The Learning Curve in Surgical Practice and Its Applicability to Rhinoplasty

The learning curve as a concept has been considered, discussed and debated in medical education and healthcare for over two decades. The precise usage has been recognised in surgical disciplines both broad specialties and sub-specialties. Rollin Daniel in his book stated that, rhinoplasty is the most difficult of all cosmetic operations for three reasons, (a) nasal anatomy is highly variable, (b) the procedure must correct form and function and (c) the final result must meet the patients expectations. With this in mind a study was carried on the perception of learning curve in rhinoplasty based on a surgeon questionnaire at Marien Hospital, Stuttgart, Germany under Prof. Gubisch. Aims of the study were, (1) to extract the perception of learning curve of Rhinoplasty from surgeons across a spectrum of experience, i.e. less experienced to experienced, (2) To calculate the perception of learning curve in rhinoplasty as for other surgical procedures i.e. minimum number, interquartile range, surgical time, accelerators, (3) To chart-out a road-map for a novice rhinoplasty surgeon for continued improvement in surgical skills and ability. The conclusion derived was the concept of learning curve in rhinoplasty cannot be applied to the operation of Septo-Rhinoplasty as a whole because the two factors i.e. interquartile range and minimum number to achieve proficiency have a wide range and cannot be generalized. It is thought that each type of Rhinoplasty should be dealt with separately and learning curve calculated accordingly, i.e. hump reduction, crooked nose and augmentation rhinoplasty.