When is the last time you had to learn to do something really hard from scratch?
I rank learning to do cataract surgery as one of the hardest things I've ever done. As a novice surgeon, I went from never having done any surgery to completing my first independent cataract operation within 3 months. The learning curve is steep, and the stakes for getting it wrong are even higher.
Learning hard skills.
Learning to operate is a bit like learning to play an instrument. You spend hours practicing the basic moves before you ever get to 'perform' in front of anyone, or do anything that resembles the complete product. It's called 'theatre' for a reason.
The difference between them is that 'missing a beat' in the case of an eye operation might mean blindness. Although I'd practiced it thousands of times on various pieces of fruit or on surgical simulators, it's a totally different experience when it's someone's eyes in your hands.
The reality also is that you actually have very limited time "in the eye" as a novice surgeon. Most surgical trainers will start you from the last step - that way, if something doesn't go to plan, it's much easier to rectify it without any impact on the patient's outcome. This means you could be in the operating room for five hours, and only have ten minutes of operating time.
So how do you go from doing surgery on a tomato to completing a full case on a real, awake person?
Create tight feedback loops through structured reflection.
The secret sauce is to create a tight feedback loop around each operating session. This is creating space for structured reflection. I understood the importance of squeezing those previous minutes in the eye for everything that I could.
After every session, I would make it a point to debrief with my trainers and to get feedback on what was good, and what could be improved. I recorded all of my surgery and spent a bit of time watching them the evening after. If something didn't go to plan, I would watch the recordings over and over until I understood what went wrong.
I kept a log of all my cases in a Notion spreadsheet (see below). Every time I was about to operate, I would look at this and make sure I wouldn't repeat any of my mistakes, whilst keeping any improvements or strengths from my last few cases.
The key insight I had early on in my journey is that actually, most of the growth happens away from the operating room. The secret is then to double down on that, and build a structure around the practice. This is how you translate knowledge into skill, and how you solidify good habits and pre-empt bad ones.
When you need to get good quickly and safely at something, you sometimes don't have the luxury of "10,000 hours". I'm now always looking to build feedback loops when learning new things.