Learning curves for three specific procedures by anesthesiology residents using the learning curve cumulative sum (LC-CUSUM) test

Abstract

Background: The learning curve cumulative sum (LC-CUSUM) test is an innovative tool that allows quantitative monitoring of individual medical performance during the learning process by determining when a predefined acceptable level of performance is reached. This study used the LC-CUSUM test to monitor the learning process and failure rate of anesthesia residents training for specific subspecialty anesthesia procedures.

Methods: The study included 490 tracheal punctures (TP) for jet ventilation, 340 thoracic epidural analgesia (TEA) procedures, and 246 fiberoptic nasal intubations (FONI) performed by 18 residents during their single 6-month rotation.

Results: Overall, 27 (14-52), 19 (5-41), and 14 (6-33) TP, TEA, and FONI procedures were performed, respectively, by each resident. In total, 2 of 18 residents achieved an acceptable failure rate for TEA according to the literature and 4 of 18 achieved an acceptable failure rate for FONI, while none of the residents attained an acceptable rate for TP.

Conclusions: A single 6-month rotation in a reference teaching center may not be sufficient to train residents to perform specific or sub-specialty procedures as required. A regional learning network may be useful. More patient-based data are necessary to conduct a risk adjustment analysis for such specific procedures.

Keywords: Anesthesiology residency; Cumulative sum; Epidural; Intubation; Learning curve; Tracheal puncture.

Fig. 1. Learning curve cumulative sum (LC-CUSUM) test results for tracheal puncture for the 18 residents. Dashed line represents the decision limit “h” at 0.375. No residents crossed this decision limit.

Fig. 2. Learning curve cumulative sum (LC-CUSUM) test results for thoracic epidural analgesia for the 18 residents. Dashed line represents the decision limit “h” at 0.9.

Fig. 3. Learning curve cumulative sum (LC-CUSUM) test results for fiberoptic nasotracheal intubation for the 18 residents. Dashed line represents the decision limit “h” at 1.4.