• E Guasch, J Díez, and F Gilsanz.
• Servicio de Anestesiología, Reanimación y Terapia del Dolor, Unidad de Investigación, Universidad Autónoma de Madrid, Hospital Universitario La Paz, Madrid. emiguasch@hotmail.com
• Rev Esp Anestesiol Reanim. 2010 Jan 1;57(1):11-5.

Background And ObjectiveSkill acquisition in anesthesiology is subject to a great deal of interindividual variability. Our aim was to develop and test an individualized tool for monitoring acquisition of technical skills based on the cumulative sum (CUSUM) approach. This system objectively assesses whether an individual has acquired a minimum skill level and identifies the moment when the skill has been learned.Material And MethodsNine third-year residents in anesthesiology and postoperative recovery care participated. The residents anonymously recorded their first 100 obstetric epidural analgesia procedures in a database. The data were then analyzed with the CUSUM method. We considered acceptable skill acquisition to be reflected by a first-attempt success rate of 80% and a rate of success with help of 20%.ResultsA total of 765 epidural blocks were analyzed, giving a mean (SD) of 84.7 (2.8) procedures per resident (range, 47-100 procedures per resident). Seven residents became competent with the skill after 23 procedures and 2 residents were not successful in learning the skill. At the end of the study, 3 residents had required help with more than 20% of the procedures. Data collection from the trainees seemed to vary, leading to possible under- or overestimation of failures and/or need for help. Accidental dural puncture occurred 6 times (0.78%) and blood vessel puncture 40 times (5.2%).ConclusionsAlthough some third-year residents reach the targeted rate of success quickly, we believe that close supervision is useful to control progress along the learning curve for individuals who need more help.

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