title: Training Performance in Diagnosis of Congenital Uterine Anomalies With 3-Dimensional Sonography: A Learning Curve Cumulative Summation Analysis.
abstract: OBJECTIVE
  We evaluated learning curve cumulative summation (CUSUM) of 3-dimensional (3D) sonography for diagnosis of congenital uterine anomalies and the deviations of the level of trainees' performance at the control-stage CUSUM.
  
  
  METHODS
  First-year (R1), second-year (R2), and third-year (R3) residents in obstetrics and gynecology received a training program to learn how to analyze 3D sonographic volumes and to classify congenital uterine anomalies. Each trainee worked on 155 3D sonographic volumes from preselected patients. Their results were evaluated by learning curve CUSUM and standard CUSUM. The time for each volume analysis was calculated for the expert examiner and the trainees.
  
  
  RESULTS
  Trainees R1, R2, and R3 reached competence at the 85th, 58th, and 40th evaluations, respectively, with success rates of 80%, 81%, and 85%, and kept the process under control with error levels of less than 4.5% until the end of the test. The trainees significantly reduced the average time of the evaluation per volume (P < .001).
  
  
  CONCLUSIONS
  Learning curve CUSUM provided quantitative indicators of the learning evolution of 3D sonography for diagnosis of congenital uterine anomalies by obstetrics and gynecology residents. The training received by the residents was adequate for diagnosis of congenital uterine anomalies using 3D sonography.
authors.affiliation: Department of Obstetrics, Gynecology, and Reproduction, Institut Universitari Dexeus, Barcelona, Spain marpas@dexeus.com.
authors.forename: M Angela
authors.initials: MA
authors.lastname: Pascual
authors.affiliation: Department of Obstetrics and Gynaecology, Medical School, University of Navarra, Pamplona, Spain.
authors.forename: Juan Luís
authors.initials: JL
authors.lastname: Alcazar
authors.affiliation: Department of Obstetrics, Gynecology, and Reproduction, Institut Universitari Dexeus, Barcelona, Spain.
authors.forename: Betlem
authors.initials: B
authors.lastname: Graupera
authors.affiliation: Department of Obstetrics, Gynecology, and Reproduction, Institut Universitari Dexeus, Barcelona, Spain.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Rodriguez
authors.affiliation: Department of Obstetrics and Gynecology, University of Cagliari, Cagliari, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Guerriero
authors.affiliation: Department of Obstetrics, Gynecology, and Reproduction, Institut Universitari Dexeus, Barcelona, Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Mallafre
authors.affiliation: Department of Obstetrics, Gynecology, and Reproduction, Institut Universitari Dexeus, Barcelona, Spain.
authors.forename: Cristina
authors.initials: C
authors.lastname: de Lorenzo
authors.affiliation: Department of Obstetrics, Gynecology, and Reproduction, Institut Universitari Dexeus, Barcelona, Spain.
authors.forename: Lourdes
authors.initials: L
authors.lastname: Hereter
mesh_terms: D002983:Clinical Competence; D005260:Female; D006176:Gynecology / Q000193:education*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods*; D007396:Internship and Residency; D059032:Learning Curve; D011446:Prospective Studies; D012189:Retrospective Studies; D014463:Ultrasonography / Q000379:methods*; D014564:Urogenital Abnormalities / Q000000981:diagnostic imaging*; D014599:Uterus / Q000002:abnormalities* / Q000000981:diagnostic imaging
keywords: 3-dimensional sonography; congenital uterine anomalies; gynecologic ultrasound; learning curve cumulative summation; müllerian duct anomaly; training