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Invited Critique |

Doctor, How Many Have You Done?  Comment on “Impact of Surgeon Experience on 5-Year Outcome of Laparoscopic Nissen Fundoplication”

E. Christopher Ellison, MD
Arch Surg. 2011;146(3):347. doi:10.1001/archsurg.2011.33.
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Patients expect their surgeons to be proficient at the procedures that they will undergo. They relate volume with increasing levels of skill acquisition. The Dreyfus model of skill acquisition defines 5 levels of skill: novice, advanced beginner, competent, proficient, and expert. Mastering an operation is a complex learning event requiring acquisition of technical skill, visual-spatial and tactile skills, ability to differentiate abnormal from normal tissues and organs, and judgment. These are learned over time by cumulative operative experience. In addition, there is likely some transferable skill between operations. How many operations does it take to become proficient?

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