Assessing doctors' competence: application of CUSUM technique in monitoring doctors' performance

Lim, Teck Onn; Soraya, Ayu; Ding, Lili; Morad, Z.

doi:10.1093/oxfordjournals.intqhc.a002616

Cited by 117 publications

(90 citation statements)

References 17 publications

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“…The treating institutions and surgeons are further independent prognostic factors which determine the frequency of locoregional recurrence, and thus survival [7]. Japanese and Western studies have shown a clear survival benefit for systematic LN dissection or D2 lymphadenectomy in the treatment of gastric cancer [11]. Japanese classification, with its anatomically-based N-staging established from analysis of lymphadenectomy effectiveness, provides a comprehensive treatment and surgical guide for surgeons [17].…”

Section: Discussionmentioning

confidence: 99%

“…For the other parameters, the cumulative sum (CUSUM) failure method is useful, because a CUSUM chart can display multiple parameters and takes time and experience into account [1,11]; the influence of patient selection should also be evaluated on the learning curve.…”

Section: Introductionmentioning

confidence: 99%

“…The CUSUM method was used to document outcomes over time [1,3,11]. Each patient was designated as a success or failure, which is required for this type of statistical analysis.…”

Section: Introductionmentioning

confidence: 99%

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Multidimensional learning curve in laparoscopy-assisted gastrectomy for early gastric cancer

et al. 2006

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Background: Laparoscopy-assisted gastrectomy (LAG) is a complex and time-consuming procedure, which is increasingly used for early gastric cancer (EGC). We provide a multidimensional analysis of the learning curve in LAG. Methods: Cumulative sum method was used to analyze outcomes of 109 patients undergoing LAG for EGC by one surgeon over a two year period; the influence of patient selection was evaluated. Target failure rate was set at 10%, with failure defined as open conversion, mortality, major morbidity, residual tumor, or inappropriate lymphadenectomy. Results: There were 19 failures-fourteen performance and five oncologic. The learning curve, which displayed a slight rising trend and three phases was achieved after 40 cases with selected patients; it was broken, however, by the introduction of advanced procedures and unselected patients. Conclusions: Advanced procedures and broad indications in LAG should be delayed until a learning curve is completed under the target failure rate.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Multidimensional learning curve in laparoscopy-assisted gastrectomy for early gastric cancer

et al. 2006

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“…35,36 They compared the cusum graphs of a registrar with those of a consultant performing nonanesthetic medical procedures. The consultant's graphs rapidly produced a steady-state plot with acceptable failure rates, whereas the registrar's graphs were more haphazard and showed a significant learning curve.…”

Section: Use Of Cusum For Quality Control In Anesthesiamentioning

confidence: 99%

Assessment of procedural skills training and performance in anesthesia using cumulative sum analysis (cusum)

Starkie

Drake

2013

Can J Anesth/J Can Anesth

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Assessment of procedural skills training and performance in anesthesia using cumulative sum analysis (cusum) É valuation de la formation en habiletés techniques et de la performance en anesthésie au moyen de l'analyse des sommes cumulées (cusum) Abstract Purpose The current methods (work based assessments and logbooks) used to assess procedural competency and performance have well-documented deficiencies. Cumulative sum analysis (cusum), a statistical method that generates performance graphs over time, is an alternative tool that is not currently widely used. The purpose of this review is to investigate its current role in anesthetic procedural skills training and performance.Tim

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“…CUSUM was developed during World War II in order to evaluate the efficiency of ammunition production lines. It has since been used in medicine for both assessing the competence of trainees and also in the assessment of doctors performing certain procedures in which they are already deemed competent [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Learning curve of vessel cannulation in rats using cumulative sum analysis

Christakis

Georgiou

Minnion

et al. 2015

Journal of Surgical Research

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Extensive experience in rodent surgery and training junior surgeons Cover LetterDear Ms/Mr, We would be grateful if you would consider our manuscript entitled "Learning curve of cannulation of jugular and femoral vein in rats using Cumulative Summation Analysis" for publication in The Journal of Surgical Research. Our study investigates the learning curve required for competency and proficiency at blood vessel cannulation in rodents.Vessel cannulation in rats, such as of the femoral and jugular vein, is a technically challenging procedure even for an experienced surgeon. In this study we analyse the results of 200 cannulations of the femoral and jugular vein in rats performed within one year by a single surgeon. The use of Cumulative Summation analysis allows calculating the required experience to most effectively cannulate the jugular and femoral vein, which is approximately 50 and 100 cases, respectively.These results highlight the difficulty involved in performing such micro-surgical operations in rodents. The knowledge of the average time taken to cannulate these vessels allows experiments to be optimally planned, avoiding unexpected time over-runs. Furthermore, our results bring into the spotlight the need for training and direct supervision for the inexperienced researchers, as there is an ongoing need to reduce animal use in research through minimising adverse events.To the authors' knowledge this is the first study to report the learning curve for mastering the technique of catheterisation of the femoral and jugular vein in rats. We feel it will be of interest to readers of The Journal of Surgical Research, and particularly those using rodent microsurgery. Subject category: ResearchAuthors' contributions I.C., J.C., R.S. carried out the design and coordinated the study, participated in all of the experiments and prepared the manuscript. J.M., P.G., V.C., F.P., K.M., S.B.provided assistance in the design of the study, coordinated and carried out most of the experiments and participated in manuscript preparation. T.T., F.P., K.M. and S.B.approved the final version of the manuscript. All authors have read and approved the content of the manuscript.-3 - AbstractBackground:

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Assessing doctors' competence: application of CUSUM technique in monitoring doctors' performance

Abstract: We recommend the use of CUSUM charting as a tool for personal audit at an individual level. It may also be used to show proof of technical competence for the purpose of credentialing.

Cited by 117 publications

References 17 publications

Multidimensional learning curve in laparoscopy-assisted gastrectomy for early gastric cancer

Multidimensional learning curve in laparoscopy-assisted gastrectomy for early gastric cancer

Assessment of procedural skills training and performance in anesthesia using cumulative sum analysis (cusum)

Learning curve of vessel cannulation in rats using cumulative sum analysis

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