The Next Generation: Surgeon Learning Curve in a Mature Operative Rib Management Program

Area of Science:

• Trauma Surgery
• Surgical Education
• Thoracic Surgery

Background:

• Operative time is a validated metric for assessing surgeon learning curves in surgical stabilization of rib fractures (SSRF).
• Previous studies have not evaluated the impact of proctoring on the learning curve for subsequent generations of surgeons in SSRF.
• This study investigates the efficacy of proctoring in accelerating surgeon learning for SSRF.

Purpose of the Study:

• To compare the learning curves of self-taught surgeons (TOS) versus proctored surgeons (TNG) for SSRF.
• To determine if proctoring accelerates the learning curve for SSRF.

Main Methods:

• A retrospective review of SSRF cases at a level 1 trauma center was conducted over 7 years.
• Cumulative summation (CUSUM) analysis of operative times was used to assess learning curves.
• Learning curves were compared between the original series (TOS) and the next generation (TNG) of surgeons.

Main Results:

• A total of 163 patients underwent SSRF, with a median Injury Severity Score of 24.
• TOS surgeons exhibited early learning "missteps" (positive CUSUM slope) in their initial cases.
• TNG surgeons, benefiting from proctoring, demonstrated early successes (negative CUSUM slope).
• The composite cumulative score for TNG surgeons was significantly lower than for TOS surgeons by the end of the study period.

Conclusions:

• Operative time remains a reliable surrogate for evaluating SSRF learning curves.
• Proctored novice surgeons (TNG) show an accelerated learning curve compared to self-taught novice surgeons (TOS) in a mature program.
• Proctoring is an effective method for enhancing surgical skill acquisition in SSRF.