Five Key Messages

1. The learning curve plots improvement in surgical performance as a function of increasing experience.

2. Individuals progress along the learning curve at different rates.

3. Simulation training can decrease the length of the learning curve for trainees prior to entering the operating room.

4. Proficiency-based rather than time- or case-based simulation curricula are most effective in ensuring that individuals meet learning goals.

5. Effective simulation training is a cost-effective measure for teaching trainees surgical skills.

Defining the Learning Curve

The learning curve, described as the change in rate of learning in a specific task for the average individual, was first described in 1885 by German psychologist Hermann Ebbinghaus in his studies of human memory (1). Ebbinghaus's characterisation of the learning curve was based on his observation that the time required to perform verbal tasks increased as the task difficulty increased. The first mathematical model of the learning curve was developed to illustrate work productivity in aviation when Wright determined that as the production of aircraft increased, cost decreased (2). The learning curve model has since been broadened to describe the decrease in cost, be it financial, temporal, physical or mental, associated with the increased repetitions of a task.

Within surgical education, the concept of a learning curve has been described for both real and simulated operative procedures, showing improvement of technical skill as a function of procedural repetition (3–6).