A Study of the Related-factors that Affect the Surgeons’ Learning Curves¬¬: Using Laparoscopic Cholecystectomy as an Example

• Main Authors: Chih-Wei Chen, 陳之薇
• Other Authors: 鍾國彪
• Format: Others
• Language: zh-TW
• Published: 2009
• Online Access: http://ndltd.ncl.edu.tw/handle/50699390330836594598

碩士 === 國立臺灣大學 === 醫療機構管理研究所 === 97 === Introduction: The purpose of this study was to determine what effects the surgeons’ learning curve. The learning process of a surgeon seems to follow the learning curve; hence, there are abundance research about the relation between surgery procedures and learning curves. Recently, laparoscopic surgery is one of the most common topics examined among learning curve issues. This new surgery requires a different training program and has impact on the learning process of surgeons. In recent years, most related research based their analysis using database. As there were some limitations on the data period, the complete information may not have been represented. In addition, it is difficult to know the viewpoint and perception of surgeons based on the database. This study uses laparoscopic surgery as an example and was design to investigate the learning curve of surgeon by studying the important related-factors affecting the learning curve of surgeons. Methods: A three-page, 52-item questionnaire was developed after reviewing existing literatures and was modified by 3 experts and though pretest process. The questionnaire was designed to investigate the factors that have influenced the surgeons’ learning curves. This is a cross-sectional study. After looking for cooperation with hospitals and approved by some Institution Review Broad, there are 34 hospital included 10 academic medical centers, 20 regional hospitals, 4 district hospitals agreed to participate in this study. The participants of this study were general surgeons. There were 155 valid samples with collection period from April 29 to June 22, 2009. Results: The study results show how many procedures of laparoscopic cholecystectomies could pass the learning curve to achieve a steady performance from 5 to 100 in surgeons’ point of view, and average procedure is 38. After chi-square and logistic regression analysis, it shows that surgeons who are more experience or have receive more training program think that it does not need much procedures to reach the learning curve. It also shows that the improvement of operative time has significant positive related with the accumulated volumes of open surgery, and the improvement of complication rate has significant positive related with the experience of other laparoscopic surgery. In addition, it shows new technical training model such as surgical trainer, virtual reality simulator training and video cources have significant related with variables of learning curve, which indicates these training model do help and accelerate the learning curve. Recommendations:Recommendations for study in the future included: first, adopt longitudinal study to compare the result of different time points; second, cooperated with case hospital and use some clinical data to compare the result from objective and subjective viewpoint; third, using different laparoscopic surgery as an example to study the learning curve.