Cumulative sum analysis score and phacoemulsification competency learning curve

Gustavo Vedana; Filipe G Cardoso; Alexandre S Marcon; Licio E K Araújo; Matheus Zanon; Daniella C Birriel; Guilherme Watte; Albert S Jun

doi:10.18240/ijo.2017.07.11

Cumulative sum analysis score and phacoemulsification competency learning curve

Int J Ophthalmol. 2017 Jul 18;10(7):1088-1093. doi: 10.18240/ijo.2017.07.11. eCollection 2017.

Authors

Gustavo Vedana^{1

2}, Filipe G Cardoso², Alexandre S Marcon², Licio E K Araújo², Matheus Zanon², Daniella C Birriel², Guilherme Watte³, Albert S Jun¹

Affiliations

¹ Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore 21287, USA.
² Irmandade Santa Casa, Misericórdia, Porto Alegre 90020160, Brazil.
³ Federal University of Rio Grande do Sul, Porto Alegre 90035003, Brazil.

Abstract

Aim: To use the cumulative sum analysis score (CUSUM) to construct objectively the learning curve of phacoemulsification competency.

Methods: Three second-year residents and an experienced consultant were monitored for a series of 70 phacoemulsification cases each and had their series analysed by CUSUM regarding posterior capsule rupture (PCR) and best-corrected visual acuity. The acceptable rate for PCR was <5% (lower limit h) and the unacceptable rate was >10% (upper limit h). The acceptable rate for best-corrected visual acuity worse than 20/40 was <10% (lower limit h) and the unacceptable rate was >20% (upper limit h). The area between lower limit h and upper limit h is called the decision interval.

Results: There was no statistically significant difference in the mean age, sex or cataract grades between groups. The first trainee achieved PCR CUSUM competency at his 22^nd case. His best-corrected visual acuity CUSUM was in the decision interval from his third case and stayed there until the end, never reaching competency. The second trainee achieved PCR CUSUM competency at his 39^th case. He could reach best-corrected visual acuity CUSUM competency at his 22^nd case. The third trainee achieved PCR CUSUM competency at his 41^st case. He reached best-corrected visual acuity CUSUM competency at his 14^th case.

Conclusion: The learning curve of competency in phacoemulsification is constructed by CUSUM and in average took 38 cases for each trainee to achieve it.

Keywords: best corrected visual acuity; cataract surgery; cumulative sum analysis; phacoemulsification learning curve; posterior capsule rupture; score.