title: CUSUM analysis of learning curves for the head-mounted microscope in phonomicrosurgery.
abstract: To observe the learning curve of the head-mounted microscope in a phonomicrosurgery simulator using cumulative summation (CUSUM) analysis, which incorporates a magnetic phonomicrosurgery instrument tracking system (MPTS).
  
  
  
  Retrospective case series.
  
  
  
  Eight subjects (6 medical students and 2 surgeons inexperienced in phonomicrosurgery) operated on phonomicrosurgical simulation cutting tasks while using the head-mounted microscope for 400 minutes total. Two 20-minute sessions occurred each day for 10 total days, with operation quality (Qs ) and completion time (T) being recorded after each session. Cumulative summation analysis of Qs and T was performed by using subjects' performance data from trials completed using a traditional standing microscope as success criteria.
  
  
  
  The motion parameters from the head-mounted microscope were significantly better than the standing microscope (P < 0.01), but T was longer than that from the standing microscope (P < 0.01). No subject successfully adapted to the head-mounted microscope, as assessed by CUSUM analysis.
  
  
  
  Cumulative summation analysis can objectively monitor the learning process associated with a phonomicrosurgical simulator system, ultimately providing a tool to assess learning status. Also, motion parameters determined by our MPTS showed that, although the head-mounted microscope provides better motion control, worse Qs and longer T resulted. This decrease in Qs is likely a result of the relatively unstable visual environment that it provides. Overall, the inexperienced surgeons participating in this study failed to adapt to the head-mounted microscope in our simulated phonomicrosurgery environment.
  
  
  
  4 Laryngoscope, 126:2295-2300, 2016.
authors.affiliation: Department of Otorhinolaryngology, Fujian Provincial Clinical College of Fujian Medical University, Fuzhou, Fujian Province.
authors.forename: Ting
authors.initials: T
authors.lastname: Chen
authors.affiliation: Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A.
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Vamos
authors.affiliation: Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A.
authors.forename: Seth H
authors.initials: SH
authors.lastname: Dailey
authors.affiliation: Department of Otolaryngology, Eye, Ear, Nose and Throat Hospital, Fudan University, Shanghai, China. jjjiang@wisc.edu.|Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, U.S.A.. jjjiang@wisc.edu.
authors.forename: Jack J
authors.initials: JJ
authors.lastname: Jiang
mesh_terms: D000328:Adult; D004867:Equipment Design; D005260:Female; D006257:Head; D006801:Humans; D059032:Learning Curve; D060328:Magnetic Phenomena; D008297:Male; D008853:Microscopy / Q000295:instrumentation* / Q000379:methods; D008866:Microsurgery / Q000193:education* / Q000295:instrumentation* / Q000379:methods; D012189:Retrospective Studies; D000066908:Simulation Training / Q000379:methods / Q000706:statistics & numerical data*; D013997:Time Factors
keywords: CUSUM; head-mounted microscope; learning procedure; phonomicrosurgery; simulation; surgical training