P Pottier, T Dejoie, J B Hardouin, A G Le Loupp, B Planchon, A Bonnaud, V R Leblanc
Effect of stress on clinical reasoning during simulated ambulatory consultations
Medical teacher
remains uncertain surgeons safely pass learning curve laparoscopic pancreatoduodenectomy lpd without potentially harming patients aimed develop difficulty scoring system dss select appropriate patient surgeons total 773 elective pancreatoduodenectomy surgeries july 2014 december 2019 including 346 lpd 427 open pancreatoduodenectomy cases included 10level dss lpd developed additional 77 consecutive lpd surgeries could provide information learning stage lpd externally validated performance december 2019 december 2021 incidences postoperative complications claviendindoiii gradually decreased learning curve stage iiii 2000 1094 579 p 0008 respectively dss consisted following independent risk factors 1 tumor location 2 vascular resection reconstruction 3 learning curve stage 4 prognostic nutritional index 5 tumor size 6 benign malignant tumor weighted cohens statistic concordance reviewers calculated difficulty score index 0873 c statistics dss postoperative complication claviendindoiii 0818 learning curve stage patients dss5 lower postoperative complications claviendindoiii dss5 4354118 p 0004 training cohort lower postoperative pancreatic fistula 19235714 p 00352 delayed gastric emptying 19237143 p 0001 bile leakage rate 0002143 p 00368 validation cohort learning curve stage developed validated difficulty score model patient selection could facilitate stepwise adoption lpd surgeons different stages learning curve