title: Is the learning curve for laparoscopic fundoplication determined by the teacher or the pupil?
abstract: BACKGROUND
  For all surgical procedures, a surgeons' learning curve can be anticipated during which complication rates are increased. The aims of this study were to evaluate individual learning curves for a group of surgeons performing laparoscopic fundoplication and to evaluate if the Procedicus MIST-simulator (Mentice Inc., Göteborg, Sweden) accurately predicts surgical performance.
  
  
  METHODS
  Twelve Nordic centers participated, each contributing with a "master" and a "pupil" surgeon. The pupils were tested in the simulator and thereafter performed their first 20 supervised operations. All procedures were videotaped and evaluated by 3 independent reviewers.
  
  
  RESULTS
  A significant decrease in operative time (P <0.001) and a trend (P = 0.12) toward improved score were seen during the series. The master significantly affected the pupil's score (P =0.0137). The simulator-test showed no correlation with the operative score.
  
  
  CONCLUSIONS
  Individual learning curves varied, and the teacher was shown to be the most important factor influencing the pupil's performance score. The correlation between assessed performance and patient outcome will be further investigated.
authors.affiliation: Department of Surgery, Karolinska Hospital, SE-171 76 Stockholm, Sweden. gunna.ahlberg@karolinska.se
authors.forename: Gunnar
authors.initials: G
authors.lastname: Ahlberg
authors.forename: Olli
authors.initials: O
authors.lastname: Kruuna
authors.forename: Carl-Eric
authors.initials: CE
authors.lastname: Leijonmarck
authors.forename: Jari
authors.initials: J
authors.lastname: Ovaska
authors.forename: Arne
authors.initials: A
authors.lastname: Rosseland
authors.forename: Rune
authors.initials: R
authors.lastname: Sandbu
authors.forename: Cecilia
authors.initials: C
authors.lastname: Strömberg
authors.forename: Dag
authors.initials: D
authors.lastname: Arvidsson
mesh_terms: D003198:Computer Simulation; D018662:Fundoplication / Q000379:methods / Q000592:standards*; D005764:Gastroesophageal Reflux / Q000601:surgery; D013502:General Surgery / Q000193:education*; D006801:Humans; D010535:Laparoscopy / Q000379:methods / Q000592:standards*; D007858:Learning; D011361:Professional Competence; D013647:Task Performance and Analysis; D013997:Time Factors; D014741:Video Recording