Hand surgery depends upon the application of scientific knowledge but also technical skill. This is, as yet, largely immeasurable. Like all skills it can be improved. In particular, surgeons havf over the last century made significant progress in simplifying and improving or replacing surgical techniques to make surgery more reliable. Unlike in the recent Olympics or most other sporting endeavours, surgeons will not reach 10,000 hours of practice, particularly not in any one operation. In hand surgery we undertake a large range of operations. Of these we will perform more than 1000 of very few operations, perhaps only carpal tunnel releases. We may perform a few hundred of a limited range of operations and fewer than 100, and often fewer than even 20, of most operations that we perform. Therefore, we never become truly expert in almost any operation we undertake.
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