Skip to main content

Advertisement

SpringerLink
Log in

The Science Behind the Learning Curve

  • Others
  • Published:
Indian Journal of Surgery Aims and scope Submit manuscript

Abstract

Measuring the surgical learning curve (LC) has potential benefits for patient safety and surgical education. Even though it is known that the learning of a practical skill becomes easier with time, the LC remained underutilized in medicine and surgery for decades. The understanding of the LC amongst surgeons needs to be enhanced in terms of its components, measurement, application, and reporting. This prompted us to review the science behind the learning curve and enrich the existing knowledge and its application in surgical learning and research. Application of knowledge of learning curve can help the surgeons to more rapidly achieve/maintain a high expertise level, improvise outcomes for their patients, and facilitate the investigators to scientifically report, audit, or research the surgical learning/innovations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

References

  1. Khan N, Abboudi H, Khan MS, Dasgupta P, Ahmed K (2014) Measuring the surgical ‘learning curve’: methods, variables and competency. BJU Int 113(3):504–508. https://doi.org/10.1111/bju.12197

    Article  PubMed  Google Scholar 

  2. Wright TP (1936) Factors affecting the cost of airplanes. J Aeronaut Sci 3:122–128

    Article  Google Scholar 

  3. Luft HS, Bunker JP, Enthoven AC (2007) Should operations be regionalized? The empirical relation between surgical volume and mortality 1979. Clin Orthop Relat Res 457:3–9. https://doi.org/10.1097/BLO.0b013e318034285e

    Article  PubMed  Google Scholar 

  4. Forbes N, Mohamed R, Raman M (2016) Learning curve for endoscopy training: is it all about numbers? Best Pract Res Clin Gastroenterol 30(3):349–356. https://doi.org/10.1016/j.bpg.2016.04.003

    Article  PubMed  Google Scholar 

  5. Hopper AN, Jamison MH, Lewis WG (2007) Learning curves in surgical practice. Postgrad Med J 83(986):777–779. https://doi.org/10.1136/pgmj.2007.057190

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Cook JA, Ramsay CR, Fayers P (2007) Using the literature to quantify the learning curve: a case study. Int J Technol Assess Health Care Spring 23(2):255–60. https://doi.org/10.1017/S0266462307070341

    Article  Google Scholar 

  7. Park HM, Han SS, Park SJ, Kim SW (2020) Learning curve for pancreatoduodenectomy: can it be generalized? ANZ J Surg 90(7–8):1414–1421. https://doi.org/10.1111/ans.15874

    Article  PubMed  Google Scholar 

  8. Busweiler LA, Schouwenburg MG, van Berge Henegouwen MI et al (2017) Textbook outcome as a composite measure in oesophagogastric cancer surgery. Br J Surg 104(6):742–750. https://doi.org/10.1002/bjs.10486

    Article  CAS  PubMed  Google Scholar 

  9. Ramsay CR, Grant AM, Wallace SA, Garthwaite PH, Monk AF, Russell IT (2000) Assessment of the learning curve in health technologies. A systematic review. Int J Technol Assess Health Care Autumn 16(4):1095–108. https://doi.org/10.1017/s0266462300103149

    Article  CAS  Google Scholar 

  10. Kim MS, Kim WJ, Hyung WJ et al (2021) Comprehensive learning curve of robotic surgery: discovery from a multicenter prospective trial of robotic gastrectomy. Ann Surg 273(5):949–956. https://doi.org/10.1097/SLA.0000000000003583

    Article  PubMed  Google Scholar 

  11. Spiegelhalter DJ (2005) Funnel plots for comparing institutional performance. Stat Med 24(8):1185–1202. https://doi.org/10.1002/sim.1970

    Article  PubMed  Google Scholar 

  12. Duclos A, Carty MJ, Peix JL et al (2012) Development of a charting method to monitor the individual performance of surgeons at the beginning of their career. PLoS ONE 7(7):e41944. https://doi.org/10.1371/journal.pone.0041944

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Uecker M, Kuebler JF, Ure BM, Schukfeh N (2020) Minimally invasive pediatric surgery: the learning curve. Eur J Pediatr Surg 30(2):172–180. https://doi.org/10.1055/s-0040-1703011

    Article  PubMed  Google Scholar 

  14. Reitano E, de Angelis N, Schembari E et al (2021) Learning curve for laparoscopic cholecystectomy has not been defined: a systematic review. ANZ J Surg 9:E554–E560. https://doi.org/10.1111/ans.17021

    Article  Google Scholar 

  15. Zheng-Yan L, Feng Q, Yan S, Ji-Peng L et al (2021) Learning curve of robotic distal and total gastrectomy. Br J Surg 108(9):1126–1132. https://doi.org/10.1093/bjs/znab152

    Article  PubMed  Google Scholar 

  16. Jeong O, Ryu SY, Choi WY, Piao Z, Park YK (2014) Risk factors and learning curve associated with postoperative morbidity of laparoscopic total gastrectomy for gastric carcinoma. Ann Surg Oncol 21(9):2994–3001. https://doi.org/10.1245/s10434-014-3666-x

    Article  PubMed  Google Scholar 

  17. Montague ML, Kishore A, McGarry GW (2003) Audit-derived guidelines for training in endoscopic sinonasal surgery (ESS)–protecting patients during the learning curve. Clin Otolaryngol Allied Sci 28(5):411–416. https://doi.org/10.1046/j.1365-2273.2003.00734.x

    Article  CAS  PubMed  Google Scholar 

  18. Eyers T (2017) Laparoscopic and other colorectal trials: ethics of the learning curve. ANZ J Surg 87(11):859. https://doi.org/10.1111/ans.14165

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatric Surgery, Netaji Subhash Chandra Bose Government Medical College, Nagpur Road, Jabalpur, India, 482003

    Vikesh Agrawal

  2. Department of Surgery, Netaji Subhash Chandra Bose Government Medical College, Jabalpur, India, 482003

    Dhananjaya Sharma

Authors
  1. Vikesh Agrawal
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dhananjaya Sharma
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Vikesh Agrawal.

Ethics declarations

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Agrawal, V., Sharma, D. The Science Behind the Learning Curve. Indian J Surg 85, 456–462 (2023). https://doi.org/10.1007/s12262-022-03452-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12262-022-03452-x

Keywords

Search

Navigation