The use of the Cusum Technique in the assessment of trainee competence in new procedures

Bolsin, Steve; Colson, Mark

doi:10.1093/intqhc/12.5.433

Cited by 316 publications

(211 citation statements)

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“…It produces graphs that allow rapid detection of deviations from a preestablished standard, initially being developed during World War II as a quality control tool in munitions factories. 15 The graphs are generated by relatively simple calculations based on set acceptable and unacceptable failure rates and the degree to which type 1 (a) and type 2 (b) errors (false positive and false negative errors) will be tolerated (Appendix). The null hypothesis is: the true failure rate is not different from the acceptable failure rate.…”

Section: Résumémentioning

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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Section: Résumémentioning

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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“…Para ello, se ha sugerido el control de calidad basado en un análisis de gráficos CUSUM (cumulative sums method) que son una representación de la tendencia y el desenlace al medir una serie de procedimientos (15,16,26,27). Las pruebas secuenciales de este tipo tienen algunas ventajas cuando se comparan con los métodos tradicionales de análisis de resultados: la independencia del tamaño muestral, una mayor potencia para detectar cambios transitorios en las tendencias, la continuidad del análisis en el tiempo y la posibilidad de realizar una evaluación rápida de los datos (17,26,27).…”

Section: Tabla II Fallas Más Frecuentes Del Equipo Laparoscópicounclassified

“…Las pruebas secuenciales de este tipo tienen algunas ventajas cuando se comparan con los métodos tradicionales de análisis de resultados: la independencia del tamaño muestral, una mayor potencia para detectar cambios transitorios en las tendencias, la continuidad del análisis en el tiempo y la posibilidad de realizar una evaluación rápida de los datos (17,26,27). Por lo anterior, las curvas de aprendizaje CUSUM, no solo sirven como indicador del rendimiento satisfactorio para adquirir la habilidad clínica, sino también para evaluar la calidad del desempeño y como una medición continua de los efectos que pudieran provocar cualquier cambio en la técnica (18,27).…”

Section: Tabla II Fallas Más Frecuentes Del Equipo Laparoscópicounclassified

“…Es oportuno detallar la relevancia en el hecho de que la metodología que verifica la aptitud para la enseñanza, también puede examinar la competencia y la calidad de los procedimientos quirúrgicos: el constatar la idoneidad cobra cada día mayor interés en los centros especializados por el gran impacto que suponen para las instituciones: a) el exceso en horas-operador empleados en los centros de atención hospitalaria que no cuentan con personal capacitado o con la competencia requerida para la realización de un procedimiento, b) el exceso de recursos empleados en la realización de procedimientos complejos y avanzados cuando ocurren complicaciones y c) la alta prevalencia de conflictos legales asociados a mala praxis derivada de la aplicación de procedimientos con fallas, lo que ha obligado al gremio médico y a las instituciones prestadoras de servicios de salud a implementar controles de calidad efectivos (15)(16)(17)(18)27).…”

Section: Tabla II Fallas Más Frecuentes Del Equipo Laparoscópicounclassified

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Desempeño de los procedimientos laparoscópicos en ginecología: adquisición y mantenimiento de la idoneidad

Zárate

Zaragoza

Landa

et al. 2011

Rev. chil. obstet. ginecol.

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RESUMENEl avance de la tecnología y de las nuevas técnicas quirúrgicas en las especialidades médicas, ha convertido a la cirugía de mínima invasión ginecológica en una alternativa para el beneficio de los pacientes, obteniendo en la mayoría de los casos mejores resultados que la cirugía convencional. El objetivo de este documento es describir cuales son los mejores recursos y técnicas para el desarrollo y mantenimiento de destrezas en cirugía laparoscópica ginecológica, así como evidenciar los factores que favorecen o afectan la curva de aprendizaje y la calidad del desempeño. Así mismo, la metodología que supervisa el aprendizaje también puede examinar la competencia y la calidad del desempeño continuo en los procedimientos quirúrgicos. No existe una diferencia significativa entre las técnicas de entrenamiento en cirugía laparoscópica de mínima invasión, pero si es evidente que el entrenamiento previo mejora la habilidad individual y se obtienen resultados precisos y reproducibles. Es difícil mantener la consistencia, por lo que la ejecución deberá ser supervisada por métodos cuantitativos a fin de disminuir las complicaciones. Es evidente que se deben actualizar los programas académicos en la especialidad de ginecología, donde se incorpore un verdadero módulo de cirugía laparoscópica para que los médicos en formación adquieran destrezas con los procedimientos de baja complejidad, y al desarrollarse en los niveles de dificultad quirúrgica, se pueda supervisar la calidad del desempeño con métodos estadísticos adecuados. PALABRAS CLAVE: Cirugía laparoscópica ginecológica, curva de aprendizaje SUMMARYThe advancement of new surgical techniques in medical specialties has become minimally invasive gynecologic surgery into a modern surgical technique. There are a number of advantages to the patient with laparoscopic surgery versus an open procedure, obtaining in most cases mayor benefits than traditional surgery techniques. The purpose of this study was to describe which are the best aspects and techniques for developing and maintaining skills in gynecologic laparoscopic surgery and identify the factors affecting learning curves. A lot of factors are involved: like institutional policies and the characteristics of the surgeon such as attitude and capacity for acquiring new skills. Prior laparoscopic training has been shown to facilitate the process of learning, reduces complication rates and operative time. The type of training the surgeon has received is not significantly related to this learning curve. Maintaining consistency is challenging: however, assessing laparoscopic learning can also examine surgical competence. Consequently the implementation should be monitored by quantitative methods in order to provide both numerical and graphical representation of the learning process. The learning curves combined with the advantages of feedback using the rating REV CHIL OBSTET GINECOL 2011; 76(4): 275 -281

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“…51,52 This produces an easily interpreted performance chart with acceptable and unacceptable performance boundaries. 24,53,54 This is already an accepted standard for registrars accredited by ANZCA in the Geelong, Alfred and Princess Alexandra hospitals, and for other subscribing specialist anaesthetists. 46 The data collection is linked to ANZCA approval for logbook and procedural performance documentation for accredited trainees.…”

Section: The Problem In Health Carementioning

confidence: 99%

Using portable digital technology for clinical care and critical incidents: a new model

Bolsin

Faunce²,

Colson³

2005

Aust. Health Review

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The number of patients suffering adverse incidents during treatment in hospitals is not declining. The cost of this poor safety record in Australia is $1 billion to $4.7 billion each year. Quality and safety initiatives focus on promoting adverse event reporting. Major problems include poor reporting of adverse events and lack of clinician involvement.We propose a model for clinician-led reporting based on secure transmission of encrypted data from a programmed personal digital assistant (PDA) to a secure database, leading to automated analysis of clinician-performance data. The programmed PDA also facilitates the reporting of critical incidents. All critical incidents are automatically fed back by email to the organisational The problem in health careThe available evidence suggests that the percentage of hospitalised patients suffering an adverse incident during admission is not declining. 1-5Major inquiries into publicised revelations of substandard health care performance continue to find one of the major contributing factors is an institutional and professional culture opposed to self-reporting and open disclosure.6-10 The costs of this continuing poor safety record run to billions of dollars in most developed societies. 1,5,11 Current quality and safety initiatives focus on promoting adverse or sentinel incident reporting to institutional committees seeking to discover contributory causes and implement corrective strategies 1,12,13 Unfortunately, poor individual reporting rates for adverse events in health care and inadequate clinician involvement in the related processes continue. 1,[14][15][16][17][18] This is despite other industries, such as aviation and environmental resource management, making considerable progress in this area. 19,20 The adoption of sustained health care quality improvement programs is similarly poor despite the fact that numerous authors have documented the benefits of such programmes to improved What is known about the topic? New information technologies promise to make meaningful, accurate data about patient care broadly available, and the potential advantages for quality and safety have long been anticipated. Realising those benefits has been a difficult and slow process. What does this paper add?A system which enables anaesthetists to record routine clinical data, and critical incidents, by means of hand-held computers has been successfully introduced in three major hospitals, with good results. Careful attention to the ownership and security of data, and the questions of cost and indemnity have been critical to the success of this model. What are the implications?Direct input of clinical data by clinicians at the point of care is practically and financially feasible, and professionally acceptable, in at least some settings, and offers significant potential benefits for the safety and quality of patient care.

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The use of the Cusum Technique in the assessment of trainee competence in new procedures

Cited by 316 publications

References 2 publications

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

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

Desempeño de los procedimientos laparoscópicos en ginecología: adquisición y mantenimiento de la idoneidad

Using portable digital technology for clinical care and critical incidents: a new model

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