The ‘learning curve’ in surgery: what is it, how do we measure it and can we influence it?

Subramonian, Kesavapillai; Muir, Gordon

doi:10.1111/j.1464-410x.2004.04891.x

Cited by 113 publications

(76 citation statements)

References 17 publications

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“…The link between experience in clinical practice and the quality of care delivered has been a focus of some professions such as surgery (1)(2)(3); however, within other fields, including radiology, learning curves have not been studied beyond their relation to the use of emerging technologies (4).…”

mentioning

confidence: 99%

When Radiologists Perform Best: The Learning Curve in Screening Mammogram Interpretation

Miglioretti¹,

Gard²,

Carney³

et al. 2009

Radiology

110

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Purpose:To examine changes in screening mammogram interpretation as radiologists with and radiologists without fellowship training in breast imaging gain clinical experience. Materials and Methods:In an institutional review board-approved HIPAA-compliant study, the performance of 231 radiologists who interpreted screen-film screening mammograms from 1996 to 2005 at 280 facilities that contribute data to the Breast Cancer Surveillance Consortium was examined. Radiologists' demographic data and clinical experience levels were collected by means of a mailed survey. Mammograms were grouped on the basis of how many years the interpreting radiologist had been practicing mammography, and the influence of increasing experience on performance was examined separately for radiologists with and those without fellowship training in breast imaging, taking into account case-mix and radiologist-level differences. Results:A total of 1 599 610 mammograms were interpreted during the study period. Performance for radiologists without fellowship training improved most during their 1st 3 years of clinical practice, when the odds of a false-positive reading dropped 11%-15% per year (P Ͻ .015) with no associated decrease in sensitivity (P Ͼ .89). The number of women recalled per breast cancer detected decreased from 33 for radiologists in their 1st year of practice to 24 for radiologists with 3 years of experience to 19 for radiologists with 20 years of experience. Radiologists with fellowship training in breast imaging experienced no learning curve and reached desirable goals during their 1st year of practice. Conclusion:Radiologists' interpretations of screening mammograms improve during their first few years of practice and continue to improve throughout much of their careers. Additional residency training and targeted continuing medical education may help reduce the number of work-ups of benign lesions while maintaining high cancer detection rates. Note: This copy is for your personal, non-commercial use only. To order presentation-ready copies for distribution to your colleagues or clients, use the Radiology Reprints form at the end of this article. Physicians begin practicing independently in their chosen field after residency training is completed, yet little is known about how their clinical skills develop over the course of their careers. The link between experience in clinical practice and the quality of care delivered has been a focus of some professions such as surgery (1-3); however, within other fields, including radiology, learning curves have not been studied beyond their relation to the use of emerging technologies (4).Variability in radiologists' interpretive performance of mammography in the United States has been extensively studied (5-11). Prior research has found that radiologists with more years of experience in interpreting mammograms have lower false-positive rates than their less experienced counterparts, with inconsistent effects on sensitivity (7-9,12,13). However, these studies compared groups of radiologi...

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mentioning

confidence: 99%

When Radiologists Perform Best: The Learning Curve in Screening Mammogram Interpretation

Miglioretti¹,

Gard²,

Carney³

et al. 2009

Radiology

110

View full text Add to dashboard Cite

show abstract

“…There are a variety of methods of constructing learning curves [5]. They all assume that successive exposures in a learning series may be plotted on the x-axis; response characteristics on y-axis and the data points distributed in the xy plane may be legitimately connected by a curve.…”

Section: Discussionmentioning

confidence: 99%

“…Various statistical methods are reported in assessments of the learning curve [5]. Commonly, data were split into arbitrary groups and the means compared by chi-squared test or ANOVA.…”

Section: Discussionmentioning

confidence: 99%

Learning Curve in Laparoscopic Inguinal Hernia Repair: Experience at a Tertiary Care Centre

et al. 2015

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One of the major reasons for laparoscopy not having gained popularity for repair of groin hernia is the perceived steep learning curve. This study was conducted to assess the learning curve and to predict the number of cases required for a surgeon to become proficient in laparoscopic groin hernia repair, by comparing two laparoscopic surgeons. The learning curve evaluation parameters included operative time, conversions, intraoperative complications and postoperative complications, and these were compared between the senior and the junior surgeon. One hundred thirty-eight cases were performed by the senior surgeon, and 63 cases by the junior surgeon. Both were comparable in terms of intraoperative and postoperative complications. Using the moving average method, minimum of 13 laparoscopic hernia repairs are required to reach at par the operating time of an experienced surgeon. For total extraperitoneal (TEP) repair, the number of cases was 14; and for transabdominal preperitoneal (TAPP) repair, this number was 13.

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“…35 This concept was introduced to surgery after the advent of minimally invasive surgery in the 1980s but remains difficult to define. Subramonian et al defined it as, "The time taken and/or the number of procedures an average surgeon needs to be able to perform a procedure independently with a reasonable outcome".…”

Section: Impact Of the Surgical Learning Curve During The Transition mentioning

confidence: 99%

Transitioning from Open to Robotic Radical Prostatectomy: A Look Back

Goldenberg

Ahlering²,

Buchan

et al. 2011

Robotic Urologic Surgery

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The ‘learning curve’ in surgery: what is it, how do we measure it and can we influence it?

Cited by 113 publications

References 17 publications

When Radiologists Perform Best: The Learning Curve in Screening Mammogram Interpretation

When Radiologists Perform Best: The Learning Curve in Screening Mammogram Interpretation

Learning Curve in Laparoscopic Inguinal Hernia Repair: Experience at a Tertiary Care Centre

Transitioning from Open to Robotic Radical Prostatectomy: A Look Back

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