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. 2017 Apr;70(2):196-202.
doi: 10.4097/kjae.2017.70.2.196. Epub 2017 Jan 12.

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

Gregoire Weil  1 , Cyrus Motamed  1 , David J Biau  1 , Marie Laurence Guye  1
Affiliations

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

Gregoire Weil et al. Korean J Anesthesiol. 2017 Apr.

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.

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Figures

Fig. 1
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
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
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.
See this image and copyright information in PMC

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