Monday, 12 August 2013

See One, Do One, teach one - Measuring the Learning Curve.

One of the possible victims of public reporting of surgical outcomes of individual surgeons is Surgical Innovation.  When a surgeon is under scrutiny, he dare not innovate lest he fails. Learning a new technique means that initially the operative outcome will not be as good as when the surgery is performed by a surgeon already experienced in this new technique. But if the new technique carries potential advantages, it must be disseminated. So how is this quandary solved? How does a surgeon get over this so called learning curve? This paper by German surgeons on the training of minimally invasive mitral heart valve surgery turns the measuring of the learning curve into a quasi science. There are recognised ways of getting over the learning curve without harming or disadvantaging  patients - using simulation and operating with experienced 'buddies' to start with (so called buddy system) are 2 commonly used. Measuring the learning curve and knowing when a surgeon is ready to fly solo is therefore of crucial importance - which is why this paper from Leipzig is worthy of mention.