Characterizing the learning curve for a basic laparoscopic drill.
BACKGROUND
The psychomotor challenges inherent in laparoscopic surgery are evident by the steep procedural "learning curves" documented throughout the literature. Few methods have been described to evaluate learning curves. The cumulative summation (CUSUM) method is a criterion-based evaluation of the learning process. The purpose of this study is to describe the CUSUM learning curves for a simple task for individuals and for a group of novice laparoscopists.


METHODS
Sixteen medical students undertook four weekly sessions of 10 laparoscopic pegboard transfers in the MISTELS system. Their performance was scored and recorded for each trial. CUSUM learning curves were constructed based on the goal of achieving mean scores for senior, intermediate, or junior laparoscopists >or=95% of the time.


RESULTS
Based on senior criteria, one student achieved the goal by the 40th peg transfer trial. Based on intermediate criteria, three students achieved the goal by their 40th trial (trials 21 and 36), and for junior criteria, 10 students achieved the acceptable success rate by their 40th trial (range, 26-40).


CONCLUSIONS
CUSUM analysis suggests criterion-based practice is useful for novice laparoscopists. It allows educators to track the progress of an individual toward target criteria for each MISTELS task, to more logically allocate time for training and set attainable goals, to objectively evaluate trainee acquisition of basic laparoscopic skills, and to identify trainees who need remediation.
Fraser
S A
SA
Steinberg-Bernstein Centre for Minimally Invasive Surgery, McGill University, Montreal General Hospital, 1650 Cedar Avenue, Room L9.309, Montreal, Quebec, H3G 1A4, Canada.
Feldman
L S
LS
Stanbridge
D
D
Fried
G M
GM
D002983:Clinical Competence; D013502:General Surgery / Q000193:education*; D010535:Laparoscopy / Q000592:standards*