Combined cumulative sum (CUSUM) and chronological environmental analysis as a tool to improve the learning environment for linear-probe endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) trainees: a pilot study.
BACKGROUND
Cumulative sum (CUSUM) analysis can be used to continuously monitor the performance of an individual or process and detect deviations from a preset or standard level of achievement. However, no previous study has evaluated the utility of CUSUM analysis in facilitating timely environmental assessment and interventions to improve performance of linear-probe endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). The aim of this study was to evaluate the usefulness of combined CUSUM and chronological environmental analysis as a tool to improve the learning environment for EBUS-TBNA trainees.


METHODS
This study was an observational chart review. To determine if performance was acceptable, CUSUM analysis was used to track procedural outcomes of trainees in EBUS-TBNA. To investigate chronological changes in the learning environment, multivariate logistic regression analysis was used to compare several indices before and after time points when significant changes occurred in proficiency.


RESULTS
Presence of an additional attending bronchoscopist was inversely associated with nonproficiency (odds ratio, 0.117; 95% confidence interval, 0-0.749; P = 0.019). Other factors, including presence of an on-site cytopathologist and dose of sedatives used, were not significantly associated with duration of nonproficiency.


CONCLUSIONS
Combined CUSUM and chronological environmental analysis may be useful in hastening interventions that improve performance of EBUS-TBNA.
Department of Pulmonary and Critical Care Medicine, Tokyo Bay Urayasu-Ichikawa Medical Center, 3-4-32 Toudaijima, Urayasushi, Chiba, 279-0001, Japan. norisue.yasuhiro@gmail.com.
Yasuhiro
Y
Norisue
Japan Community Healthcare Organization, 3-22-12, Takanawa, Tokyo, 108-0074, Japan.
Yasuharu
Y
Tokuda
Mercy Hospital, 1235 E Cherokee St, Springfield, MO, 65804, USA.
Mayrol
M
Juarez
Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA.
Ryo
R
Uchimido
Department of Emergency and Critical Care Medicine, St. Marianna University Hospital, 2-16-1, Miyamae, Kawasaki, Kanagawa, Japan.
Shigeki
S
Fujitani
Division of Pulmonary, Critical Care and Sleep Medicine, Saint Louis University, 1402S. Grand Avenue, Saint Louis, MO, 63104-1004, USA.
David A
DA
Stoeckel
D001999:Bronchoscopy / Q000193:education*; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003627:Data Interpretation, Statistical; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods*; D006801:Humans; D007564:Japan; D016015:Logistic Models; D015999:Multivariate Analysis; D010865:Pilot Projects; D058996:Quality Improvement
CUSUM analysis; EBUS-TBNA; Endobronchial ultrasound-guided transbronchial needle aspiration; Quality improvement