Establishing learning curves for surgical residents using Cumulative Summation (CUSUM) Analysis

Curr Surg. 2005 May-Jun;62(3):330-4. doi: 10.1016/j.cursur.2004.09.016.


Background: The assessment of technical proficiency is of paramount importance in the training of surgical residents. The fact that technical proficiency is underrepresented in the context of the ACGME outcomes project is evidenced in that proficiency skills comprise less than 5% of all assessments that evaluate residents. In this study, we use Cumulative Summation Analysis (CUSUM) as a visual objective analytic tool to determine performance accuracy and establish learning curves for PGY-1s in surgery.

Methods: From April 2001 to May 2002, 11 surgical residents completed a 1-month anesthesia rotation. Each resident was asked to complete a preoperative airway assessment followed by endotracheal intubation with induction of anesthesia. Airway assessment was performed independently by a resident and a licensed anesthesiologist or certified anesthetist with the modified Mallampati Score. Data were sequentially collected and plotted for summated successes and failures.

Results: The average intern required approximately 19 intubation attempts to complete the learning curve experience. There was no learning curve for airway assessment.

Conclusions: The CUSUM analysis is an effective objective tool to define learning curves for technical skills. Vital information is provided for surgical programs that place residents in positions to manage airways, and limitless potential for defining the learning curves for technical skills is provided.

MeSH terms

  • Adult
  • Clinical Competence*
  • Competency-Based Education*
  • General Surgery / education*
  • Humans
  • Internship and Residency*
  • Intubation, Intratracheal