Wednesday, August 16, 2017

Should a learning curve be allowed in medical education today?

Dr KK Aggarwal

For a doctor, it’s not enough to just know facts; application of that knowledge into clinical skills is even more important. Traditionally, medical students have relied on acquiring these skills by learning on real patients during their clinical postings as undergraduates and then as part of postgraduate training.

In this hands-on, often experimental, way of learning, raises ethical and legal concerns.

Mistakes are bound to occur during the learning process. We learn from our mistakes more than our successes. But patients today are empowered and enlightened. They are unwilling to accept this experimentation on their body. Primum non cere – “above all, do no harm” is fundamental to the practice of medicine.

We do cadaveric dissections to learn anatomy. But, surgical procedures are learned on live cases. When we learn something new, performance improves with experience... as also with a surgical procedure, where complication rates depend on the experience of a surgeon. There is therefore a learning curve.

An expert surgeon is defined by the number of similar surgeries done; complication rates, success rates, re-hospitalization rates are all factors that also define an expert surgeon. Patients today can ask the doctors to disclose these numbers before consenting to a procedure.

A single center study published in the year 2013 in the journal Circulation reported that
75-125 minimally invasive mitral valve surgeries were required to be performed by an average cardiac surgeon to gain mastery in the procedure. And, more than one such surgery per week was required to maintain good results.

In this age of digitization, all procedure-based skills should now be learnt via simulation lab. Although they are not a replacement for the actual patient-based operative experience, simulation labs provide a safe environment for learning. Practicing on a simulator, which has all possible simulations of a variety of real life clinical scenarios, ranging from low to high fidelity, shortens the learning curve and avoids “preventable” errors.

Learning by trial and error is no longer a feasible approach in this age of patient-centric medicine, where doctors have to work with patients as equal partners.

Simulation-based training is the need of the hour in both undergraduate and postgraduate studies and even continuing medical education, when students and doctors can refine their knowledge, skills, without compromising patient safety.

Disclaimer: The views expressed in this write up are entirely my own.

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