Three Essays on Surgeons’ Learning Effects: Workplace Mobility, Prior Experiences and Adaptive Learning Phase

• Main Authors: Yu-Ning Chein, 簡毓寧
• Other Authors: 陸怡蕙
• Format: Others
• Language: zh-TW
• Published: 2014
• Online Access: http://ndltd.ncl.edu.tw/handle/8uf65a

博士 === 國立臺灣大學 === 農業經濟學研究所 === 102 === This thesis includes three empirical studies on the learning effect of surgeons: Essay 1: (Chapter 2 in this study) An Analysis of Surgeons’ Learning Effect Accounting for the Impact of Workplace Switching Drawn from Taiwan’s National Health Insurance Database (NHID), data with inpatients underwent the uterine-leiomyoma-causing hysterectomy surgery during 1997-2008 are used to evaluate the association between surgical volume and outcome. We focus on examining the volume-outcome relationship from two distinct perspectives. The first involves the learning differences between switching and non-switching surgeons. The second concerns switching surgeons’ mean differences in learning rate during the pre- and post-switching periods. Our result confirms the persistence of performance improvement as surgeons’ trials accumulate, but find no significant learning differences between the non-switching and switching surgeons evaluated at the pre-switching period. Furthermore, in addition to hospital accreditation, an upward switching such as from the regional hospitals into the medical centers and from the district hospitals into the regional hospitals or medical centers, are found to explain the variations in learning rates among hysterectomy surgeons. Essay 2: (Chapter 3 in this study) Determinants of Surgical Performance: Taking Surgeons’ Prior Experiences and Hospital Accreditation into Account Adapting the “personal mastery” essence of the learning organization and based on the theory of human resource development, this study examines the determinants of the volume-outcome relationship for the abdominal total hysterectomy with a special emphasis on surgeons’ out-of-sample experience and hospital-specific capital. It is found that regardless of out-of-sample prior experience, hysterectomy surgeons in large hospitals on average exhibit improvement in surgical outcome with the increase in accumulated volume, and only those starting out as a junior physician during the sample period experience a positive learning effect in spite of affiliated hospital accreditation. The result not only demonstrates the significance of prior experience and hospital specialty on hysterectomy surgeons’ learning and surgical outcome, it also offers a plausible explanation to the organizational learning differences observed in previous research. Essay 3: (Chapter 4 in this study) Hysterectomy Surgeons’ Adaptive Learning Phase: Evidence from Abdominal and Laparoscopic Surgeries This study examines the adaptive learning phases of the dynamic learning process in hysterectomy surgeries. The data used in this study is taken from Taiwan’s National Health Insurance Database (NHID). Only inpatients underwent the hysterectomy surgery in medical center as a result of uterine-leiomyoma during the time period of 1997-2008 were selected into our final sample. Rolling-window OLS (ordinary least squares) estimation with consecutive windows of 25, 30, 35, 40, 45, and 50 patients, respectively, is used to illustrate surgeons’ S-shaped learning pattern. Taking the TAH and LH surgeries as an example, this study provides evidences supporting the presence of the adaptive phase in hysterectomy surgeons’ dynamic learning process. Moreover, it is found that the duration for slow learning is consistently long for the two types of hysterectomy surgery. A comparison of the abdominal as well as laparoscopic surgeries suggests that the duration of the adaptive phases for LH is shorter than that of the TAH.