Outcomes in Stapedotomy Surgery: The Learning Curve Redefined.
OBJECTIVE
The aim of this study is to determine if the cumulative summation test for the learning curve (LC-CUSUM) and the cumulative summation graph (CUSUM) can be used to demonstrate landmark points of competence and maintenance of proficiency in stapes surgery over a continuous time period.


METHODS
Retrospective review from January 1999 until August 2014.


METHODS
Tertiary referral hospital.


METHODS
All adult patients with confirmed otosclerosis.


METHODS
Two-hundred and four primary and revision stapedotomy.


METHODS
Learning curves were constructed using the CUSUM and LC-CUSUM. Failure was defined as closure of the ABG >10 dB in less than 10% of patients to demonstrate the landmark point of competency and to highlight any fluctuations over a prolonged period.


RESULTS
When the failure rate was defined as closure of the ABG >10 dB, it was not possible to create useful LC-CUSUM and CUSUM graphs, but by redefining the failure rate as > 15 dB, competency was reached at case 43 and maintained with natural fluctuations occurring between cases 137 and 149 and again at case 196.


CONCLUSIONS
LC-CUSUM and CUSUM are a more robust analytical method of illustrating the learning curve and suggest that the traditional benchmark of closure of the ABG ≤10 dB in more than 90% of patients may need reconsideration. It can also be used as standardized audit tools when monitoring results and used to plan future training programs as they clearly define a point when novice trainees become competent.
*Department of Otolaryngology †Research and Education Network, Westmead Hospital, Westmead Millennium Institute, Westmead, New South Wales, Australia.
Glen J
GJ
Watson
Karen
K
Byth
Melville
M
da Cruz
D000328:Adult; D002983:Clinical Competence / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D010040:Otosclerosis / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D013201:Stapes Surgery / Q000379:methods* / Q000592:standards