Let’s Discuss Learning Curves

Learning curves are often referred to in the context of education and training, but in medical discussions their duration and importance is debated. The fact remains that learning curves exist, and they have an impact on intraoperative adverse events, time of surgery and long term outcome.

When learning a new procedure, performance tends to improve with experience, and by drawing the increase in skill during time and experience the image of a learning curve appears.  As with everything, our early attempts are filled with mistakes and errors. While we in the later stages of a learning curve improve our outcomes and reduce the mistakes, at the same time, speed up our time used to complete the task. This concept applies across the full spectrum of medical specialities and procedures, and there are many studies mentioning learning curve. However very few studies have actively removed the procedures done during learning curve from the actual end results: when evaluating a new product or procedures this means we have flawed the data, but more on this later.

Two things have dramatically changed in the last decade: The introduction of minimally invasive techniques that tend to be more technically challenging, and the rate of introduction of new products and innovations.

 The clinical importance of this was brought into stark relief by the General Medical Council inquiry into the Bristol Paediatric Surgical Unit, which stated that patients should not be exposed to surgeons operating during the early phase of their learning curves. Yet, doctors continue to learn using patients as their practice tools. This is where London Medical Education Academy is aiming to provide an ethical and affordable alternative by offering hands on surgical training using fresh frozen cadavers.

Donors who generously give their body to medical teaching understand the importance of being able to practice in a safe environment where nobody can be harmed, and realise that the gift they give will be helping patient and doctors for many years following their own passing.

Consultant appointments in the NHS, in the UK,  occur after a defined training period. However, outcomes improve with experience and trainees will be appointed to consultant posts while still on several different learning curves, having not yet completed their initial learning curve for certain procedures. In this environment, the challenge becomes providing enough time to allow further education and funding, to allow continued medical education to strengthen the skills.

Published papers on the topic makes the statement that appointed consultants must recognise the need for continuing post‐accreditation training, structured appraisal and senior mentors, in order to facilitate continuing medical education so that acceptable outcomes may be achieved and maintained. From a legal perspective, the importance of learning curve in the current climate is highly relevant, and further discussion on this topic is needed.