Naik Viren N, Devito Isabella, Halpern Stephen H
Department of Anesthesia, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Can J Anaesth. 2003 Aug-Sep;50(7):694-8. doi: 10.1007/BF03018712.
Cumulative sum (cusum) analysis is a statistical and graphical tool that examines trends for sequential events over time. It has been used to determine proficiency in technical procedures. We used cusum to determine the number of labour epidural attempts necessary for proficiency in our training program.
Residents unfamiliar with epidural anesthesia kept a log of their labour epidural successes and failures during a six-month hospital rotation. Failure was defined as a dural puncture or relinquishing the procedure to staff. Cusum analysis was performed using an acceptable failure rate of 10%. Residents were deemed competent when their graph remained below the calculated cusum boundary.
Eleven anesthesia residents were recruited. The number of epidural attempts over six months ranged from 75 to 128. Ten residents attained competency by cusum between one and 85 attempts. One resident failed to achieve competency by cusum after 75 attempts.
After a period of training, residents are expected to perform the skill of labour epidural insertion independently. This study illustrates that some residents may need as many as 75 attempts to ensure proficiency. Training programs could use cusum to track the progress of their residents' technical skills in order to guarantee an adequate experience.
累积和（cusum）分析是一种统计和图形工具，用于检查随时间推移的连续事件趋势。它已被用于确定技术操作的熟练程度。我们使用cusum来确定在我们的培训项目中熟练进行分娩硬膜外麻醉所需的尝试次数。
不熟悉硬膜外麻醉的住院医师在为期六个月的医院轮转期间记录他们分娩硬膜外麻醉的成功与失败情况。失败定义为硬膜穿刺或放弃操作转由工作人员进行。使用10%的可接受失败率进行cusum分析。当住院医师的图表保持在计算出的cusum边界以下时，判定其具备能力。
招募了11名麻醉住院医师。六个月内硬膜外麻醉尝试次数在75至128次之间。10名住院医师在1至85次尝试后通过cusum分析达到了能力标准。一名住院医师在75次尝试后未通过cusum分析达到能力标准。
经过一段时间的培训，住院医师应能够独立进行分娩硬膜外穿刺操作。本研究表明，一些住院医师可能需要多达75次尝试才能确保熟练掌握。培训项目可以使用cusum来跟踪住院医师技术技能的进展情况，以确保有足够的经验。
