• Glen J Watson, Karen Byth, and Melville da Cruz.
• *Department of Otolaryngology †Research and Education Network, Westmead Hospital, Westmead Millennium Institute, Westmead, New South Wales, Australia.
• Otol. Neurotol. 2015 Dec 1; 36 (10): 1601-3.

ObjectiveThe aim of this study is to determine if the cumulative summation test for the learning curve (LC-CUSUM) and the cumulative summation graph (CUSUM) can be used to demonstrate landmark points of competence and maintenance of proficiency in stapes surgery over a continuous time period.Study DesignRetrospective review from January 1999 until August 2014.SettingTertiary referral hospital.PatientsAll adult patients with confirmed otosclerosis.Intervention(S)Two-hundred and four primary and revision stapedotomy.Main Outcome Measure(S)Learning curves were constructed using the CUSUM and LC-CUSUM. Failure was defined as closure of the ABG >10 dB in less than 10% of patients to demonstrate the landmark point of competency and to highlight any fluctuations over a prolonged period.ResultsWhen the failure rate was defined as closure of the ABG >10 dB, it was not possible to create useful LC-CUSUM and CUSUM graphs, but by redefining the failure rate as > 15 dB, competency was reached at case 43 and maintained with natural fluctuations occurring between cases 137 and 149 and again at case 196.ConclusionsLC-CUSUM and CUSUM are a more robust analytical method of illustrating the learning curve and suggest that the traditional benchmark of closure of the ABG ≤10 dB in more than 90% of patients may need reconsideration. It can also be used as standardized audit tools when monitoring results and used to plan future training programs as they clearly define a point when novice trainees become competent.

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