How Many Cases Does It Take to Become a Master?

How Many Cases Does It Take to Become a Master?

Technical Proficiency in Hand-Assisted Laparoscopic Colon and Rectal Surgery: Determining How Many Cases Are Required to Achieve Mastery

Pendlimari R, Holubar SD, Dozois EJ, Larson DW, Pemberton JH, Cima RR
Arch Surg. 2012;147:317-322

Summary

How long does it take to master the technique of hand-assisted colorectal procedures? The authors used change-point analysis, a statistical procedure based on operative time as an indicator of technical proficiency, to study the number of operations necessary to achieve mastery for 2 surgeons as they sequentially performed hand-assisted laparoscopic colorectal surgery. For surgeon A, the change point occurred at the 108th procedure; for surgeon B, it was at the 105th procedure. After the change point had been reached, there were significant reductions in morbidity (P = .02), readmission rate (P = .03), and length of stay (P ≤ .001).

Viewpoint

Previous studies have suggested that experience with about 25 procedures would be sufficient to achieve technical proficiency with hand-assisted laparoscopic colorectal surgery. This study used a different endpoint: becoming a master surgeon. Here, the estimated number of procedures -- approximately 100 -- was much greater. The implication is that even after technical proficiency is gained, achieving master status will take much more time. As all surgeons know, experience counts.

Abstract