Cumulative sum: An individualized proficiency metric for laparoscopic fundamentals

Hu, Yinin; Warren, Harry L.; McMurry, Timothy L.; Goodrich, Robyn N.; Choi, Joanna; Mahmutovic, Adela; Kim, Helen; Rasmussen, Sara K.

doi:10.1016/j.jpedsurg.2015.10.049

Cited by 5 publications

(1 citation statement)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…CuSum has been used to calculate the average practice time needed to attain proficiency in technical procedures such as endoscopy and laparoscopic fundamentals. 11,13,14 In all cases, CuSum captures variability in learning curves and relapses in proficiency on an individual basis in a manner that is not resource intensive. Additionally, risk-adjusted CuSum has been used to monitor surgical performance for clinical outcomes including mortality.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Skills Retention Following a Randomized Prospective Trial on Adaptive Procedural Training

Ramirez

Kim

et al. 2018

Journal of Surgical Education

Self Cite

View full text Add to dashboard Cite

OBJECTIVE Cumulative sum (CuSum) is a real-time proficiency-monitoring tool adapted for simulation-based training. This study’s objective was to investigate long-term outcomes of a double blinded, randomized control trial conducted with medical students assessing CuSum-guided curriculum against volume-based standards. The trial found a nearly 20% reduction in practice time to reach proficiency using the CuSum curriculum but long-term effects of decreased practice volume on proficiency is unknown. DESIGN Prior participants completed a survey assessing confidence, exposure, and feedback at 12 to 18 months following trial completion. They underwent retention testing of suturing, intubation, and central venous catheter placement (CVC), which was video-recorded and assessed by an expert evaluator. Baseline characteristics among repeat subjects were compared using chi-squared tests. Retention and initial trial outcome were compared using paired parametric statistical methods. SETTING The study was conducted at a major tertiary care center and training hospital. PARTICIPANTS Medical students, which completed the initial randomized control trial were eligible for enrollment. A total of 30/46(65%) responded to the survey, whereas 33/46(72%) completed retention testing. RESULTS Average scores and decay in procedural tasks over time for suturing, intubation and CVC were 91.6% (−4.7%), 86.1% (−4.1%), and 76.2% (−14.8%), respectively. Compared to the control group, the CuSum group mean difference in retention evaluation scores was −5.6% (p = 0.12). Confidence was not associated with initial or retention testing performance in any procedural task. Higher confidence was associated with additional exposure to the procedural task in suturing and intubation (p = 0.03 and p = 0.02, respectively). For intubation, higher confidence was reported by participants who received positive feedback (p = 0.01), and those assigned to the volume-based training arm (p = 0.03). CONCLUSION CuSum-guided training was equivalent to conventional training for suturing, intubation, and CVC. These findings importantly suggest medical students can retain competency in invasive surgical tasks with modest decay in proficiency over time regardless of initial training method.

show abstract

Section: Discussionmentioning

confidence: 99%