Foot & Ankle International (FAI) Journal will no longer publish ‘learning curve’ studies
April 30 2024 - 5:30PM
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 SurgeonsFoot
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 AOFASThe 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 InternationalFoot &
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.
Elizabeth Edwards
American Orthopaedic Foot & Ankle Society (AOFAS)
618-795-4824
eedwards@aofas.org