Related Experiment Video
Updated: Jun 20, 2026
08:21
Utilizing a 3D Printed Laparoscopic Nissen Fundoplication Model to Shorten a Resident's Learning Curve
Published on: August 15, 2025
Learning by doing, scale effects, or neither? Cardiac surgeons after residency
1Fuqua School of Business, Duke University, 1 Towerview Drive, Durham, NC 27708-0127, USA. m.huesch@duke.edu
Health Services Research
|September 8, 2009
Summary
For new cardiac surgeons performing coronary artery bypass grafts (CABG), neither surgeon experience nor patient volume significantly improved patient outcomes. Evidence for "learning by doing" was not found, suggesting potential for volume redistribution.
Area of Science:
- Cardiovascular Surgery
- Health Services Research
- Surgical Outcomes
Background:
- Postresidency cardiac surgeons, often termed "new" surgeons, face scrutiny regarding their impact on patient outcomes.
- Understanding the influence of surgeon experience and patient volume is crucial for optimizing care quality in coronary artery bypass grafting (CABG).
Purpose of the Study:
- To investigate the relationship between surgeon scale, cumulative experience, and postoperative outcomes in "new" cardiac surgeons performing CABG.
- To determine if "learning by doing," scale, or selection effects are evident in early-career CABG surgeons.
Main Methods:
- Analysis of administrative data for 19,978 adult CABG patients in Florida (1998-2006).
- Inclusion of data on 57 cardiac surgeons completing residencies after 1997.
- Utilized pooled linear, fixed effects panel, and instrumented regressions, controlling for patient risk, hospital factors, and surgeon characteristics, with "forgetting" effects incorporated into experience estimation.
Main Results:
- Neither surgeon scale nor cumulative surgical volume demonstrated a significant impact on mortality or consistent effects on morbidity.
- Analysis accounting for "forgetting" indicated rapid depreciation of prior experience.
- Instrumental variables were strong, but the exogeneity of surgical volume was not rejected.
Conclusions:
- No compelling evidence supports "learning by doing," scale, or selection effects in postresidency cardiac surgeons performing CABG.
- Further research is warranted to explore the potential for redistributing patient volume among "new" surgeons based on observed outcomes without negatively impacting care.
