Learning curves in minimally invasive esophagectomy

Surgical innovation and pioneering are important for improving patient outcome, but can be associated with learning curves. Although learning curves in surgery are a recognized problem, the impact of surgical learning curves is increasing, due to increasing complexity of innovative surgical procedures, the rapid rate at which new interventions are implemented and a decrease in relative effectiveness of new interventions compared to old interventions. For minimally invasive esophagectomy(MIE), there is now robust evidence that implementation can lead to significant learning associated morbidity(morbidity during a learning curve, that could have been avoided if patients were operated by surgeons that have completed the learning curve). This article provides an overview of the evidence of the impact of learning curves after implementation of MIE. In addition, caveats for implementation and available evidence regarding factors that are important for safe implementation and safe pioneering of MIE are discussed.

Web-based system for training and dissemination of a magnification chromoendoscopy classification

AIM： To evaluate the use of web-based technologies to assess the learning curve and reassess reproducibility of a simplified version of a classification for gastric magnification chromoendoscopy （MC）. METHODS： As part of a multicenter trial, a hybrid approach was taken using a CD-ROM, with 20 films of MC lasting 5 s each and an ＂autorun＂ file triggering a local HTML frameset referenced to a remote questionnaire through an Internet connection. Three endoscopists were asked to prospectively and independently classify 10 of these films randomly selected with at least 3 d apart. The answers were centrally stored and returned to participants together with adequate feedback with the right answer. RESULTS： For classification in 3 groups, both intra- [Cohen＇s kappa （K） = 0.79-1.00 to 0.89-1.00] and inter-observer agreement increased from 1st （moderate） to 6th observation （k = 0.94）. Also, agreement with reference increased in the last observations （0.90, 1.00 and 1.00, for observers A, B and C, respectively）. Validity of 100% was obtained by all observers at their 4th observation. When a 4th （sub）group was considered, inter-observer agreement was almost perfect （K = 0.92） at 6th observation. The relation with reference clearly improved into K （0.93-1.00） and sensitivity （75%-100%） at their 6th observations. CONCLUSION： This MC classification seems to be easily explainable and learnable as shown by excellent intra- and inter-observer agreement, and improved agreement with reference. A web system such as the one used in this study may be useful for endoscopic or other image based diagnostic procedures with respect to definition, education and dissemination.

From Grammar to Critical Thinking in Seven Steps at 2013 KOTESOL DCC Symposium

＂From Grammar to Critical Woosong University, 2013 Thinking in Seven The purpose of the Steps＂ was presented at the 2013 KOTESOL DCC Symposium, project was to accelerate the learning curve of students with a higher than average IQ （intelligence quotient）, but functionally low in English. The students were required to write an essay, in the last hour of a four hour class. The students were challenged to fix sentences, write the reason they chose, and speak their answer. To determine if this was a one book idea, another test was tried with regular students, using an off the shelf grammar book. Using the same step by step process, the ability of students to make a story from a standard grammar book, was accomplished in a 90-minute class. Students enjoyed the activity and were able to use previously learned ideas in their sequencing and logical choices. This in turn strengthened the writing process, which was the goal. After four sessions, students in the initial trial class achieved better writing and story development skills. The second group did not continue the process due to class and schedule changes. Their understanding of the process was enlarged, but not tested