845 Flattening the Learning Curve: The Evaluation of Extended Laparoscopic Simulation Training for Novice Surgeons

Abstract Introduction Associated with faster postoperative recovery, reduced length of hospital stays and scarring; laparoscopy has become the favoured approach for many surgical procedures across a range of specialties. However, due to its challenging learning curve, it has also been associated with increased theatre time and higher complication rates. Method A prospective, observational study with box trainers was carried out by novice medical students and trainees to evaluate the efficacy of long duration courses on skill acquisition. The novice group undertook a 5-week curriculum composed of lectures, demonstrations and spaced timed-assessments involving 3 tasks: hoop placement, stacking of sugar cubes and surgical cutting. Results Time taken for novice participants to complete a task individually and collectively improved markedly from the first to the third attempt, with an overall 44% reduction in time observed over the 5-weeks. We invited back 6 novice participants and 6 core surgical trainees after 4-weeks to complete the same tests. There was a further 18% time improvement in the novice group, with 44% faster task completion. Conclusions Given the success of this study and other simulation courses reported in the literature, we recommend more courses adopt a spaced-out approach; and a simulation curriculum for surgical trainees to cultivate greater skill acquisition.

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Learning curve of trainees performing laparoscopic appendectomy- a register-based study

10.21203/rs.3.rs-688361/v1 ◽

2021 ◽

Author(s):

Nathalie Young ◽

Lennart Boström ◽

Gabriel Sandblom ◽

Hans Järnbert Pettersson

Keyword(s):

Learning Curve ◽

Complication Rate ◽

Moving Average ◽

Operation Time ◽

Patient Characteristics ◽

First Year ◽

Complication Rates ◽

Surgical Trainees ◽

Trainee Surgeon ◽

Training Programmes

Abstract Background Appendectomy is one of the first procedures that surgical trainees are expected to manage alone. The purpose of this study was to analyse the learning curve of a cohort of surgical trainees and to explore the association between trainee surgeon volume and complication rate. Method The study was based on a cohort extracted from the local appendectomy register at Södersjukhuset (transl. South Hospital), Stockholm. The register includes patient characteristics, surgical method, operation time, and 30-day complications. First-year surgical trainees attending the hospital’s trainee programme were included and followed over five years of training. Trainees who had performed less than ten procedures during the period of the study were excluded. The learning curve was described using moving average of order ten for each trainee, studying the trend in operation time with increasing volume. The cumulative sum technique was used to chart changes in complication rates of the trainees. Results 586 procedures performed by 9 surgical trainees were included, of which 97.6% were performed laparoscopically. A plateau in operation time on the learning curve was reached at 60 procedures. For three of the trainees, the 30-day complication rate decreased after completing the learning curve, whereas for two others it increased. In a multivariate analysis, operation times differed more between the trainees than it did between procedures performed early or late in the programme. Shortest versus longest mean operation time (41 min versus 89 min). Conclusion At least 60 procedures are required to reach sufficient proficiency in appendectomy. This highlights the importance of meticulous selection of surgical trainees, structure of training programmes, feedback, and assessment.

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A SIMPLE AFFORDABLE HOMEMADE LAPAROSCOPIC MODEL FOR NARROWING THE LEARNING CURVE OF UROLOGICAL TRAINEES- SKILL ACQUISITION USING TWO KEY LAPAROSCOPIC RADICAL PROSTATECTOMY STEPS

European Urology Supplements ◽

10.1016/s1569-9056(06)60281-9 ◽

2006 ◽

Vol 5 (2) ◽

pp. 91

Author(s):

S.S. Kommu ◽

F.H. Mumtaz

Keyword(s):

Radical Prostatectomy ◽

Learning Curve ◽

Skill Acquisition ◽

Laparoscopic Radical Prostatectomy

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Similar 90-day outcomes among inpatient and outpatient arthroplasties

The Bone & Joint Journal ◽

10.1302/0301-620x.103b7.bjj-2020-2341.r1 ◽

2021 ◽

Vol 103-B (7 Supple B) ◽

pp. 84-90

Author(s):

JaeWon Yang ◽

Adam S. Olsen ◽

Joseph Serino ◽

E. Bailey Terhune ◽

Anne DeBenedetti ◽

...

Keyword(s):

Emergency Department ◽

Learning Curve ◽

Reoperation Rate ◽

Ambulatory Setting ◽

Complication Rates ◽

Revision Thas ◽

Unicompartmental Knee Arthroplasties ◽

Same Day Discharge ◽

Outpatient Group ◽

Clinic Visits

Aims The proportion of arthroplasties performed in the ambulatory setting has increased considerably. However, there are concerns whether same-day discharge may increase the risk of complications. The aim of this study was to compare 90-day outcomes between inpatient arthroplasties and outpatient arthroplasties performed at an ambulatory surgery centre (ASC), and determine whether there is a learning curve associated with performing athroplasties in an ASC. Methods Among a single-surgeon cohort of 970 patients who underwent arthroplasty at an ASC, 854 (88.0%) were matched one-to-one with inpatients based on age, sex, American Society of Anesthesiologists (ASA) grade, BMI, and procedure (105 could not be adequately matched and 11 lacked 90-day follow-up). The cohort included 281 total hip arthroplasties (THAs) (32.9%), 267 unicompartmental knee arthroplasties (31.3%), 242 primary total knee arthroplasties (TKAs) (28.3%), 60 hip resurfacings (7.0%), two revision THAs (0.3%), and two revision TKAs (0.3%). Outcomes included readmissions, reoperations, visits to the emergency department, unplanned clinic visits, and complications. Results The inpatient and outpatient groups were similar in all demographic variables, reflecting successful matching. The reoperation rate was 0.9% in both cohorts (p = 1.000). Rates of readmission (2.0% inpatient vs 1.6% outpatient), any complications (5.9% vs 5.6%), minor complications (4.2% vs 3.9%), visits to the emergency department (2.7% vs 1.4%), and unplanned clinic visits (5.7% vs 5.5%) were lower in the outpatient group but did not reach significance with the sample size studied. A learning curve may exist, as seen by significant reductions in the reoperation and overall complication rates among outpatient arthroplasties over time (p = 0.032 and p = 0.007, respectively), despite those in this group becoming significantly older and heavier (both p < 0.001) during the study period. Conclusion Arthroplasties performed at ASCs appear to be safe in appropriately selected patients, but may be associated with a learning curve as shown by the significant decrease in complication and reoperation rates during the study period. Cite this article: Bone Joint J 2021;103-B(7 Supple B):84–90.

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Predicting Temporal Exceptions in Concurrent Workflows

Models for Capitalizing on Web Engineering Advancements ◽

10.4018/978-1-4666-0023-2.ch011 ◽

2012 ◽

pp. 196-218 ◽

Cited By ~ 1

Author(s):

Iok-Fai Leong ◽

Yain-Whar Si ◽

Robert P. Biuk-Aghai

Keyword(s):

Business Processes ◽

Critical Path ◽

Workflow Management ◽

Business Environment ◽

Complex Problem ◽

Control Flow ◽

Prediction Algorithm ◽

Task Completion ◽

Ripple Effect ◽

Long Duration

Current Workflow Management Systems (WfMS) are capable of managing simultaneous workflows designed to support different business processes of an organization. These departmental workflows are considered to be interrelated since they are often executed concurrently and are required to share a limited number of resources. However, unexpected events from the business environment and lack of proper resources can cause delays in activities. Deadline violations caused by such delays are called temporal exceptions. Predicting temporal exceptions in concurrent workflows is a complex problem since any delay in a task can cause a ripple effect on the remaining tasks from the parent workflow as well as from the other interrelated workflows. In addition, different types of loops are often embedded in the workflows for representing iterative activities, and presence of such control flow patterns in workflows can further increase the difficulty in estimation of task completion time. In this chapter, the authors describe a critical path based approach for predicting temporal exceptions in concurrent workflows that are required to share limited resources. This approach allows predicting temporal exceptions in multiple attempts while workflows are being executed. The accuracy of the proposed prediction algorithm is analyzed based on a number of simulation scenarios. The result shows that the proposed algorithm is effective in predicting exceptions for instances where long duration tasks are scheduled (or executed) at the early phase of the workflow.

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Learning curve and complications of minimally invasive transforaminal lumbar interbody fusion

Neurosurgical FOCUS ◽

10.3171/2013.5.focus13157 ◽

2013 ◽

Vol 35 (2) ◽

pp. E7 ◽

Cited By ~ 37

Author(s):

Pedro S. Silva ◽

Paulo Pereira ◽

Pedro Monteiro ◽

Pedro A. Silva ◽

Rui Vaz

Keyword(s):

Minimally Invasive ◽

Learning Curve ◽

Interbody Fusion ◽

Operative Time ◽

Pedicle Screws ◽

Transforaminal Lumbar Interbody Fusion ◽

Complication Rates ◽

Lumbar Interbody Fusion ◽

Adjacent Level ◽

Negative Exponential

Object Minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) has the potential advantage of minimizing soft-tissue damage and reducing recovery time compared to open procedures. A steep learning curve has been described for the technique. The aim of the present study was to define the learning curve that describes the progress of a single surgeon performing the MI-TLIF. Methods One hundred fifty consecutive patients with degenerative lumbar disease who underwent 1- or 2-level MI-TLIF were included in the study. Operative time, corrected operative time per level, and complications were analyzed. The learning curve was assessed using a negative exponential curve-fit regression analysis. Results One hundred ten patients underwent 1-level and 18 patients underwent 2-level MI-TLIF; the remaining 22 underwent a single-level procedure plus an ancillary procedure (decompression at adjacent level, vertebral augmentation through fenestrated pedicle screws, interspinous device at adjacent level). Negative exponential curves appropriately described the relationship between operative time and experience for 1-level surgery and after correction of operative time per level (R2 = 0.65 and 0.57). The median operative time was 140 minutes (interquartile range 120–173 minutes), and a 50% learning milestone was achieved at Case 12; a 90% learning milestone was achieved at Case 39. No patient required transfusion in the perioperative period. The overall complication rate was 12.67% and the most frequent complication was a dural tear (5.32%). Before the 50% and 90% learning milestones, the complication rates were 33% and 20.51%, respectively. Conclusions The MI-TLIF is a reliable and effective option for lumbar arthrodesis. According to the present study, 90% of the learning curve can be achieved at around the 40th case.

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Training to proficiency in surgery using simulation: is there a moral obligation?

Journal of Medical Ethics ◽

10.1136/medethics-2021-107678 ◽

2022 ◽

pp. medethics-2021-107678

Author(s):

Conor Toale ◽

Marie Morris ◽

Dara O Kavanagh

Keyword(s):

Learning Curve ◽

New Technology ◽

Training Paradigm ◽

Surgical Ethics ◽

Surgical Trainees ◽

Simulation Based ◽

Predetermined Level ◽

Trainee Surgeon ◽

The Right ◽

To Receive

A deontological approach to surgical ethics advocates that patients have the right to receive the best care that can be provided. The ‘learning curve’ in surgical skill is an observable and measurable phenomenon. Surgical training may therefore carry risk to patients. This can occur directly, through inadvertent harm, or indirectly through theatre inefficiency and associated costs. Trainee surgeon operating, however, is necessary from a utilitarian perspective, with potential risk balanced by the greater societal need to train future independent surgeons.New technology means that the surgical learning curve could take place, at least in part, outside of the operating theatre. Simulation-based deliberate practice could be used to obtain a predetermined level of proficiency in a safe environment, followed by simulation-based assessment of operative competence. Such an approach would require an overhaul of the current training paradigm and significant investment in simulator technology. This may increasingly be viewed as necessary in light of well-discussed pressures on surgical trainees and trainers.This article discusses the obligations to trainees, trainers and training bodies raised by simulation technology, and outlines the current arguments both against and in favour of a simulation-based training-to-proficiency model in surgery. The significant changes to the current training paradigm that would be required to implement such a model are also discussed.

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Feasibility of Single-Staged Bilateral Anterior Scoliosis Correction in Growing Patients

Global Spine Journal ◽

10.1177/2192568219892904 ◽

2019 ◽

Vol 11 (1) ◽

pp. 76-80 ◽

Cited By ~ 1

Author(s):

Alice Baroncini ◽

Luis Rodriguez ◽

Kushagra Verma ◽

Per D. Trobisch

Keyword(s):

Learning Curve ◽

Retrospective Analysis ◽

Pulmonary Complications ◽

Future Research ◽

Scoliosis Surgery ◽

Complication Rates ◽

Scoliosis Correction ◽

Double Curve ◽

Thoracic Approach ◽

A Minor

Study Design: Retrospective analysis. Objectives: The objective of this study was to analyze the feasibility of correcting double-curve scoliosis using dynamic scoliosis correction (DSC, also known as vertebral body tethering), which requires a bilateral anterior approach with deflation of both lungs. Typically, this approach falls under the exclusionary criteria for the eligibility for anterior scoliosis surgery. No data exists on the feasibility of single-staged bilateral DSC. Methods: A retrospective analysis was performed utilizing the data from 25 patients who underwent a bilateral anterior thoracic approach and instrumentation. Thirty-day postoperative complication rates were analyzed. A learning curve subanalysis was also performed to compare the first 12 patients to the remainder of the 13 patients, with a T-test ( P ≤ .05). Results: Of the 25 patients treated, there was 1 intraoperative event: After performing lumbar DSC, the contralateral DSC was abandoned due to unexpected pleural scarring and staged selective thoracic fusion was performed. We observed 4 postoperative complications: 2 patients had recurrent pleural effusions, 1 patient was diagnosed with pneumonia, and 1 patient had a minor pulmonary embolism without cardiopulmonary consequences (after an international 24 hour flight). All patients recovered well. We observed a significant influence of learning curve on surgical time (328 vs 280 min, P = .03) and blood loss (480 vs 197 mL, P = .03). Conclusion: Data suggests that bilateral, single-stage surgery for DSC is feasible albeit with an elevated complication rate that may partially attributable to the learning curve. Future research should focus on the cause of pulmonary complications and include a matched comparative analysis with traditional posterior fusion.

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A different approach to assess resident phacoemulsification learning curve: analysis of both completion and complication rates

Eye ◽

10.1038/sj.eye.6703103 ◽

2008 ◽

Vol 23 (3) ◽

pp. 683-687 ◽

Cited By ~ 25

Author(s):

J-S Lee ◽

C-H Hou ◽

M-L Yang ◽

J Z-C Kuo ◽

K-K Lin

Keyword(s):

Learning Curve ◽

Curve Analysis ◽

Complication Rates

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Staged Bilateral Hip or Knee Arthroplasties

Journal of Orthopaedic Surgery ◽

10.1177/230949900701500206 ◽

2007 ◽

Vol 15 (2) ◽

pp. 159-162 ◽

Cited By ~ 9

Author(s):

FR Hashmi ◽

K Barlas ◽

CF Mann ◽

FR Howell

Keyword(s):

Hospital Admission ◽

Hospital Stay ◽

Operating Time ◽

Length Of Hospital Stay ◽

Mean Difference ◽

Complication Rates ◽

Early Complication ◽

Early Complications ◽

Hospital Stays ◽

The Mean

Purpose. To compare the operating time, amount of blood transfused, length of hospital stay, and early complications (within 6 months) between 2-week staged bilateral arthroplasties and matched randomised controls undergoing unilateral arthroplasties. Methods. From October 1992 to October 2000, 90 patients who underwent bilateral hip or knee arthroplasties with a 2-week interval were compared with matched randomised controls undergoing unilateral arthroplasties. A single surgeon performed all procedures. Results. After the match-up process, 30 pairs of patients were included in the analysis. There were no significant differences in the operating times, amount of blood transfused, and early complication rates. The mean difference in length of hospital stay was significant ( t= −3.552, df=29, p<0.001). Conclusion. Compared to staged procedures with an interval months apart, staged sequential arthroplasty with a 7- to 10-day interval during one hospital admission is more efficient, as it facilitates earlier rehabilitation without higher complication rates, and entails shorter hospital stays.

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