• Elizabeth D Krebs, William Z Chancellor, Robert B Hawkins, Jared P Beller, J Hunter Mehaffey, Nicholas R Teman, Gorav Ailawadi, and Leora T Yarboro.
• Department of Surgery, University of Virginia, Charlottesville, Va.
• J. Thorac. Cardiovasc. Surg. 2020 Aug 1; 160 (2): 460-466.e1.

ObjectivesObjective measures of cardiac surgery trainee progress are limited despite a push for competency-based assessments. We hypothesized that the cumulative sum failure technique could provide a risk-adjusted, quantitative measure of resident learning curves and competence.MethodsRecords of all coronary artery bypass grafting and valve operations performed by cardiac-track residents from 2007 to 2017 at a single institution were stratified by operative resident. Multivariable regression evaluated the association among resident, case number, and postoperative outcomes. To evaluate performance over time, risk-adjusted cumulative sum failure analysis was performed, taking into account institutional expected values and comparing residents with study-defined "early alert" and "concern" boundaries.ResultsA total of 3937 Society of Thoracic Surgeons Predicted Risk of Mortality cases were evaluated from 19 residents. Observed-to-expected ratios for mortality and combined morbidity-mortality were 0.66 and 0.72, respectively, and each individual resident exhibited better than predicted outcomes (all observed:expected ratios <1). When evaluating cumulative sum failure learning curves, residents exhibited an initial slight increase in complications, followed by improvement and better than expected performance. The "early alert" boundary was crossed by 36.8% of residents at any point in training, with 94.7% of residents under this boundary at the end of training. The higher "concern" boundary was crossed by 2 residents (10.5%), although all residents ended their training below this boundary.ConclusionsOutcomes for trainee-performed cardiac surgery procedures were excellent, with no association between individual trainees and adverse events. Cumulative sum failure analysis based on postoperative outcomes is a potential tool for objective evaluation of resident proficiency.Copyright © 2019. Published by Elsevier Inc.

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