Cumulative sum analysis score and phacoemulsification competency learning curve

Area of Science:

• Ophthalmology
• Surgical Education
• Medical Statistics

Background:

• Phacoemulsification is a key cataract surgery technique.
• Assessing surgical competency objectively is crucial for patient safety and effective training.
• Traditional methods for evaluating surgical skills may lack objectivity and statistical rigor.

Purpose of the Study:

• To objectively construct the learning curve for phacoemulsification competency using the cumulative sum analysis score (CUSUM).
• To establish objective benchmarks for posterior capsule rupture (PCR) and best-corrected visual acuity (BCVA) outcomes during surgical training.

Main Methods:

• Three second-year residents and one consultant performed 70 phacoemulsification cases each.
• Cumulative sum analysis (CUSUM) was applied to analyze outcomes regarding posterior capsule rupture (PCR) and best-corrected visual acuity (BCVA).
• Defined acceptable (<5% PCR, <10% BCVA worse than 20/40) and unacceptable (>10% PCR, >20% BCVA worse than 20/40) rates to establish competency thresholds.

Main Results:

• No significant differences in patient demographics or cataract grades were observed between groups.
• Trainees achieved CUSUM competency for PCR at an average of 38 cases (ranging from 22 to 41 cases).
• Competency for best-corrected visual acuity was achieved earlier, with one trainee reaching it by the 14th case, while another did not reach it within 70 cases.

Conclusions:

• The CUSUM analysis provides an objective method for constructing the phacoemulsification learning curve.
• Surgical competency in phacoemulsification, as measured by CUSUM, requires an average of 38 cases for trainees.
• CUSUM analysis can identify variations in learning trajectories for different surgical outcomes like PCR and BCVA.