S3103 Learning Curve - Cumulative Sum Analysis (LC-CUSUM) for Assessing Competency in Performing Colonoscopy – A Systematic Review

Abstract

INTRODUCTION: Learning curves (LC) created with Cumulative summation analysis (CUSUM) is a statistical method to assess the procedural competency attained by trainees in different medical specialties. The aim of this study is to analyze the LC-CUSUM in assessing the number of procedures needed for achieving competency in colonoscopy. METHODS: We searched multiple databases such as PubMed, Embase, Web of science and conference proceedings from inception through May 2020 to identify studies that analyzed the competency of trainees in colonoscopy by utilizing CUSUM analysis. The cecal intubation rate (CIR) of 90% is a key indicator of competency achievement in colonoscopy. Since the number of colonoscopies required to achieve a CIR ≥ 90% is not well established, studies reporting on the LC–CUSUM analysis of number of colonoscopies needed to achieve a CIR ≥ 90% were included. RESULTS: Based on the stringent inclusion criteria used, 3 studies were identified. Overall there were 352 trainees and 76603 colonoscopy procedures included in this analysis of 3 studies. Colonoscopy competency to reach a target CIR ≥90% by CUSUM analysis was attained at variable numbers such as 200,493 and 250 procedures for majority of the included trainees. CONCLUSION: LC-CUSUM analysis identifies early trends, allowing trainers to identify a struggling trainee sooner and alter their curriculum to improve their learning curve during colonoscopy training. Use of CUSUM analysis to track competency could be more effective than fulfilling a preset number of procedures to attain a target competency marker such as a CIR. Wide variations in the number of procedures needed to attain the target CIR ≥90% could be explained by the differences in the study cohorts (Gastroenterology fellows vs General surgery residents) and the quality of training. It is clearly evident that there is a paucity of studies evaluating a dynamic assessment tool such as LC-CUSUM which provides an opportunity for early intervention. Future large cohort studies are warranted to address this need.Figure 1.: Studies using LC-CUSUM in assessing the number of procedures needed for achieving competency in colonoscopy.