Abstract：
OBJECTIVE: To determine the individual learning curves for cordocentesis in a low-cost simulator for maternal-fetal medicine (MFM) fellows.
METHODS: This observational, descriptive, educational, and prospective study was performed from July through November 2022. After an introductory course based on a standardized technique for cordocentesis, each second-year MFM fellow who accepted to participate in the study performed this procedure using a low-cost simulation model, and experienced operators supervised the cordocenteses. Learning curves were then created using cumulative sum analysis (CUSUM).
RESULTS: Seven second-year MFM fellows with no previous experience in cordocentesis accepted to participate in the study. A total of 2676 procedures were assessed. On average, residents performed 382 ± 70 procedures. The mean number of procedures to achieve proficiency was 369 ± 70, the overall success rate was 84.16%, and the corresponding failure rate was 15.84%. At the end of the study, all fellows were considered competent in cordocentesis. One fellow required 466 attempts to achieve competency, performing a total of 478 procedures, but the resident with the fewest attempts to reach competency required 219 procedures, completing 232 procedures. Some of the most frequent reasons for failed attempts included not reaching the indicated point for vascular access (20.99%) and being unable to retrieve the sample (69.10%).
CONCLUSIONS: CUSUM analysis to assess learning curves, in addition to using low-cost simulation models, helped to appraise individualized learning, allowing an objective demonstration of competency for cordocentesis among MFM fellows.
METHODS: This observational, descriptive, educational, and prospective study was performed from July through November 2022. After an introductory course based on a standardized technique for cordocentesis, each second-year MFM fellow who accepted to participate in the study performed this procedure using a low-cost simulation model, and experienced operators supervised the cordocenteses. Learning curves were then created using cumulative sum analysis (CUSUM).
RESULTS: Seven second-year MFM fellows with no previous experience in cordocentesis accepted to participate in the study. A total of 2676 procedures were assessed. On average, residents performed 382 ± 70 procedures. The mean number of procedures to achieve proficiency was 369 ± 70, the overall success rate was 84.16%, and the corresponding failure rate was 15.84%. At the end of the study, all fellows were considered competent in cordocentesis. One fellow required 466 attempts to achieve competency, performing a total of 478 procedures, but the resident with the fewest attempts to reach competency required 219 procedures, completing 232 procedures. Some of the most frequent reasons for failed attempts included not reaching the indicated point for vascular access (20.99%) and being unable to retrieve the sample (69.10%).
CONCLUSIONS: CUSUM analysis to assess learning curves, in addition to using low-cost simulation models, helped to appraise individualized learning, allowing an objective demonstration of competency for cordocentesis among MFM fellows.
摘要：
目的：确定在低成本的母胎医学（MFM）模拟器中进行脐带穿刺术的个体学习曲线。
方法：这种观察，描述性,描述性教育,前瞻性研究于2022年7月至11月进行.在基于标准化的脐带穿刺术技术的入门课程之后，每个接受参与研究的第二年MFM研究员使用低成本模拟模型执行此程序，有经验的操作员监督警戒线。然后使用累积和分析(CUSUM)创建学习曲线。
结果：接受7名在骨髓穿刺术中没有经验的第二年MFM研究员参加了这项研究。总共评估了2676个程序。平均而言,居民进行了382±70次手术。达到熟练程度的平均程序数量为369±70，总体成功率为84.16％，相应的故障率为15.84%。在研究结束时,所有研究员都被认为有能力进行脐带穿刺术.一个人需要466次尝试来实现能力，总共执行了478个程序，但是试图达到能力最少的居民需要219个程序，完成232程序。尝试失败的一些最常见的原因包括未达到指定的血管通路点（20.99％）和无法取回样品（69.10％）。
结论：评估学习曲线的CUSUM分析，除了使用低成本的仿真模型，帮助评估个性化学习，允许在MFM研究员中客观展示脐带穿刺术的能力。
方法：这种观察，描述性,描述性教育,前瞻性研究于2022年7月至11月进行.在基于标准化的脐带穿刺术技术的入门课程之后，每个接受参与研究的第二年MFM研究员使用低成本模拟模型执行此程序，有经验的操作员监督警戒线。然后使用累积和分析(CUSUM)创建学习曲线。
结果：接受7名在骨髓穿刺术中没有经验的第二年MFM研究员参加了这项研究。总共评估了2676个程序。平均而言,居民进行了382±70次手术。达到熟练程度的平均程序数量为369±70，总体成功率为84.16％，相应的故障率为15.84%。在研究结束时,所有研究员都被认为有能力进行脐带穿刺术.一个人需要466次尝试来实现能力，总共执行了478个程序，但是试图达到能力最少的居民需要219个程序，完成232程序。尝试失败的一些最常见的原因包括未达到指定的血管通路点（20.99％）和无法取回样品（69.10％）。
结论：评估学习曲线的CUSUM分析，除了使用低成本的仿真模型，帮助评估个性化学习，允许在MFM研究员中客观展示脐带穿刺术的能力。
