title: Adaptive simulation training using cumulative sum: a randomized prospective trial.
abstract: BACKGROUND
  Cumulative sum (Cusum) is a novel tool that can facilitate adaptive, individualized training curricula. The purpose of this study was to use Cusum to streamline simulation-based training.
  
  
  METHODS
  Preclinical medical students were randomized to Cusum or control arms and practiced suturing, intubation, and central venous catheterization in simulation. Control participants practiced between 8 and 9 hours each. Cusum participants practiced until Cusum proficient in all tasks. Group comparisons of blinded post-test evaluations were performed using Wilcoxon rank sum.
  
  
  RESULTS
  Forty-eight participants completed the study. Average post-test composite score was 92.1% for Cusum and 93.5% for control (P = .71). Cusum participants practiced 19% fewer hours than control group participants (7.12 vs 8.75 hours, P < .001). Cusum detected proficiency relapses during practice among 7 (29%) participants for suturing and 10 (40%) for intubation.
  
  
  CONCLUSIONS
  In this comparison between adaptive and volume-based curricula in surgical training, Cusum promoted more efficient time utilization while maintaining excellent results.
authors.affiliation: Department of Surgery, University of Virginia School of Medicine, P.O. Box 800709, Charlottesville, VA, 22908-0709, USA.
authors.forename: Yinin
authors.initials: Y
authors.lastname: Hu
authors.affiliation: Department of Surgery, University of Virginia School of Medicine, P.O. Box 800709, Charlottesville, VA, 22908-0709, USA.
authors.forename: Kendall D
authors.initials: KD
authors.lastname: Brooks
authors.affiliation: Department of Surgery, University of Virginia School of Medicine, P.O. Box 800709, Charlottesville, VA, 22908-0709, USA.
authors.forename: Helen
authors.initials: H
authors.lastname: Kim
authors.affiliation: Department of Surgery, University of Virginia School of Medicine, P.O. Box 800709, Charlottesville, VA, 22908-0709, USA.
authors.forename: Adela
authors.initials: A
authors.lastname: Mahmutovic
authors.affiliation: Department of Surgery, University of Virginia School of Medicine, P.O. Box 800709, Charlottesville, VA, 22908-0709, USA.
authors.forename: Joanna
authors.initials: J
authors.lastname: Choi
authors.affiliation: Department of Surgery, University of Virginia School of Medicine, P.O. Box 800709, Charlottesville, VA, 22908-0709, USA.
authors.forename: Ivy A
authors.initials: IA
authors.lastname: Le
authors.affiliation: Department of Surgery, University of Virginia School of Medicine, P.O. Box 800709, Charlottesville, VA, 22908-0709, USA.
authors.forename: Bartholomew J
authors.initials: BJ
authors.lastname: Kane
authors.affiliation: Department of Surgery, University of Virginia School of Medicine, P.O. Box 800709, Charlottesville, VA, 22908-0709, USA.
authors.forename: Eugene D
authors.initials: ED
authors.lastname: McGahren
authors.affiliation: Department of Surgery, University of Virginia School of Medicine, P.O. Box 800709, Charlottesville, VA, 22908-0709, USA. Electronic address: skr3f@virginia.edu.
authors.forename: Sara K
authors.initials: SK
authors.lastname: Rasmussen
mesh_terms: D000328:Adult; D002405:Catheterization, Central Venous; D002983:Clinical Competence; D003162:Competency-Based Education; D004501:Education, Medical; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D011214:Practice, Psychological; D011446:Prospective Studies; D000066908:Simulation Training; D013536:Suture Techniques / Q000193:education*; D013997:Time Factors
keywords: Adaptive learning; Cumulative sum; Medical student education; Resident education; Surgical education; Surgical simulation