Assessment of surgical competence in parotid surgery using a CUSUM assessment tool

The introduction of professional revalidation and clinical governance imposes an increasing requirement for clinicians to provide evidence of competence. This paper introduces a CUSUM (CUmulative SUM) mathematical tool for determining trend and applies the technique to 84 consecutive parotidectomies (superficial, partial or total/near total) performed by one surgeon (J.S.). Using this operation, the paper illustrates how attainment and maintenance of competence in the field of otolaryngological surgery may be demonstrated at differing levels of rigour. The role of the CUSUM in assessing a trainee's surgical progress is also explored.