title: Defining competence in obstetric epidural anaesthesia for inexperienced trainees.
abstract: BACKGROUND
  Cumulative sum (CUSUM) analysis has been used for assessing competence of trainees learning new technical skills. One of its disadvantages is the required definition of acceptable and unacceptable success rates. We therefore monitored the development of competence amongst trainees new to obstetric epidural anaesthesia in a large public hospital.
  
  
  METHODS
  Obstetric epidural data were collected prospectively between January 1996 and December 2011. Success rates for inexperienced trainees were calculated retrospectively for (1) the whole database, (2) for each consecutive attempt and (3) each trainee's individual overall success rate. Acceptable and unacceptable success rates were defined and CUSUM graphs generated for each trainee. Competence was assessed for each trainee and the number of attempts to reach competence recorded.
  
  
  RESULTS
  Mean (sd) success rate for all inexperienced trainees was 76.8 (0.1%), range 63-90%. Consecutive attempt success rate produced a learning curve with a mean success rate commencing at 58% on attempt 1. After attempt 10 the attempt number had no effect on subsequent success rates. From these results, the acceptable and unacceptable success rates were set at 65 and 55% respectively. CUSUM graphs demonstrated 76 out of 81 trainees competent after a mean of 46 (22) attempts.
  
  
  CONCLUSIONS
  CUSUM is useful for assessing trainee epidural competence. Trainees require approximately 50 attempts, as defined by CUSUM, to reach competence.
authors: Department of Anaesthesia, Derriford Hospital, Derriford Road, Plymouth PL6 8DH, UK elizabeth.drake@nhs.net.
authors: E J
authors: EJ
authors: Drake
authors: Department of Anaesthesia, Derriford Hospital, Derriford Road, Plymouth PL6 8DH, UK.
authors: J
authors: J
authors: Coghill
authors: Department of Anaesthesia, Derriford Hospital, Derriford Road, Plymouth PL6 8DH, UK Plymouth University Peninsula Schools of Medicine and Dentistry, PL6 8BU, UK.
authors: J R
authors: JR
authors: Sneyd
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000592:standards*; D000773:Anesthesia, Obstetrical / Q000592:standards*; D000776:Anesthesiology / Q000193:education*; D019985:Benchmarking; D002983:Clinical Competence / Q000592:standards*; D004521:Educational Measurement; D005260:Female; D006779:Hospitals, Public; D006801:Humans; D059032:Learning Curve; D009774:Obstetrics / Q000592:standards*; D011247:Pregnancy; D011446:Prospective Studies; D012189:Retrospective Studies; D017211:Treatment Failure
keywords: anesthesia regional; competence; epidural; learning curves; obstetric