Learning curve for endoscopy training: Is it all about numbers?

Forbes, Nauzer; Mohamed, Rachid; Raman, Maitreyi

doi:10.1016/j.bpg.2016.04.003

Cited by 38 publications

(26 citation statements)

References 33 publications

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“…Another source of learning heterogeneity is knowledge transfer through observation of others as well as intentional learning efforts (Reagans et al, 2005). The existence of heterogeneous learning rates among surgeons (e.g., Forbes et al, 2016;Terzi et al, 2016) supports the argument that there is a large component of tacit learning about how to coordinate tasks required for surgery (Reagans et al, 2005). For example, one related surgical process task that can affect patient flow is coordinating the multiple process dependencies by sharing appropriate information with system staff (Crowston, 1997;Malone and Crowston, 1994), which in turn allows interdependent tasks to be integrated during the interaction process (Okhuysen and Bechky, 2009).…”

Section: Learning Theorymentioning

confidence: 99%

An empirical examination of surgeon experience, surgeon rating, and costs in perioperative services

Venkataraman

Fredendall

Taaffe

et al. 2018

J of Ops Management

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We examine how physicians affect the flow of patients through Perioperative Services (POS) on the day of surgery by studying the effects of surgeon experience and surgeon quality (measured by Healthgrades rating) on patients' flow. We control for the work environment created by the POS manager's resource allocation decision, which determines the utilization levels of the three POS departments: Pre‐operative (PreOp), Operating Room (OR), and Post Anesthesia Care Unit (PACU). Using patient level data from a large teaching hospital, we find that POS managers in all three departments view overtime costs as more important than idle time costs, which implies that they keep capacity slack available for patient care in each department. Further, our findings suggest that highly experienced surgeons take ownership of their patients' experience in the POS and that their patients spend less time in PreOp and the OR. We argue that not only do more experienced surgeons perform surgical procedures more efficiently, but they also coordinate better with PreOp to reduce patient waiting time there. We find that a surgeon's rating has no direct effect on a patient's actual surgery time in the OR, but that the effect of surgeon experience on actual surgery time is higher, in magnitude, for a lower‐rated surgeon than for a higher‐rated surgeon. Finally, we conduct a counterfactual analysis and find that highly experienced surgeons reduce the total length of a patient's stay in the POS.

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Section: Learning Theorymentioning

confidence: 99%

An empirical examination of surgeon experience, surgeon rating, and costs in perioperative services

Venkataraman

Fredendall

Taaffe

et al. 2018

J of Ops Management

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“…Suboptimal technique and inadequate withdrawal times (WTs) are considered to be major factors responsible for this disparity [15]. Several interventions have been studied that aim to improve ADR, ranging from medical devices [16] to optimized endoscopy curricula for trainees [17]. Of particular interest are educational interventions specifically targeted at independently practicing endoscopists.…”

Section: Introductionmentioning

confidence: 99%

Educational interventions are associated with improvements in colonoscopy quality indicators: a systematic review and meta-analysis

et al. 2020

Self Cite

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Background and study aims The quality of screening-related colonoscopy depends on several physician- and patient-related factors. Adenoma detection rate (ADR) varies considerably between endoscopists. Educational interventions aim to improve endoscopists’ ADRs, but their overall impact is uncertain. We aimed to assess whether there is an association between educational interventions and colonoscopy quality indicators. Methods A comprehensive search was performed through August 2019 for studies reporting any associations between educational interventions and any colonoscopy quality indicators. Our primary outcome of interest was ADR. Two authors assessed eligibility criteria and extracted data independently. Risk of bias was also assessed for included studies. Pooled rate ratios (RR) with 95 % confidence intervals (CI) were reported using DerSimonian and Laird random effects models. Results From 2,253 initial studies, eight were included in the meta-analysis for ADR, representing 86,008 colonoscopies. Educational interventions were associated with improvements in overall ADR (RR 1.29, 95 % CI 1.25 to 1.42, 95 % prediction interval 1.09 to 1.53) and proximal ADR (RR 1.39, 95 % CI 1.29 to 1.48), with borderline increases in withdrawal time, ([WT], mean difference 0.29 minutes, 95 % CI – 0.12 to 0.70 minutes). Educational interventions did not affect cecal intubation rate ([CIR], RR 1.01, 95 % CI 1.00 to 1.01). Heterogeneity was considerable across many of the analyses. Conclusions Educational interventions are associated with significant improvements in ADR, in particular, proximal ADR, and are not associated with improvements in WT or CIR. Educational interventions should be considered an important option in quality improvement programs aiming to optimize the performance of screening-related colonoscopy.

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“…Operative time is the most commonly used marker of pro ciency of certain skills and procedures [2,7,8]. It is generally acknowledged that the learning phases involved three distinctive phases [9]. During the rst phase, trainees focus on the basic skills of performing the procedure and how to diminish the mistakes or complications.…”

Section: Discussionmentioning

confidence: 99%

Defining the Learning Curve is Necessary to Improve Oocyte Retrieval Skills: Lessons from A Single High-Volume Reproductive CenterDefining the Learning Curve is Necessary to Improve Oocyte Retrieval Skills: Lessons from A Single High-Volume Reproductive Center

Cao

You

et al. 2020

Preprint

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Objective: The objective of this study was to determine the novice trainee’s learning curve for oocytes retrieval procedure through assessment of oocytes retrieval efficiency, operative time and other operative characteristics. Methods: This retrospective cohort study included 200 consecutive patients undergoing transvaginal ultrasound guided oocytes retrieval procedure. Those patients underwent oocyte retrieval procedure by a single operator and one experienced supervisor. Their clinical data, including demographic data, ovarian stimulation cycle information, surgical procedure, and laboratory data were collected over 3 months. CUSUM analyses based on the operative time were performed to determine the learning curve. Results: The mean operative time was 10.10 min. Based on the CUSUM plot of operative time, the learning curve can be divided into three separated phases, phase 1 (case 1 to case 49) was learning phase, phase 2 (case 50 to case 130) was acquisition phase, and phase 3 (case 131 to case 200) was proficiency phase. The operative time was significantly shortened from phase 1 to phase 3 (phase 1, 13.37 ± 4.83min; phase 2, 10.21 ± 3.30 min; phase 3, 7.67 ± 3.24 min, P < 0.001). The oocyte retrieval efficiency was also notably improved from phase 1 to phase 3 (78.2% to 100% based on method 1 to determine oocyte retrieval efficiency, and 104.2% to 121.1% based on method 2 to determine oocyte retrieval efficiency). The retrieved oocytes number, the fertilization rate, clinical pregnancy rate among the three phases showed no significant differences. No patients had severe adverse events. As determined by multiple linear regression, learning phase is the only independent predictor of oocyte retrieval efficiency. Conclusion: Trainees practice transvaginal ultrasound guided oocytes retrieval are expected to achieve a stabilized procedure over consecutive training cases, with acquisition of the skills at 49 cases, and proficiency at 130 cases. Cumulative operative experience can improve the operative time and oocytes retrieval efficiency, but showed minimal influence on retrieved oocytes number and reproductive outcomes.

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Learning curve for endoscopy training: Is it all about numbers?

Cited by 38 publications

References 33 publications

An empirical examination of surgeon experience, surgeon rating, and costs in perioperative services

An empirical examination of surgeon experience, surgeon rating, and costs in perioperative services

Educational interventions are associated with improvements in colonoscopy quality indicators: a systematic review and meta-analysis

Defining the Learning Curve is Necessary to Improve Oocyte Retrieval Skills: Lessons from A Single High-Volume Reproductive CenterDefining the Learning Curve is Necessary to Improve Oocyte Retrieval Skills: Lessons from A Single High-Volume Reproductive Center

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