Vedana Gustavo, Cardoso Filipe G, Marcon Alexandre S, Araújo Licio E K, Zanon Matheus, Birriel Daniella C, Watte Guilherme, Jun Albert S
Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore 21287, USA.
Irmandade Santa Casa, Misericórdia, Porto Alegre 90020160, Brazil.
Int J Ophthalmol. 2017 Jul 18;10(7):1088-1093. doi: 10.18240/ijo.2017.07.11. eCollection 2017.
To use the cumulative sum analysis score (CUSUM) to construct objectively the learning curve of phacoemulsification competency.
Three second-year residents and an experienced consultant were monitored for a series of 70 phacoemulsification cases each and had their series analysed by CUSUM regarding posterior capsule rupture (PCR) and best-corrected visual acuity. The acceptable rate for PCR was <5% (lower limit h) and the unacceptable rate was >10% (upper limit h). The acceptable rate for best-corrected visual acuity worse than 20/40 was <10% (lower limit h) and the unacceptable rate was >20% (upper limit h). The area between lower limit h and upper limit h is called the decision interval.
There was no statistically significant difference in the mean age, sex or cataract grades between groups. The first trainee achieved PCR CUSUM competency at his 22 case. His best-corrected visual acuity CUSUM was in the decision interval from his third case and stayed there until the end, never reaching competency. The second trainee achieved PCR CUSUM competency at his 39 case. He could reach best-corrected visual acuity CUSUM competency at his 22 case. The third trainee achieved PCR CUSUM competency at his 41 case. He reached best-corrected visual acuity CUSUM competency at his 14 case.
The learning curve of competency in phacoemulsification is constructed by CUSUM and in average took 38 cases for each trainee to achieve it.
使用累积和分析评分（CUSUM）客观构建白内障超声乳化手术技能的学习曲线。
对三名二年级住院医师和一名经验丰富的顾问医生进行监测，每人连续进行70例白内障超声乳化手术，并通过CUSUM分析他们在术中后囊破裂（PCR）和最佳矫正视力方面的情况。PCR的可接受率<5%（下限h），不可接受率>10%（上限h）。最佳矫正视力低于20/40的可接受率<10%（下限h），不可接受率>20%（上限h）。下限h和上限h之间的区域称为决策区间。
各组之间在平均年龄、性别或白内障分级方面无统计学显著差异。第一名受训者在第22例手术时达到了PCR CUSUM技能水平。他的最佳矫正视力CUSUM从第三例手术开始就处于决策区间，一直保持到最后，从未达到技能水平。第二名受训者在第39例手术时达到了PCR CUSUM技能水平。他在第22例手术时达到了最佳矫正视力CUSUM技能水平。第三名受训者在第41例手术时达到了PCR CUSUM技能水平。他在第14例手术时达到了最佳矫正视力CUSUM技能水平。
通过CUSUM构建白内障超声乳化手术技能的学习曲线，每名受训者平均需要38例手术才能达到该技能水平。
