title: Learning curves for three specific procedures by anesthesiology residents using the learning curve cumulative sum (LC-CUSUM) test.
abstract: BACKGROUND
  The learning curve cumulative sum (LC-CUSUM) test is an innovative tool that allows quantitative monitoring of individual medical performance during the learning process by determining when a predefined acceptable level of performance is reached. This study used the LC-CUSUM test to monitor the learning process and failure rate of anesthesia residents training for specific subspecialty anesthesia procedures.
  
  
  METHODS
  The study included 490 tracheal punctures (TP) for jet ventilation, 340 thoracic epidural analgesia (TEA) procedures, and 246 fiberoptic nasal intubations (FONI) performed by 18 residents during their single 6-month rotation.
  
  
  RESULTS
  Overall, 27 (14-52), 19 (5-41), and 14 (6-33) TP, TEA, and FONI procedures were performed, respectively, by each resident. In total, 2 of 18 residents achieved an acceptable failure rate for TEA according to the literature and 4 of 18 achieved an acceptable failure rate for FONI, while none of the residents attained an acceptable rate for TP.
  
  
  CONCLUSIONS
  A single 6-month rotation in a reference teaching center may not be sufficient to train residents to perform specific or sub-specialty procedures as required. A regional learning network may be useful. More patient-based data are necessary to conduct a risk adjustment analysis for such specific procedures.
authors.affiliation: Department of Anesthesia, Institute Gustave Roussy, Villejuif, France.
authors.forename: Gregoire
authors.initials: G
authors.lastname: Weil
authors.affiliation: Department of Anesthesia, Institute Gustave Roussy, Villejuif, France.
authors.forename: Cyrus
authors.identifier: 0000-0002-0298-9882
authors.initials: C
authors.lastname: Motamed
authors.affiliation: Department of Anesthesia, Institute Gustave Roussy, Villejuif, France.
authors.forename: David J
authors.initials: DJ
authors.lastname: Biau
authors.affiliation: Department of Anesthesia, Institute Gustave Roussy, Villejuif, France.
authors.forename: Marie Laurence
authors.initials: ML
authors.lastname: Guye
keywords: Anesthesiology residency; Cumulative sum; Epidural; Intubation; Learning curve; Tracheal puncture