Excellence in clinical neurosurgery: practice and judgment make perfect.

Having discussed the importance of excellence in research in neurosurgery in my previous lecture, I will now make a strong case for the pursuit of excellence in clinical neurosurgery. Here, the adage ‘‘practice makes perfect’’ will be used time and again to underscore the important roles of repetition of manual and intellectual tasks to achieve excellence in our subspecialty. To this adage, however, I have also added the concept of ‘‘judgment,’’ which comes into play whenever we look after our patients with neurosurgical disease. It takes judgment to know when to operate, but perhaps more important, when not to operate. Even the most skillful technical neurosurgeons run the risk of unexpected patient outcomes if good judgment is not applied to the patients on whom they operate. It is the combination of practice and judgment that perhaps sets us apart as neurosurgeons from other professionals in which a lapse in judgment in their disciplines would not have the far-reaching ramifications that it does for us and our patients. Some of the other disciplines I will be reviewing here in terms of practice making perfect include performance piano and professional tennis and golf as examples.