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Fellowship training as a modifier of the surgical learning curve.
Acad Med. 2010 May; 85(5):863-8.AM

Abstract

PURPOSE

To investigate the effects of fellowship training on a surgeon's learning curve for cancer control after open radical prostatectomy.

METHOD

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.

RESULTS

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).

CONCLUSIONS

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.

Authors+Show Affiliations

Columbia University Division of Urology, Mount Sinai Medical Center, Miami Beach, Florida, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

20520043

Citation

Bianco, Fernando J., et al. "Fellowship Training as a Modifier of the Surgical Learning Curve." Academic Medicine : Journal of the Association of American Medical Colleges, vol. 85, no. 5, 2010, pp. 863-8.
Bianco FJ, Cronin AM, Klein EA, et al. Fellowship training as a modifier of the surgical learning curve. Acad Med. 2010;85(5):863-8.
Bianco, F. J., Cronin, A. M., Klein, E. A., Pontes, J. E., Scardino, P. T., & Vickers, A. J. (2010). Fellowship training as a modifier of the surgical learning curve. Academic Medicine : Journal of the Association of American Medical Colleges, 85(5), 863-8. https://doi.org/10.1097/ACM.0b013e3181d73a45
Bianco FJ, et al. Fellowship Training as a Modifier of the Surgical Learning Curve. Acad Med. 2010;85(5):863-8. PubMed PMID: 20520043.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fellowship training as a modifier of the surgical learning curve. AU - Bianco,Fernando J, AU - Cronin,Angel M, AU - Klein,Eric A, AU - Pontes,J Edson, AU - Scardino,Peter T, AU - Vickers,Andrew J, PY - 2010/6/4/entrez PY - 2010/6/4/pubmed PY - 2010/7/16/medline SP - 863 EP - 8 JF - Academic medicine : journal of the Association of American Medical Colleges JO - Acad Med VL - 85 IS - 5 N2 - PURPOSE: To investigate the effects of fellowship training on a surgeon's learning curve for cancer control after open radical prostatectomy. METHOD: 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. RESULTS: 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). CONCLUSIONS: 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. SN - 1938-808X UR - https://www.unboundmedicine.com/medline/citation/20520043/Fellowship_training_as_a_modifier_of_the_surgical_learning_curve_ L2 - https://doi.org/10.1097/ACM.0b013e3181d73a45 DB - PRIME DP - Unbound Medicine ER -