Cumulative sum: a proficiency metric for basic endoscopic training.
Cumulative sum: a proficiency metric for basic endoscopic training.
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累积总和：基本内窥镜培训的熟练程度指标。
DOI：
10.1016/j.jss.2014.05.056
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Sawyer,RobertG
中科院分区：
文献类型：
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作者：
Hu,Yinin;Jolissaint,JoshuaS;Ramirez,Adriana;Gordon,Ryan;Yang,Zequan;Sawyer,RobertG
背景随着工作时间限制越来越多地限制了一些手术经验，个性化的评估方法是必要的。我们前瞻性地评估了累积总和(CUSUM)的值，以衡量外科实习生对经皮内窥镜胃造口术(PEG术)的熟练程度。材料和方法9名研究生1年级外科住院医师每人接受了为期1个月的内窥镜检查轮换。前瞻性记录所有聚乙二醇置入物的操作持续时间。任务失败的标准包括需要参加接管或程序持续时间10分钟。累积参数是先验定义的，可接受和不可接受的失败率分别为5%和15%。同时，专家内窥镜医师对CUSUM结果视而不见，使用多类别、5分的Likert量表调查每周评估受训人员的熟练程度。结果9名外科住院医师平均每人进行了21次钉子。专家评估和CUSUM分析分别确定了8名和7名参与者在中位数分别为11.5和12例后达到了熟练程度。对于四名通过CUSUM标准达到熟练程度的住院医生来说，最终被确定为表现不佳。专家评估没有发现这些复发。6名通过这两个指标都达到熟练程度的参与者总共完成了32个多余的案例，这些案例本可以重新分配给表现不佳的培训人员。结论尽管缺乏专家评估的细粒度洞察力，CUSUM分析对不熟练表现的复发更敏感。将累积分析添加到专家评估中可以提供纵向的形成性反馈，并促进手术经验的有效再分配。
BackgroundAs work hour restrictions increasingly limit some operative experiences, personalized evaluative methods are needed. We prospectively assessed the value of cumulative sum (Cusum) to measure proficiency with percutaneous endoscopic gastrostomy (PEG) among surgical trainees.Materials and methodsNine postgraduate year 1 surgery residents each underwent a 1-month rotation dedicated to endoscopy. Procedure durations for all PEG insertions were recorded prospectively. Criteria for task failure included need for attending takeover or procedure duration >10 min. Cusum parameters were defineda priori, with acceptable and unacceptable failure rates of 5% and 15%, respectively. Concurrently, expert endoscopists blinded to Cusum results evaluated trainee proficiency weekly using a multicategory, five-point Likert-scale survey.ResultsNine surgical residents performed an average of 21 PEGs each. Expert evaluations and Cusum analyses identified eight and seven participants who attained proficiency after a median of 11.5 and 12 cases, respectively. For four of the residents who achieved proficiency by Cusum criteria, eventual relapses to inadequate performance were identified. These relapses were not detected by expert evaluation. Six participants who attained proficiency by both metrics performed a combined 32 superfluous cases, which could have been redistributed to poor-performing trainees.ConclusionsAlthough lacking the granular insight of expert evaluations, Cusum analysis is more sensitive to relapses of subproficient performance. Adding Cusum analysis to expert evaluations can provide longitudinal, formative feedback and promote efficient redistribution of operative experiences.