Use of the Learning Curve–Cumulative Summation test for quantitative and individualized assessment of competency of a surgical procedure in obstetrics and gynecology: fetoscopic laser ablation as a model

• Published in: American journal of obstetrics and gynecology 2011-03, Vol.204 (3), p.218.e1-218.e9
• Main Authors: Papanna, Ramesha, MD, MPH, Biau, David J., MD, PhD, Mann, Lovepreet K., MBBS, Johnson, Anthony, DO, Moise, Kenneth J., MD
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Clinical Competence; Delivery. Postpartum. Lactation; Educational Measurement; Female; Fetofetal Transfusion - surgery; Fetoscopy - education; formal training; Gynecology. Andrology. Obstetrics; Humans; laser photocoagulation; Laser Therapy; Learning Curve; learning curve-cumulative summation; Medical sciences; Models, Educational; Obstetrics - education; Obstetrics and Gynecology; Pregnancy; Retrospective Studies; twin-twin transfusion syndrome; Young Adult
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2010.10.910

Objective We sought to determine the learning curve (LC) for fetoscopic laser photocoagulation (FLP) as a model for the evaluation of training in surgical procedures. Study Design A retrospective review of consecutive case series of FLP from 2 centers with 3 operators (operator I [O-I], observer trained; operator II [O-II], hands-on trained; and operator III [O-III], clinical fellow) was performed and the LC-cumulative summation (CUSUM) test was plotted. Results The acceptable and unacceptable success rates for at least 1 fetus survival after FLP were set at 82% and 70%, respectively, from a systematic review. A total of 171 consecutive cases were performed by the 3 operators (O-I, 91; O-II, 49; and O-III, 31). From LC-CUSUM test O-I needed 60 procedures, O-II needed 20 procedures, and O-III needed 20 procedures to reach an acceptable performance rate for at least 1 survivor. Conclusion The LC-CUSUM test can be used to accurately assess the LC in a surgical procedure in obstetrics and gynecology. Hands-on trained operators exhibit a shorter LC.