An implementation of the learning curve cumulative summation test to evaluate a practicum for endometrial cancer ultrasound staging

Abstract

The learning curve cumulative summation (LC-CUSUM) test is commonly used as a quantitative assessment of the individual learning process. This study aimed to evaluate the skill acquisition process for performing ultrasound staging of endometrial cancer using the LC-CUSUM test. Methods: Sixty-seven ultrasound examinations performed by two operators were evaluated using the LC-CUSUM test according to their rate of success or failure to correctly stage myometrial invasion, serosa involvement, and pelvic and para-aortic lymph node involvement. The reference standard was the pathologic result. After the learning phase, the cumulative summation (CUSUM) test was applied to assess performance maintenance. Results: The processes achieved satisfactory performance in the majority of the cases according to the established definitions. Operator 1 reached adequate performance within the 30th procedure for all the locations considered, while operator 2 performed fewer than 30 ultrasound examinations by the audit time. The CUSUM test confirmed that the target quality was preserved after the learning phase. Moreover, the ultrasound staging for endometrial cancer was highly accurate. Conclusion: Using the LC-CUSUM test made it possible to monitor the achievement and maintenance of a satisfactory performance quantitatively. The LC-CUSUM test could be a valuable instrument to survey diagnostic pathways in gynecological ultrasonography quantitatively.

Learning Curve for Ultrasound Assessment of Myometrial Infiltration in Endometrial Cancer Visualizing Videoclips: Potential Implications for Training

“…We have shown that adequate skills for assessing myometrial infiltration in women with endometrial cancer may be acquired by interpreting two-dimensional real-time videoclips. Our data are in agreement with those reported by Xholli and colleagues [16]. These authors evaluated the learning curve for transvaginal ultrasound assessment of myometrial infiltration in women with endometrial cancer in a retrospective study.…”

“…In fact, performance after training should be tested in a real-time stetting. Nevertheless, data from the study of Xholli and colleagues indicated that a similar number of cases were needed to achieve competence using apparently real-time examination (around 30 cases [16]), and, as stated above, the use of offline training has been demonstrated as a valid tool for training [21,22].…”

“…There is a paucity of studies about the learning curve of sonographers performing transvaginal ultrasound assessments of uterine wall infiltration in women with endometrial cancer. To the best of our knowledge, there is only a recent study assessing the learning curve for evaluating myometrial infiltration by transvaginal ultrasound in women with endometrial cancer [16]. Therefore, the aim of our study was to determine the learning curve with the cumulative summation test for assessing myometrial infiltration in cases of endometrial cancer using transvaginal ultrasound (TVS) visualizing videoclips.…”

Transvaginal ultrasound versus magnetic resonance imaging for preoperative assessment of myometrial infiltration in patients with low‐grade endometrioid endometrial cancer: A systematic review and head‐to‐head meta‐analysis

“…Recently, there are numerous publications studying the importance of training programs and the implementation of standardized techniques to evaluate MI in EC via TVS in order to achieve an improvement in diagnostic accuracy 30–32 . Xholi et al 31 conducted a retrospective study in order to evaluate the learning curve for TVS assessment of MI in women with EC. Sixty‐seven real‐time ultrasound scanning examinations performed by two expert examiners were assessed using the learning curve cumulative summation (LC‐CUSUM) test.…”

“…27 Green et al 28 Recently, there are numerous publications studying the importance of training programs and the implementation of standardized techniques to evaluate MI in EC via TVS in order to achieve an improvement in diagnostic accuracy. [30][31][32] Xholi et al 31 the process under control after reaching this competence. Therefore, they conclude that 30-40 cases would be needed to obtain optimal skills in determining myometrial infiltration.…”