title: Use of the Learning Curve-Cumulative Summation Test for Leopold Maneuvers Assessment in a Simulator: A Pilot Study.
abstract: BACKGROUND
  Simulation enables medical students to practice clinical skills in a safe environment. Graduates in medicine must be able to correctly perform an examination on a pregnant woman using Leopold maneuvers. Learning curves-cumulative summation (LC-CUSUM) may help determine when the student has achieved a specific skill. Our objective was to perform the LC-CUSUM test regarding the ability of students to correctly carry out Leopold maneuvers; a pregnancy simulator was used, transferring the results to a clinical setting.
  
  
  METHODS
  Five medical students were trained to carry out Leopold maneuvers using the simulator. Each student performed maneuvers for 50 cases of different fetus positions; a LC-CUSUM was plotted for each student. Afterward, the students performed the Leopold maneuvers on 5 pregnant women.
  
  
  RESULTS
  Of the 5 students, 3 achieved a level of proficiency; the attempts needed for reaching this level were 13, 13, and 37, respectively. The other 2 students did not reach proficiency level. Of the students who became successfully proficient with the simulator, one of them attained a 100% success rate in pregnant patients, whereas the other two had success rates of 80%. The students who did not achieve a level of competency with the simulator had only a 60% success rate with patients.
  
  
  CONCLUSIONS
  Because of the differences observed between students in the number of attempts needed for achieving proficiency in Leopold maneuvers, we believe that each student should build his/her own learning curve. Achieving competency in carrying out Leopold maneuvers using the simulator could be transferable to patients.
authors.affiliation: From the Medical Simulation Center (N.D., M.C.R.-D.), Medical Education Unit (N.D., M.C.R.-D.), School of Medicine (S.G.), University of Navarra; and Department of Obstetrics and Gynecology (L.P., J.L.A.), Clinic University of Navarra, Navarra, Spain.
authors.forename: Nieves
authors.initials: N
authors.lastname: Díez-Goñi
authors.forename: Sergio
authors.initials: S
authors.lastname: Guillén
authors.forename: María C
authors.initials: MC
authors.lastname: Rodríguez-Díez
authors.forename: Laura
authors.initials: L
authors.lastname: Pineda
authors.forename: Juan L
authors.initials: JL
authors.lastname: Alcázar
mesh_terms: D002983:Clinical Competence; D004521:Educational Measurement / Q000379:methods*; D005260:Female; D006801:Humans; D059032:Learning Curve; D008348:Manikins; D009774:Obstetrics / Q000193:education*; D010808:Physical Examination / Q000379:methods*; D010865:Pilot Projects; D011247:Pregnancy