Abstract
Background:
The psychomotor challenges inherent in laparoscopic surgery are evident by the steep procedural “learning curves” documented throughout the literature. Few methods have been described to evaluate learning curves. The cumulative summation (CUSUM) method is a criterion-based evaluation of the learning process. The purpose of this study is to describe the CUSUM learning curves for a simple task for individuals and for a group of novice laparoscopists.
Methods:
Sixteen medical students undertook four weekly sessions of 10 laparoscopic pegboard transfers in the MISTELS system. Their performance was scored and recorded for each trial. CUSUM learning curves were constructed based on the goal of achieving mean scores for senior, intermediate, or junior laparoscopists ≥95% of the time.
Results:
Based on senior criteria, one student achieved the goal by the 40th peg transfer trial. Based on intermediate criteria, three students achieved the goal by their 40th trial (trials 21 and 36), and for junior criteria, 10 students achieved the acceptable success rate by their 40th trial (range, 26–40).
Conclusion:
CUSUM analysis suggests criterion-based practice is useful for novice laparoscopists. It allows educators to track the progress of an individual toward target criteria for each MISTELS task, to more logically allocate time for training and set attainable goals, to objectively evaluate trainee acquisition of basic laparoscopic skills, and to identify trainees who need remediation.
Similar content being viewed by others
References
De Oliveira Filho GR (2002) The construction of learning curves for basic skills in the anesthetic procedures: an application for the cumulative sum method. Anesth Analg 95: 411–416
Derossis AM, Bothwell J, Sigman HH, Fried GM (1998) The effect of practice on performance in a laparoscopic simulator. Surg Endosc 12: 1117–1120
Derossis AM, Fried GM, Abrahamowicz M, Sigman HH, Barkun JS, Meakins JL (1998) Development of a model for training and evaluation for laparoscopic skills. Am J Surg 175: 482–487
Kennedy RS, Dunlap WP, Wilkes RL, Lane NE (1985) Factor analysis of a fifteen-minute microcomputer-based performance test battery. EOTR, Essex Corporation, Orlando, FL
Konrad C, Schupfer G, Wietlisbach M, Gerber H (1998) Learning manual skills in anesthesiology: Is there a recommended number of cases for anesthetic procedures? Anesth Analg 86: 635–639
Lane NE (1987) Skill acquisition rates and patterns: issues and training implications. Springer-Verlag, New York
Lawler PG, Patla VR, Garcia E, Puttick N (1991) Assessment of training in anaesthesia and related skills. Anaesthesia 46: 597
McCarter FD, Luchette FA, Malloy M, Hurst JM, Davis K, Johannigman JA, Frame SB, Fischer JE (2000) Institutional and individual learning curves for focused abdominal ultrasound for trauma. Ann Surg 231: 689–700
Melvin WS, Johnson JA, Ellison EC (1996) Laparoscopic skills enhancement. Am J Surg 172: 377–379
Molloy M, Bower RH, Hasselgren P-O, Dalton BJ (1999) Cholangiography during laparoscopic cholecystectomy—cumulative sum analysis of an institutional learning curve. J Gastrointest Surg 3: 185–188
Rogers DA, Elstein AS, Bordage G (2001) Improving continuing medical education for surgical techniques: applying the lessons learned in the first decade of minimal access surgery. Ann Surg 233: 159–166
Rosser JC, Rosser LE, Savalgi RS (1997) Skill acquisition and assessment for laparoscopic surgery. Arch Surg 132: 200–204
Schmidt RA, Lee TD (1999) Motor control and learning: a behavioral emphasis, 3rd ed. Human Kinetics, Windsor, ON, Canada
Scott DJ, Young WN, Tesfay ST, Frawley WH, Rege RV, Jones DB (2001) Laparoscopic skills training. Am J Surg 182: 137–142
Shapiro SJ, Paz-Partlow M, Daykhovsky L, Gordon LA (1996) The use of a modular skills center for the maintenance of laparoscopic skills. Surg Endosc 10: 816–819
Smith CD, Farrell TM, McNatt SS, Metreveli RE (2001) Assessing laparoscopic manipulative skills. Am J Surg 181: 547–550
Van Rij AM, McDonald JR, Pettigrew RA, Putterill MJ, Reddy CK, Wright JJ (1995) CUSUM as an aid to early assessment of the surgical trainee. Br J Surg 82: 1500–1503
Williams SM, Parry BR, Schlup MMT (1992) Quality control: an application of the CUSUM. Br Med J 304: 1359–1361
Acknowledgment
This research was supported by an unrestricted educational grant from Tyco-Healthcare Canada.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Fraser, S.A., Feldman, L.S., Stanbridge, D. et al. Characterizing the learning curve for a basic laparoscopic drill. Surg Endosc 19, 1572–1578 (2005). https://doi.org/10.1007/s00464-005-0150-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-005-0150-5