scholarly journals The learning curve for transoral incisionless fundoplication

2021 ◽  
Vol 09 (11) ◽  
pp. E1785-E1791
Author(s):  
Mohamad Dbouk ◽  
Olaya I. Brewer Gutierrez ◽  
Bijun Sai Kannadath ◽  
Jose Valentin Camilion ◽  
Saowanee Ngamruengphong ◽  
...  
Keyword(s):  
Learning Curve ◽  
Maximum Efficiency ◽  
Basic Training ◽  
Training Experience ◽  
Transoral Incisionless Fundoplication ◽  
Refractory Gerd ◽  
Hands On ◽  
Cusum Analysis ◽  
Breakpoint Analysis ◽  
Mean Time

Abstract Background and study aims Transoral incisionless fundoplication (TIF) is a safe and effective minimally invasive endoscopic technique for treating gastroesophageal reflux disease (GERD). The learning curve for this technique has not been reported. We studied the learning curve for TIF when performed by a gastroenterologist by identifying the threshold number of procedures needed to achieve consistent technical success or proficiency (consistent creation of TIF valve ≥ 270 degrees in circumference, ≥ 2 cm long) and efficiency after didactic, hands-on and case observation experience. Patients and methods We analyzed prospectively collected data from patients who had TIF performed by a single therapeutic endoscopist within 17 months after basic training. We determined thresholds for procedural learning using cumulative sum of means (CUSUM) analysis to detect changes in achievement rates over time. We used breakpoint analysis to calculate procedure metrics related to proficiency and efficiency. Results A total of 69 patients had 72 TIFs. The most common indications were refractory GERD (44.7 %) and proton pump inhbitor intolerance (23.6 %). Proficiency was achieved at the 18th to 20th procedure. The maximum efficiency for performing a plication was achieved after the 26th procedure, when mean time per plication decreased to 2.7 from 5.1 minutes (P < 0.0001). TIF procedures time varied until the 44th procedure, after which it decreased significantly from 53.7 minutes to 39.4 minutes (P < 0.0001). Conclusions TIF can be safely, successfully, and efficiently performed in the endoscopy suite by a therapeutic endoscopist. The TIF learning curve is steep but proficiency can be achieved after a basic training experience and 18 to 20 independently performed procedures.

scholarly journals The learning curve for ultrasound-guided peripheral intravenous cannulation in adults: a multicenter study

2022 ◽  
Author(s):  
Fredericus HJ Van Loon ◽  
Harm J Scholten ◽  
Hendrikus HM Korsten ◽  
Angelique TM Dierick - van Daele ◽  
Arthur RA Bouwman
Keyword(s):  
Learning Curve ◽  
Prospective Observational Study ◽  
Primary Outcome ◽  
Training Session ◽  
Hands On ◽  
Individual Participant ◽  
Cusum Analysis ◽  
Multicenter Prospective Observational Study ◽  
Two Phases ◽  
Cannulation Success

Aims: To lower the threshold for applying ultrasound (US) guidance during peripheral intravenous cannulation, nurses need to be trained and gain experience in using this technique. The primary outcome was to quantify the number of procedures novices require to perform before competency in US-guided peripheral intravenous cannulation was achieved. Materials and methods: A multicenter prospective observational study, divided into two phases after a theoretical training session: a hands-on training session and a supervised life-case training session. The number of US-guided peripheral intravenous cannulations a participant needed to perform in the life-case setting to become competent was the outcome of interest. Cusum analysis was used to determine the learning curve of each individual participant. Results: Forty-nine practitioners participated and performed 1855 procedures. First attempt cannulation success was 73% during the first procedure, but increased to 98% on the fortieth attempt (p<0.001). The overall first attempt success rate during this study was 93%. The cusum learning curve for each practitioner showed that a mean number of 34 procedures was required to achieve competency. Time needed to perform a procedure successfully decreased when more experience was achieved by the practitioner, from 14±3 minutes on first proce-dure to 3±1 minutes during the fortieth procedure (p<0.001). Conclusions: Competency in US-guided peripheral intravenous cannulation can be gained after following a fixed educational curriculum, resulting in an increased first attempt cannulation success as the number of performed procedures increased.

The Marine Corps basic training experience: Correlates of platoon attrition rate differences.

1983 ◽  
Author(s):  
Ross R. Vickers ◽  
Linda K. Hervig ◽  
Marie T. Wallick ◽  
Terry L. Conway
Keyword(s):  
Marine Corps ◽  
Attrition Rate ◽  
Basic Training ◽  
Training Experience

scholarly journals Building a precision oncology workforce by multidisciplinary and case-based learning

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Srikar Chamala ◽  
Heather T. D. Maness ◽  
Lisa Brown ◽  
C. Brooke Adams ◽  
Jatinder K. Lamba ◽  
...  
Keyword(s):  
Focus Group ◽  
Course Design ◽  
Comparative Method ◽  
Group Session ◽  
Focus Group Session ◽  
Precision Oncology ◽  
Training Experience ◽  
Hands On ◽  
Case Based Learning ◽  
Case Based

Abstract Background Participants in two recent National Academy of Medicine workshops identified a need for more multi-disciplinary professionals on teams to assist oncology clinicians in precision oncology. Methods We developed a graduate school course to prepare biomedical students and pharmacy students to work within a multidisciplinary team of oncology clinicians, pathologists, radiologists, clinical pharmacists, and genetic counselors. Students learned precision oncology skills via case-based learning, hands-on data analyses, and presentations to peers. After the course, a focus group session was conducted to gain an in-depth student perspective on their interprofessional training experience, achievement of the course learning outcomes, ways to improve the course design in future offerings, and how the course could improve future career outcomes. A convenience sampling strategy was used for recruitment into the focus group session. A thematic content analysis was then conducted using the constant comparative method. Results Major themes arising from student feedback were (1) appreciation of a customized patient case-based teaching approach, (2) more emphasis on using data analysis tools, (3) valuing interdisciplinary inclusion, and (4) request for more student discussion with advanced preparation materials. Conclusions Feedback was generally positive and supports the continuation and expansion of the precision oncology course to include more hands-on instruction on the use of clinical bioinformatic tools.

Learning curve for robot-assisted Ivor Lewis esophagectomy

2021 ◽  
Author(s):  
Yu Han ◽  
Yajie Zhang ◽  
Wentian Zhang ◽  
Jie Xiang ◽  
Kai Chen ◽  
...  
Keyword(s):  
Learning Curve ◽  
Complication Rate ◽  
Major Complication ◽  
Robot Assisted ◽  
Ivor Lewis ◽  
Initial Learning ◽  
Cusum Analysis ◽  
Technical Proficiency ◽  
Major Complication Rate ◽  
Two Phases

Summary This study aimed to demonstrate the learning curve of robot-assisted minimally invasive esophagectomy (RAMIE). A retrospective analysis of the first 124 consecutive patients who underwent RAMIE with intrathoracic anastomosis (Ivor Lewis) by a single surgeon between May 2015 and August 2020 was performed. An risk-adjusted cumulative sum (RA-CUSUM) analysis was applied to generate a learning curve of RAMIE considering the major complication rate, which reflected the technical proficiency. The overall 30-day morbidity rate was 38.7%, while the major complication rate was 25.8%. The learning curve was divided into two phases based on the RA-CUSUM analysis: phase I, the initial learning phase (cases 1–51) and phase II, the proficiency phase (cases 52–124). As we compared the proficiency phase with the initial learning phase, significantly decreased trends were observed in relation to the major complication rate (37.3% vs. 18.7%, P = 0.017), total operation time (330.9 ± 55.6 vs. 267.3 ± 39.1 minutes, P &lt; 0.001), and length of hospitalization (10 [IQR, 9–14] days vs. 9 [IQR, 8–11] days, P = 0.034). In conclusion, the learning curve of RAMIE consisted of two phases, and at least 51 cases were required to gain technical proficiency.

scholarly journals CAN VIRTUAL REALITY BE AS GOOD AS OPERATING ROOM TRAINING? EXPERIENCE FROM A RESIDENCY PROGRAM IN GENERAL SURGERY

2018 ◽  
Vol 31 (4) ◽  
Author(s):  
Bruno Della Mea GASPERIN ◽  
Thamyres ZANIRATI ◽  
Leandro Totti Cavazzola
Keyword(s):  
Virtual Reality ◽  
Operating Room ◽  
General Surgery ◽  
Training Experience ◽  
Total Procedure Time ◽  
Significant Difference ◽  
Hands On ◽  
Second Year ◽  
Practice Time

ABSTRACT Background: The increasingly intense usage of technology applied to videosurgery and the advent of robotic platforms accelerated the use of virtual models in training surgical skills. Aim: To evaluate the performance of a general surgery department’s residents in a video-simulated laparoscopic cholecystectomy in order to understand whether training with virtual reality is sufficient to provide the skills that are normally acquired in hands-on experience at the operating room. Methods: An observational study with twenty-five first- and second-year general surgery residents. Each subject performed three video-laparoscopic cholecystectomies under supervision in a simulator. Only the best performance was evaluated in the study. Total number of complications and total procedure time were evaluated independently. The groups were defined according to total practice time (G1 and G2) and the year of residency (R1 and R2), each being analysed separately. Results: Twenty-one residents finished the three practices, with four follow-up losses. Mean practice time was 33.5 hours. Lowering of the rate of lesions in important structures could be identified after a level of proficiency of 60%, which all participants obtained regardless of previous in vivo experience. No significant difference between the R1 and R2 groups was observed. Conclusion: Learning in groups R1 and R2 was equal, regardless of whether previous practice was predominantly in vivo (R2) or with virtual reality (R1). Therefore, it is possible to consider that skills obtained in virtual reality training are capable of equalising the proficiency of first- and second-year residents, being invaluable to increase patient safety and homogenise learning of basic surgical procedures.

scholarly journals TCT-737 MONITORING THE LEARNING CURVE AND QUALITY OF CARE IN TAVI PROCEDURES BY CUSUM ANALYSIS

2013 ◽  
Vol 62 (18) ◽  
pp. B224-B225 ◽  
Author(s):  
Alfredo Giuseppe Cerillo ◽  
Michele Murzi ◽  
Massimiliano Mariani ◽  
Federica Marchi ◽  
Stefano Maffei ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Learning Curve ◽  
Cusum Analysis

scholarly journals Mo1283 LEARNING CURVE OF TRANSORAL INCISIONLESS FUNDOPLICATION: A SINGLE ENDOSCOPIST EXPERIENCE

2020 ◽  
Vol 91 (6) ◽  
pp. AB416
Author(s):  
Olaya I. Brewer Gutierrez ◽  
Mohamad Dbouk ◽  
Bijun S. Kannadath ◽  
Abdul A. Siddiqui ◽  
Zara Manuelyan ◽  
...  
Keyword(s):  
Learning Curve ◽  
Transoral Incisionless Fundoplication

Incorporating New Technology Into a Surgical Technique: The Learning Curve of a Single Surgeon's Stereo-Electroencephalography Experience

Neurosurgery ◽  
2019 ◽  
Vol 86 (3) ◽  
pp. E281-E289 ◽  
Author(s):  
Robert A McGovern ◽  
Robert S Butler ◽  
James Bena ◽  
Jorge Gonzalez-Martinez
Keyword(s):  
Surgical Technique ◽  
Learning Curve ◽  
Clinical Experience ◽  
Imaging Modality ◽  
Imaging Techniques ◽  
New Technology ◽  
Surgical Techniques ◽  
Vascular Imaging ◽  
New Paradigm ◽  
Cusum Analysis

Abstract BACKGROUND Technological improvements frequently outpace the publication of randomized, controlled trials in surgical patients. This makes the application of new surgical techniques difficult as surgeons solely use clinical experience to guide changes in their practice. OBJECTIVE To quantitatively examine the learning curve of incorporating new technology into a surgical technique and discuss the clinical significance of incorporating this new technology into daily practice. To identify areas of improvement for operative efficiency and safety. METHODS A retrospective observational study examining quantitative measures of operative efficiency and safety from 2009 to 2017 in 454 consecutive patients undergoing stereo-electroencephalography depth electrode implantations. RESULTS The transition to a new robotic technique significantly improved operative times (196 min [95% CI 173-219] vs 115 min [95% CI 111-118], P &lt; .0001). Cumulative sum (CUSUM) analysis demonstrated that mastery of the robotic technique took much longer than the frame-based technique (operative time peak at case 75 vs case 25, plateau of 150 vs 10 cases). Although hemorrhage rates using different vascular imaging techniques did not appear to differ using traditional statistical analysis (magnetic resonance imaging, MRI 22.3%, computed tomography angiography, CTA 17.9%, angiogram 18.1%, likelihood ratio χ2 = 4.84, P = .30), CUSUM analysis suggested MRI as the vascular imaging modality leading to higher hemorrhage and symptomatic hemorrhage rates at our center. CONCLUSION This experience demonstrates an improvement in operative efficiency through a series of changes made using clinical experience and intuition while transitioning to a completely new paradigm. CUSUM analysis identified potential areas for improvement in both operative efficiency and safety if used in a prospective manner.

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