The Journey to Competence : Similarities of Surgical and Naval Aviator Training

A Proud Family Moment

A few weeks ago, I went in late to work to watch my son and his mentor, a Marine Corps Captain, take off from Hanscom Field in Lexington, MA as part of a cross-country training mission.  My son is stationed in Meridian, MS while he completes tailhook training, which begins in simulators and progresses to takeoffs, aerobatics, formation flying, and aircraft carrier landings in a T-45 Goshawk jet trainer, pictured above.
As my son pointed out different aspects of the plane, I was impressed with how much he had learned in the last two months.  His progress increased my already tremendous respect for the Navy and the way that they invest in training, both technical knowledge and leadership skills.  I told him that he acted two decades more mature than his father at age 24, when I was coping intermittently with the extended adolescence of memorizing facts from medical school textbooks.
As I spoke with his Captain, I was impressed with the proud tradition of mentoring, that a pilot with combat experience in Iraq and Afghanistan would take a personal interest in my son’s career development.  It reminded me a great deal of my journey through surgical residency and beyond, where experienced surgeons took me through my first operations, explaining judgment, operative strategy and technique, and anticipation of complications.
Watching his Captain climb into the cockpit and attach his oxygen, radio, and seatbelt harnesses, impressed me with the ease and economy of his motions.  Like a master surgeon, he made every motion count.  He displayed in his words and actions the balance of self-assurance and humility that we strive for as surgeons .
Later that evening, when my son called to say that they had landed safely in Meridian and to thank me for coming out to see his plane take off, I relayed my impressions.  He too noted how quickly and effortlessly his Captain went through the pre- and post-flight routines and how much longer the same maneuvers took for my son.  I asked him, How many flight hours does your captain have in jets?”
“Over 1,000,” he told me.
“Do you know more now than you did 3 months ago?” I asked.
“Yes,” he told me.
“Making self-self comparisons over time is always better  than making self-other comparisons.  I bet that, before long, you will be teaching someone else to fly, similar to the way that he is teaching you now,” I said, recalling my 5 years of surgical residency.
In Unconscious Competence, I discussed the journey to competence and the four stages that a senior resident taught me during my residency:
  • Unconscious incompetence: people make mistakes because they are unaware that they are missing information (e.g. the July 1 house officer transition)
  • Conscious incompetence: usually following unconscious incompetence, they feel upset and embarrassed and question even their basic knowledge
  • Conscious competence: over time, they feel more comfortable about their skills, knowledge, and judgment
  • Unconscious competence: they trust their instincts and allow those instincts to influence their decision-making, especially when something “just doesn’t feel right.”

I commend the Navy for using simulation to minimize the consequences of unconscious incompetence and thank everyone in our armed forces not only for their service to our country but also for their dedication to training.


I have not received any compensation for writing this content. I have no material connection to the brands, topics and/or products that are mentioned herein.

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