Abstract
BackgroundThe learning curve cumulative summation test (LC CUSUM test) allows to define an individualized learning curve and determine the moment when clinical proficiency is attained. After acquisition of the skills, the cumulative summation test (CUSUM test) allows to monitor the maintenance of the required level over time. The LC CUSUM test has been frequently used in the field of Obstetrics and Gynecology (Ob/Gyn) for several procedures, but only once for OR.MethodsWe performed a retrospective study at Angers university hospital between May 2017 and September 2018. Seven Ob/Gyn residents and 5 senior physicians were included, and all OR performed during that time (n = 690) were analyzed. The performance index assessed was the oocyte retrieval rate (ORR), defined as the ratio of oocytes retrieved to follicles aspirated. We used the LC CUSUM test to analyze the learning curves of residents, and the CUSUM test to monitor the performance of senior physicians. An ORR ≥50% in 60% of retrievals was defined as the threshold for clinical proficiency.ResultsSix hundred seventy-four oocyte retrieval (OR) were included: 315 were performed by residents, 220 by senior physicians, and 139 by both residents and physicians (mixed retrievals). Four residents (57%) reached the threshold after aspirating 82, 67, 53 and 46 ovaries, respectively. The mean number of ovaries aspirated in order to reach clinical proficiency was 62, and the mean number of weeks needed was 21. The duration of the learning period varied between 26 and 80 days. Two senior physicians (40%) remained proficient across the duration of the study, while two physicians (40%) had one statistically “suboptimal” OR, and one physician (20%) had two suboptimal retrievals.ConclusionThere is a large variability in the duration of the learning period and the number of procedures needed for a resident to master OR. Senior physicians maintain an adequate performance.
Highlights
The learning curve cumulative summation test (LC CUSUM test) allows to define an individualized learning curve and determine the moment when clinical proficiency is attained
We found that the performance level of the senior physicians remained adequate across the duration of the study
The duration of the learning period was highly variable, going from 26 to 80 days, which is in accordance with Dessolle et al, while the median number of ovaries needed to puncture was 21, a relatively low number, that is in accordance with Goldman et al Our results suggest that oocyte retrieval is a simple and straightforward procedure, which can be grasped with a low number of trials
Summary
The learning curve cumulative summation test (LC CUSUM test) allows to define an individualized learning curve and determine the moment when clinical proficiency is attained. The LC CUSUM test has been frequently used in the field of Obstetrics and Gynecology (Ob/Gyn) for several procedures, but only once for OR. Several studies have shown that, in the era of vitrification, the cumulative live birth rate is directly correlated to the number of oocytes retrieved [2]. The training programs of Obstetrics and Gynecology (Ob/Gyn) residents and Reproductive Endocrinology and Infertility (REI) fellows differ between countries and continents, but some aspects can be somewhat similar. Very few studies have analyzed the learning curve of residents, or the number of retrievals needed to attain clinical proficiency, and the results have been quite heterogenous [3, 4]. According to the latest European Society of Human Reproduction and Embryology (ESHRE) report [5], there are currently no recommendations by national fertility societies across Europe concerning the minimal number of OR required for a physician to become a certified specialist
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