Rosemont, Ill., April 30, 2024 (GLOBE NEWSWIRE) -- In an April editorial called “The Fallacy of the 'Learning Curve,’” in Foot & Ankle International (FAI), a scientific journal for foot and ankle orthopaedic surgeons, FAI senior editors explained their decision to no longer accept learning curve studies in the journal and to instead encourage surgeons to strive for lifelong learning and continuous improvement.
Learning curve studies in foot and ankle orthopaedic surgery review the learning curve, or the rate of a surgeon’s competence, for specific patient procedures. These procedures may include implants, novel techniques, or adoption of new technology. Typically, these studies equate surgical competence or proficiency with the time it takes to perform a procedure, the number of X-rays taken, and rates and types of complications from the procedure.
Charles L. Saltzman, MD, editor-in-chief of FAI and one of the authors of the editorial, said the concept of learning curve studies is flawed for several reasons, including that surgical proficiency cannot be measured by surgical time.
“Surgical time does not necessarily equate to surgical competence or to quality outcomes,” wrote the FAI senior editors in the editorial. “Surgical time is a multifaceted measure of a complex interworking of surgeons, nurses, anesthesia providers, assistants, and radiology technicians, as well as the timely availability of surgical equipment and implants.”
Other benchmarks in learning curve studies that the senior editors questioned include case volume, predefined checklists, and operative simulations that may help surgeons practice new techniques but do not directly translate into a clinical setting with real patients.
“The generalizability of such data is poor, inadequately reflecting care by all surgeons in various settings,” Dr. Saltzman said. “Meaning—every surgeon is always learning and getting better. The progress of one surgeon and their actual practice is not generalizable to another.”
Instead, Dr. Saltzman said that benchmarks of proficiency in a surgical procedure should relate to the ability to consistently improve patients’ physical function and quality of life, not how many X-rays the surgeon takes in an operating room or how fast they can perform the surgery.
Based on his experience mentoring surgeons for the last three decades, Dr. Saltzman noted that all surgeons learn at different rates.
“The goal of a surgeon is to always get better—and that can be measured in terms of clinical outcomes,” Dr. Saltzman said. “Each surgeon has the responsibility to review their own results rather than compare the number of cases they have done to some published paper with a conceptually flawed benchmark.”
In addition to Dr. Saltzman, the editorial was authored by John T. Campbell, MD; George B. Holmes Jr., MD; Christopher P. Chiodo, MD; Thomas O. Clanton, MD; Ellie Pinsker, PhD; Stefan Rammelt, MD, PhD; and Robert A. Vander Griend, MD.
As the authors concluded, “The journey of surgical learning is endless. Mastery in surgery is an asymptotic goal, rather than an achievable endpoint.”
To read the full editorial, click here, and to read the April FAI monthly edition, go to https://journals.sagepub.com/toc/FAI/45/4.
About Foot and Ankle Orthopaedic Surgeons
Foot and ankle orthopaedic surgeons are medical doctors (MD and DO) who specialize in the diagnosis and treatment of musculoskeletal disorders and injuries of the foot and ankle. Their education and training consist of four years of medical school, five years of postgraduate residency, and a fellowship year of specialized surgical training. These specialists care for patients of all ages, performing reconstructive surgery for deformities and arthritis, treating sports injuries, and managing foot and ankle trauma.
About the AOFAS
The American Orthopaedic Foot & Ankle Society (AOFAS) mobilizes our dynamic community of foot and ankle orthopaedic surgeons to improve patient care through education, research, and advocacy. As the premier global organization for foot and ankle care, AOFAS delivers exceptional events and resources for continuous education, funds and promotes innovative research, and broadens patient understanding of foot and ankle conditions and treatments. By emphasizing collaboration and excellence, AOFAS inspires ever-increasing levels of professional performance leading to improved patient outcomes. For more information visit the American Orthopaedic Foot & Ankle Society online at aofas.org.
About Foot & Ankle International
Foot & Ankle International (FAI), published since 1980, is the official journal of the American Orthopaedic Foot & Ankle Society (AOFAS). This monthly medical journal emphasizes surgical and medical management as it relates to the foot and ankle with a specific focus on reconstructive, trauma, and sports-related conditions utilizing the latest technological advances. FAI offers original, clinically oriented, peer-reviewed research articles presenting new approaches to foot and ankle pathology and treatment, current case reviews, and technique tips addressing the management of complex problems. Learn more at journals.sagepub.com/home/fai.
