professional progress and developing expertise and wisdom. We have found that teachers and learners are profoundly surprised by what is learnt through this process and how it acts as a motivator for development. An evaluation of this, from the experiences of eleven senior clinicians will be published early in 2012.

Linda de Cossart CBE and Della Fish
Countess of Chester Hospital NHS Foundation Trust.
Chester, UK.
decossart@btinternet.com

References

1. de Cossart, L. and Fish, D. (2005) Cultivating a Thinking Surgeon. Shrewsbury: TFM Press.

2. Fish, D. and de Cossart, L. (2007) Developing the Wise Doctor. London: RSM Press.

3. www.ed4medprac.co.uk

• Commentor: Linda de Cossart CBE and Della Fish - Countess of Chester Hospital NHS Foundation Trust,
• Date: Jan 03, 2012