Annex A > Chapter 14 - Care in the Operating Theatre and the `Learning Curve' > The `learning curve' > New procedures

New procedures

58 Referring to new procedures Mr Wisheart, in his written evidence to the Inquiry, stated:

`There is a constant stream of new or modified procedures being described in the literature and at the national and international surgical meetings. The great majority of these are simply an incremental change (a change of detail) and only a very small minority represent a major (or radical) change in technique, instrumentation or the methods of managing operations.' [73]

59 Mr Wisheart went on:

`The vast majority of new techniques or modifications of techniques can be understood and carried out from knowledge acquired from journals, meetings or discussions.' [74]

60 Mr Wisheart stated that `a major or radical change' occurred when:

`... an innovation is described which is radically different from anything that has gone before.' [75]

He cited keyhole surgery as an example of a major change.

61 Mr Wisheart suggested a third category:

`There are new procedures which cannot really be described as representing an incremental change nor are they quite as radical as the ones I have described under the heading Major; they could be classified as Intermediate. The Fontan operation and its evolving modifications could be included under this heading.' [76]

62 Dr Brian Williams, consultant anaesthetist, stated:

`When a new procedure was introduced the recognised process was to learn by reading about it, watching it be performed and then putting it into practice either with or without supervision depending on the complexity. Simulation was not available at the time. Ethical approval from the local research and ethics committee would be required to institute research of a new technique previously untried.' [77]

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Footnotes

[73] WIT 0120 0313 Mr Wisheart

[74] WIT 0120 0313 - 0314 Mr Wisheart

[75] WIT 0120 0314 - 0315 Mr Wisheart

[76] WIT 0120 0315 - 0316 Mr Wisheart; and see Chapter 3 for an explanation of this term

[77] WIT 0352 0019 Dr Williams