An Umbrella Review of Systematic Reviews Evaluating Learning Curves for Surgical Procedures

The surgical learning curve is a critical component of surgical innovation. However, currently there is no standardised way to report or measure it. This umbrella review aims to identify and synthesise the terminology, data items, and methods used to define, describe and illustrate the learning curves for surgical procedures.MethodsAn umbrella review of systematic and scoping reviews was conducted using searches in Ovid MEDLINE, Embase, Cochrane Library, and Epistemonikos from January 2010 to January 2023. Eligible reviews examined the learning curve of a procedure, technique, or device. Data extracted included review characteristics, terminology and definitions, surgeons' learning experience, and data items used to measure the learning curve. Methodological quality was assessed using AMSTAR-2.ResultsSixty-two reviews were included, covering 1990 unique studies. A definition of the learning curve was provided in 39 reviews (63%). Sixteen additional related terms (eg, proficiency, competency, plateau) were identified, though definitions were often not provided. Surgeons' expertise was reported in 39 reviews (63%), with 19 (31%) specifying training grades. Across all reviews, 712 unique data items were identified, most commonly intra-operative metrics (n = 336, 47%), of which 42% were time-related (n = 142). Most reviews were rated as low (n = 15) or critically low (n = 45) quality.ConclusionOverall, there is substantial variability in definitions, terminology, and data items used to describe the surgical learning curve. This heterogeneity limits evidence synthesis and complicates identification of meaningful measures. The identified data items will support development of a core data set for describing and measuring learning curves for surgical procedures.