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March 16, 1994

The Learning Curve

Author Affiliations

Duke University Medical Center Durham, NC

JAMA. 1994;271(11):825. doi:10.1001/jama.1994.03510350032027

To the Editor.  —I appreciate the recent essay by Gaster1 and the editorial response2 concerning the learning curve involved in new procedures such as laparoscopic cholecystectomies. The response by Hatlie2 in examining the potential liability incurred in the learning of this procedure was informative. Nevertheless, there is another area of this particular issue that has been left unexplored and contributes both to the problem and its potential solution.The certification of various procedures throughout the medical field is not generally subject to peer review or evaluation by medical educators. Certification, in fact, can often be assumed at random by any group that wishes to assume it. If the course in which the procedure is taught is certified for continuing medical education credit, then at least there will have been review by the local body accredited to approve programming of this sort. Nevertheless, postgraduate medical education in this

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