SSAT - LEARNING CURVE TRAJECTORY: A RETROSPECTIVE OBSERVATIONAL COHORT STUDY OF CURRICULUM CONCORDANCE AND COMPETENCE

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LEARNING CURVE TRAJECTORY: A RETROSPECTIVE OBSERVATIONAL COHORT STUDY OF CURRICULUM CONCORDANCE AND COMPETENCE
Chris Brown^*, Tarig Abdelrahman, Neil Patel, Charlotte Thomas, Arfon G. Powell, John Pollitt, Tim Havard, Xavier Escofet, Wyn G. Lewis
University Hospital of Wales, Cardiff, United Kingdom

Background: Certification of completion of training (CCT) in general surgery requires demonstration of competence in index operations by means of 3, level 4 competence’ (L4C) consultant validated procedural-based assessments (PBAs). The aim of this study was to evaluate the trajectory of operative learning curves related to PBA performance levels for curriculum defined indicative operations related to numbers performed, and training time.
Methods: Consecutive 84 Higher General Surgical trainee (HST) logbook data was compared with PBA evaluations to determine the relationship between PBA performance level, operative experience, training time, and indicative numbers. Learning curve gradients were calculated (LCG) using the inverse trigonometric function of tan related to operative experience and training time.
Results: Median (range) caseload to achieve 3 L4C were; IH 64 (18 - 110), EL 83 (15 - 177), LC 87 (23 - 192), APX 95 (22 - 209), SC 45 (17 - 111) and HP 16 (6 - 28). Median LCGs to achieve L4C by caseload vs. training time were; Inguinal Hernia (IH) 27.8° vs. 29.7°, Emergency Laparotomy (EL) 15.3° vs. 33.7°, Laparoscopic Cholecystectomy (LC) 15.3° vs. 33.7°, Appendicectomy (APX) 16.2° vs. 34.5°, Segmental Colectomy (SC) 48.0° vs. 42.7°, Hartmann’s Procedure (HP) 73.3° vs. 59.9°. Significant variance was observed between learning curve trajectories for all operations whether by operative experience (p=0.001), or training time (p=0.025).
Conclusion: Significant three-fold LCG variance was observed together with discrepancies between expected indicative numbers and the median point at which competence was judged achieved; consequently CCT targets warrant further examination.

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