Defining competency in flexible cystoscopy: a novel approach using cumulative Sum analysis

Area of Science:

• Urology
• Medical Education
• Surgical Skills Assessment

Background:

• Flexible cystoscopy (FC) is a frequent urological procedure.
• Cumulative sum analysis (CUSUM) offers objective performance evaluation.
• This study explores CUSUM for assessing trainee FC learning curves and competence.

Purpose of the Study:

• To apply CUSUM analysis to evaluate a urology trainee's learning curve in flexible cystoscopy.
• To determine the number of procedures required for achieving and maintaining competence in FC.
• To assess the objective performance of flexible cystoscopy using CUSUM.

Main Methods:

• A single urology trainee with no prior FC experience performed 419 procedures.
• Flexible cystoscopy was divided into 5 assessed steps.
• CUSUM scores were used to analyze prospective data for successful FC completion.

Main Results:

• Acceptable flexible cystoscopy performance was reached by the 122nd procedure.
• Consistent complete assessment of ureteric orifices and trigone was the most challenging step.
• Full competence in flexible cystoscopy was attained after 289 procedures.

Conclusions:

• CUSUM analysis provides an objective measure for assessing flexible cystoscopy competence acquisition.
• Current recommended procedure numbers may underestimate the training required for trainee competency.
• Further validation of the CUSUM method in a larger trainee cohort is recommended.