Fellowship Training as a Modifier of the Surgical Learning Curve
- 1 May 2010
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Academic Medicine
- Vol. 85 (5), 863-868
- https://doi.org/10.1097/acm.0b013e3181d73a45
Abstract
To investigate the effects of fellowship training on a surgeon's learning curve for cancer control after open radical prostatectomy. The study cohort included 7,765 prostate cancer patients who underwent radical prostatectomy performed by 1 of 72 surgeons at four major U.S. academic medical centers between 1987 and 2003. Multivariable models were used to determine the learning curves for biochemical recurrence and surgical margins, separately for surgeons with and without fellowship training, after adjustment for standard prognostic variables. Initial results for fellowship- and non-fellowship-trained surgeons were similar (five-year probability of recurrence for first case: 19.4% and 18.3%, respectively; absolute difference: −1.1%; 95% confidence interval [CI]: −5.5%, 3.0%; P = .7). However, the rate of learning was faster among fellowship-trained surgeons (P = .006), which resulted in their overall superior cancer control (P = .001; difference: 4.7%; 95% CI: 2.6%, 7.4%). With regard to positive surgical margin rates, fellowship-trained surgeons initially had superior results than did non-fellowship-trained surgeons (P = .005; 36% versus 42%; absolute difference: 6%; 95% CI: 1%, 10%), but the difference between the groups' subsequent learning curves was not significant (P = .9 for interaction). The learning curve for biochemical recurrence depends on surgical training, whereas the learning curve for surgical margins does not. This difference suggests that improvements in margin rates result from reflection on specific aspects of surgical procedure, whereas improvements in biochemical recurrence occur by some general process of improvement in surgical technique. Further research into the mechanisms of surgical learning is warranted.Keywords
This publication has 6 references indexed in Scilit:
- Validation that a 1-year fellowship in minimally invasive and bariatric surgery can eliminate the learning curve for laparoscopic gastric bypassSurgical Endoscopy, 2009
- Laparoscopic radical prostatectomy: Six months of fellowship training doesn't prevent the learning curve when incorporating into a lower volume practiceUrologic Oncology, 2009
- Effects of Pathologic Stage on the Learning Curve for Radical Prostatectomy: Evidence That Recurrence in Organ-Confined Cancer Is Largely Related to Inadequate Surgical TechniqueEuropean Urology, 2008
- The Surgical Learning Curve for Prostate Cancer Control After Radical ProstatectomyJNCI Journal of the National Cancer Institute, 2007
- Impact of fellowship training on pathologic outcomes and complication rates of radical prostatectomyCancer, 2006
- Impact of Fellowship Training on the Learning Curve for Laparoscopic Gastric BypassObesity Surgery, 2004