Weil Gregoire, Motamed Cyrus, Biau David J, Guye Marie Laurence
Department of Anesthesia, Institute Gustave Roussy, Villejuif, France.
Korean J Anesthesiol. 2017 Apr;70(2):196-202. doi: 10.4097/kjae.2017.70.2.196. Epub 2017 Jan 12.
The learning curve cumulative sum (LC-CUSUM) test is an innovative tool that allows quantitative monitoring of individual medical performance during the learning process by determining when a predefined acceptable level of performance is reached. This study used the LC-CUSUM test to monitor the learning process and failure rate of anesthesia residents training for specific subspecialty anesthesia procedures.
The study included 490 tracheal punctures (TP) for jet ventilation, 340 thoracic epidural analgesia (TEA) procedures, and 246 fiberoptic nasal intubations (FONI) performed by 18 residents during their single 6-month rotation.
Overall, 27 (14-52), 19 (5-41), and 14 (6-33) TP, TEA, and FONI procedures were performed, respectively, by each resident. In total, 2 of 18 residents achieved an acceptable failure rate for TEA according to the literature and 4 of 18 achieved an acceptable failure rate for FONI, while none of the residents attained an acceptable rate for TP.
A single 6-month rotation in a reference teaching center may not be sufficient to train residents to perform specific or sub-specialty procedures as required. A regional learning network may be useful. More patient-based data are necessary to conduct a risk adjustment analysis for such specific procedures.
学习曲线累积和（LC-CUSUM）测试是一种创新工具，通过确定何时达到预先定义的可接受绩效水平，能够在学习过程中对个体医疗绩效进行定量监测。本研究使用LC-CUSUM测试来监测麻醉住院医师针对特定亚专业麻醉程序的培训学习过程及失败率。
该研究纳入了18名住院医师在其单次6个月轮转期间进行的490次用于喷射通气的气管穿刺（TP）、340次胸段硬膜外镇痛（TEA）操作以及246次纤维光导鼻插管（FONI）。
总体而言，每位住院医师分别进行了27（14 - 52）次、19（5 - 41）次和14（6 - 33）次TP、TEA和FONI操作。根据文献，18名住院医师中共有2名在TEA操作上达到了可接受的失败率，18名中有4名在FONI操作上达到了可接受的失败率，而在TP操作上没有住院医师达到可接受的比率。
在参考教学中心进行单次6个月的轮转可能不足以按照要求培训住院医师进行特定或亚专业操作。区域学习网络可能会有所帮助。对于此类特定操作进行风险调整分析需要更多基于患者的数据。
