The construction of learning curves for basic skills in anesthetic procedures: an application for the cumulative sum method.
This study aimed at constructing learning curves for basic procedural skills in anesthesiology using the cumulative sum method. We recorded 1234 peripheral venous cannulations, 895 orotracheal intubations, 688 spinals, and 344 epidurals performed by residents during the first 10 mo of training. Learning curves for each procedure were constructed by using the cusum method. The number of procedures performed until attainment of acceptable failure rates was calculated. All residents mastered peripheral venous cannulation after 79 +/- 47 procedures. Four of 7 residents attained acceptable failure rates at orotracheal intubation after 43 +/- 33 proce- dures. Seven of 11 residents attained acceptable failure rates at spinal anesthesia after 36 +/- 20 procedures. At epidural anesthesia, 5 of 11 residents attained acceptable failure rates after 21 +/- 11 procedures. The cusum method is a useful tool for objectively measuring performance during the learning phase of basic procedures. The wide interindividual variability in the number of procedures required to be performed before attaining acceptable failure rates suggests that performance should be followed on an individual basis.


CONCLUSIONS
Learning curves for peripheral venous cannulation, tracheal intubation, and spinal and epidural anesthesia were constructed using the cumulative sum (cusum) method. There was a wide variability in the number of procedures performed until attainment of acceptable failure rates. The cusum method may improve our means of evaluating residents' technical skills.
de Oliveira Filho
Getúlio Rodrigues
GR
Department of Anaesthesiology, Hospital Governador Celso Ramos, Florianópolis, Brazil. grof@th.com.br
D000767:Anesthesia, Epidural / Q000592:standards; D000775:Anesthesia, Spinal / Q000592:standards; D000776:Anesthesiology / Q000193:education* / Q000592:standards; D002406:Catheterization, Peripheral / Q000592:standards; D002983:Clinical Competence / Q000592:standards*; D003627:Data Interpretation, Statistical; D006801:Humans; D007396:Internship and Residency; D007442:Intubation, Intratracheal / Q000592:standards