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Inicio Revista Española de Anestesiología y Reanimación (English Edition) Use of the cumulative sum method (CUSUM) to assess the learning curves of ultras...
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Vol. 64. Issue 8.
Pages 453-459 (October 2017)
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Vol. 64. Issue 8.
Pages 453-459 (October 2017)
Original article
Use of the cumulative sum method (CUSUM) to assess the learning curves of ultrasound-guided continuous femoral nerve block
Método de suma acumulada (CUSUM) para evaluar las curvas de aprendizaje del bloqueo femoral continuo guiado por ecografía
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A. Kollmann-Camaiora
Corresponding author
and_c@hotmail.com

Corresponding author.
, N. Brogly, E. Alsina, F. Gilsanz
Departamento de Anestesiología y Reanimación, Hospital Universitario La Paz, Madrid, Spain
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Tables (2)
Table 1. Formulas needed to calculate the upper-lower decision limits and sample size calculation.
Table 2. Number of procedures performed by each resident, group, pain scores before and after the procedure and the critical number for both success criteria, efficacy of the block and efficiency in time of performance. If the resident did not achieved success the critical number could not be calculated.
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Abstract
Background

Although ultrasound is a basic competence for anaesthesia residents (AR) there is few data available on the learning process. This prospective observational study aims to assess the learning process of ultrasound-guided continuous femoral nerve block and to determine the number of procedures that a resident would need to perform in order to reach proficiency using the cumulative sum (CUSUM) method.

Methods

We recruited 19 AR without previous experience. Learning curves were constructed using the CUSUM method for ultrasound-guided continuous femoral nerve block considering 2 success criteria: a decrease of pain score>2 in a [0–10] scale after 15min, and time required to perform it.

Results

We analyze data from 17 AR for a total of 237 ultrasound-guided continuous femoral nerve blocks. 8/17 AR became proficient for pain relief, however all the AR who did more than 12 blocks (8/8) became proficient. As for time of performance 5/17 of AR achieved the objective of 12min, however all the AR who did more than 20 blocks (4/4) achieved it.

Conclusions

The number of procedures needed to achieve proficiency seems to be 12, however it takes more procedures to reduce performance time. The CUSUM methodology could be useful in training programmes to allow early interventions in case of repeated failures, and develop competence-based curriculum.

Keywords:
CUSUM
Cumulative sum
Learning curves
Ultrasound
Femoral nerve block
Resumen
Introducción

Aunque la ecografía es una competencia básica de los residentes de anestesia (RA) hay pocos datos disponibles sobre su proceso de aprendizaje. Este estudio prospectivo observacional tiene como objetivo evaluar el proceso de aprendizaje del bloqueo del nervio femoral continuo guiado por ecografía y determinar el número de procedimientos necesarios que un RA debe realizar para ser exitoso, utilizando el método de suma acumulada (CUSUM).

Método

Reclutamos 19 RA sin experiencia previa. Construimos las curvas de aprendizaje utilizando la metodología CUSUM para el bloqueo del nervio femoral continuo guiado por ecografía considerando 2 criterios de éxito: disminución del dolor>2 puntos en una escala numérica [0-10] tras 15min y el tiempo necesario para realizar la técnica.

Resultados

Analizamos los datos de 17 RA, que realizaron un total de 237 bloqueos del nervio femoral continuo guiados por ecografía. Ocho de 17 RA tuvieron éxito en cuanto a la disminución del dolor, y asimismo aquellos RA que realizaron>12 bloqueos (8/8) lo consiguieron. En cuanto al tiempo de realización, 5/17 RA alcanzaron el objetivo en 12min; y todos los RA que realizaron>20 procedimientos (4/4) lo alcanzaron.

Conclusiones

El número de procedimientos necesarios para alcanzar el éxito parece ser 12, sin embargo es necesario realizar un número mayor para reducir el tiempo de realización del mismo. La metodología CUSUM podría ser útil en programas de formación, permitiendo intervenciones precoces en casos de fallos repetidos, y realizar un currículo basado principalmente en las competencias.

Palabras clave:
CUSUM
Suma acumulada
Curvas de aprendizaje
Ecografía
Bloqueo femoral

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