US Congressional Budget Office, District of Columbia, USA.
Health Econ. 2011 Jun;20(6):699-722. doi: 10.1002/hec.1626.
In this article, we use a longitudinal census of laser in situ keratomileusis (LASIK) eye surgeries collected directly from patient charts to examine the learning-by-doing hypothesis in medicine. LASIK surgery has precise measures of presurgical condition and postsurgical outcomes. Unlike other types of surgery, the impact of unobservable underlying patient conditions on outcomes is minimal. Individual learning by doing is identified through observations of surgical outcomes over time, based on the cumulative number of surgeries performed. Collective learning is identified separately, through changes in a group adjustment rule determined jointly by all the surgeons in a structured internal review process. Our unique data set overcomes some of the measurement problems in patient outcomes encountered in other studies and improves the possibility of identifying and separating the impact of learning by doing from other effects. We cannot conclude that the outcome of LASIK surgery improves as an individual surgeon's experience increases, but we find strong evidence that experience accumulated by surgeons as a group in a clinic significantly improves outcomes.
在本文中，我们使用直接从患者图表中收集的激光原位角膜磨镶术 (LASIK) 眼科手术的纵向普查，来检验医学中的边做边学假说。LASIK 手术对术前状况和术后结果有精确的衡量标准。与其他类型的手术不同，不可观察的潜在患者状况对结果的影响最小。个体通过随着时间推移的手术结果观察来进行经验积累，这是基于所执行手术的累计数量来确定的。通过所有外科医生在结构化内部审查过程中共同确定的小组调整规则的变化，来单独确定集体学习。我们独特的数据集克服了其他研究中在患者结果中遇到的一些测量问题，并提高了从其他影响中识别和分离边做边学影响的可能性。我们不能得出 LASIK 手术的结果随着单个外科医生经验的增加而提高的结论，但我们发现有强有力的证据表明，一个诊所的外科医生集体积累的经验显著提高了手术结果。
