If we are to stock our postgraduate libraries, the obvious choices are the standard multi-volume textbooks, the atlases and the manuals of operative surgery. Inevitably, such works dominate our review pages. It pays to occasionally ‘think outside the box’ and, in that spirit, I encountered these two inexpensive paperbacks, which possess that rare quality: they set you thinking. With my surgical career end at T minus three years and counting, I was left pondering how much I could have benefitted from reading both these books in 1976, as I removed my first tonsils!
This is an inspiring book. The title did, perhaps, suggest those paperbacks we all avoid in the airport departure lounge shop: the ‘be more assertive’, ‘how to succeed in…’ self-improvement titles that never seem to work on this side of the Atlantic. Even the subtitle worried me. Every decision or operation I have ever undertaken has ‘achieved results’, however dizzy, deaf or disfigured the patient!
Press on though. At a glance, this book is obviously easy and entertaining reading. The layout is excellent and the presentation informal, and the author is a great raconteur. The tales of the firemen and the decision to get out, or the poor SAM operator forced to decide friend or foe, are unforgettable. It would spoil the impact to tell more of either story, and I will forgive the author for calling HMS Gloucester a British ‘battleship’ (some chance with current Defence cuts!). The comparison of our practice with that in the airline industry has been exhaustively covered recently, but is well done here. I suspect most of us have seen the gorilla in the basketball team video by now, but, again, the lesson learnt is well presented.
The content is best described by listing the early chapters: ‘Before the incision is made’; ‘Checkmate – the checklist phenomenon’; ‘To err is surgeon – human factors’; and ‘Why surgeons make bad decisions’. Seven chapters tell us how surgeons can evolve into expert decision-makers, or not. In the era of evidence-based protocols, the stress on the role of intuition is fascinating. Experience alone is not enough, we are told, but if you must land in the Hudson River, it cannot hurt.
This book left me even more concerned at the UK shortening of surgical training. The author warns of the perils of over-confidence, of sensory overload, of the ‘search satisfying error’ (a fascinating section).
Overall, the book is great value and great entertainment for a surgeon at any stage of training, whether novice or part-time, retired.
The title immediately suggests a relevance to only a minority of our specialty, but any trainee would do well to read this book. I was initially concerned that this book might not be applicable to a research career outside the US, but far from it. I was equally daunted to read in an opening sentence that this career is ‘post doctoral’ and that entry level is here defined as the PhD, a stage that few of us in clinical practice attain! I am glad I stuck with it, however, as there is a very good generic message, even for those of us who never contribute much more than the odd case report, the dodgy RCT, or the less than systematic review.
The book starts by outlining the stages of progress through a research career, from that new PhD to the retired professor emeritus. The second chapter, on designing research, is an excellent review of methodology, in only 24 pages. It is surely all too familiar to a scientist at this stage, but it provides a nice coverage more suited to a ‘jobbing’ surgeon or trainee. The next, brief chapter concentrates on on-line methods of keeping up to date with the evolving literature, and shows how far we have come from just reading the journals… if we choose to.
The chapter on getting one's work published is particularly good on justifying authorship, ethics and Impact Factor. Accepting the limitations of the last, it was intriguing to learn of alternative systems, such as the Eigenfactor, which sound far better. The Least Publishable Unit or LPU is a term to remember, as a witty alternative to the phrase ‘salami slicing’: the temptation to get multiple papers out of one piece of work. A chapter on membership of the scientific community describes strategies for networking, how to behave at meetings, and how to cope with the hard times in one's career. There is an excellent chapter on ‘Achieving success in academia’, which deals with such issues as work–life balance, women in biomedical research, and the value of sabbaticals and study leave.
The book's target audience is clearly clinicians considering a future in full-time research. However, the message conveyed is of equal value to anyone who intends to maintain any academic profile on completion of clinical training. For this reason, I would highly recommend this book.
