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Assessment of progress and competence in tonsillectomy surgery using cumulative sum analysis

Published online by Cambridge University Press:  12 July 2018

A K Abou-Foul ,
A Taghi ,
N S Tolley  and
Z Awad
A K Abou-Foul*
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Imperial College Healthcare NHS Trust, London, UK
A Taghi
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Imperial College Healthcare NHS Trust, London, UK
N S Tolley
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Imperial College Healthcare NHS Trust, London, UK Department of Surgery, Imperial College London, UK
Z Awad
Affiliation:
Department of Otolaryngology, Head and Neck Surgery, Imperial College Healthcare NHS Trust, London, UK Department of Surgery, Imperial College London, UK
*
Author for correspondence: Dr Ahmad K Abou-Foul, Department of Otolaryngology, Head and Neck Surgery, Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London W2 1NY, UK E-mail: [email protected] Fax: +44 203 312 1847
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Abstract

Objective

To assess the feasibility of using cumulative sum analysis to show trainees’ performance curves and highlight concerns in tonsillectomy surgery.

Methods

In this prospective study, the performance of eight otolaryngology trainees (in their first 6–12 months in the specialty) was compared to that of experts (over 150 tonsillectomies performed) in terms of operative time and post-operative complications. Cumulative sum analysis curves were generated to highlight trainees’ performance, and were updated after each performance.

Results

The average operative time was 23 minutes (standard deviation = 11) for experts and 38 minutes (standard deviation = 16) for trainees (p < 0.0001). Cumulative sum analysis charts for trainees’ operative time initially rose and then started to plateau after a number of cases (range, 25–30), while that of experts remained low. Cumulative sum analysis charts for complications can be used to monitor performance. In this study, complications were combined (because of low incidence) to allow use of this outcome measure.

Conclusion

The flexibility of the cumulative sum analysis makes it adaptable to any outcome. It is a strong adjunct in surgical training to monitor progress and competence. Its sensitivity also allows early detection of poor performance, to instigate intervention.

Keywords

TonsillectomySurgical TrainingLearning CurveClinical CompetencyOutcomes AssessmentOtolaryngology
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 132 , Issue 8 , August 2018 , pp. 734 - 738
Copyright
Copyright © JLO (1984) Limited, 2018 

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Footnotes

Dr A K Abou-Foul takes responsibility for the integrity of the content of the paper

Data from this study were presented at the 177th American Academy of Otolaryngology, Head and Neck Surgery Foundation annual meeting, 29 September – 2 October 2013, Vancouver, Canada.

References

1Hall, MJ, Schwartzman, A, Zhang, J, Liu, X. Ambulatory surgery data from hospitals and ambulatory surgery centers: United States, 2010. Natl Health Stat Report 2017;102:1–15Google Scholar
2ENT UK. Tonsillectomy commissioning guide 2016. In: https://www.rcseng.ac.uk/-/media/files/rcs/standards-and-research/commissioning/ent-uk-tonsillectomy-revised-commissioning-guide-2016-published.pdf [04 June 2018]Google Scholar
3Lowe, D, van der Meulen, J, Cromwell, D, Lewsey, J, Copley, L, Browne, J et al. Key messages from the National Prospective Tonsillectomy Audit. Laryngoscope 2007;117:717–24Google Scholar
4Page, ES. Continuous inspection schemes. Biometrika 1954;41:100–15Google Scholar
5Chen, T, Vamos, AC, Dailey, SH, Jiang, JJ. CUSUM analysis of learning curves for the head-mounted microscope in phonomicrosurgery. Laryngoscope 2016;126:2295–300Google Scholar
6Steiner, SH, Woodall, WH. Debate: what is the best method to monitor surgical performance? BMC Surg 2016;16:15Google Scholar
7Duclos, A, Carty, MJ, Peix, J-L, Colin, C, Lipsitz, SR, Kraimps, JL et al. Development of a charting method to monitor the individual performance of surgeons at the beginning of their career. PLoS One 2012;7:e41944Google Scholar
8Sharp, JF, Cozens, N, Robinson, I. Assessment of surgical competence in parotid surgery using a CUSUM assessment tool. Clin Otolaryngol Allied Sci 2003;28:248–51Google Scholar
9Roberts, G, Tang, CB, Harvey, M, Kadirkamanathan, S. Real-time outcome monitoring following oesophagectomy using cumulative sum techniques. World J Gastrointest Surg 2012;4:234–7Google Scholar
10Bokhari, MB, Patel, CB, Ramos-Valadez, DI, Ragupathi, M, Haas, EM. Learning curve for robotic-assisted laparoscopic colorectal surgery. Surg Endosc 2011;25:855–60Google Scholar
11Lerch, L, Donald, JC, Olivotto, IA, Lesperance, M, van der Westhuizen, N, Rusnak, C et al. Measuring surgeon performance of sentinel lymph node biopsy in breast cancer treatment by cumulative sum analysis. Am J Surg 2007;193:556–60Google Scholar
12Rogers, DA, Elstein, AS, Bordage, G. Improving continuing medical education for surgical techniques: applying the lessons learned in the first decade of minimal access surgery. Ann Surg 2001;233:159–66Google Scholar
13Awad, Z. A Comprehensive Evaluation of Work and Simulation Based Assessment in Otolaryngology Training. London: Imperial College London, 2014Google Scholar
14Memon, MA, Brigden, D, Subramanya, MS, Memon, B. Assessing the surgeon's technical skills: analysis of the available tools. Acad Med 2010;85:869–80Google Scholar
15Massie, J, Ali, JM. Workplace-based assessment: a review of user perceptions and strategies to address the identified shortcomings. Adv Health Sci Educ Theory Pract 2016;21:455–73Google Scholar
16Wilkinson, JR, Crossley, JG, Wragg, A, Mills, P, Cowan, G, Wade, W. Implementing workplace-based assessment across the medical specialties in the United Kingdom. Med Educ 2008;42:364–73Google Scholar
17Hu, Y, Jolissaint, JS, Ramirez, A, Gordon, R, Yang, Z, Sawyer, RG. Cumulative sum: a proficiency metric for basic endoscopic training. J Surg Res 2014;192:62–7Google Scholar
18Campbell, RD, Hecker, KG, Biau, DJ, Pang, DS. Student attainment of proficiency in a clinical skill: the assessment of individual learning curves. PLoS One 2014;9:e88526Google Scholar
19Jowell, PS, Baillie, J, Branch, MS, Affronti, J, Browning, CL, Bute, BP. Quantitative assessment of procedural competence. A prospective study of training in endoscopic retrograde cholangiopancreatography. Ann Intern Med 1996;125:983–9Google Scholar
20Li, X, Wang, J, Ferguson, MK. Competence versus mastery: the time course for developing proficiency in video-assisted thoracoscopic lobectomy. J Thorac Cardiovasc Surg 2014;147:1150–4Google Scholar