CUSUM绘制在心外科住院医师临床培养中的应用

Application of CUSUM curve in cardiac surgery resident clinical training

目的探讨累积和控制图（cumulative sum control chart, CUSUM）绘制在心外科住院医师和进修医师临床培养中的应用。方法将某位工作时间10年以上主治医师的制备乳内动脉操作情况设为对照基准（标准组，28例患者）。选取从事心外科专业临床工作不超过5年的住院医师1名（组一）、从事心外科专业临床工作超过5年的进修医师1名（组二），针对两人的制备乳内动脉操作各取40例患者资料，记录术后乳内动脉流量、乳内动脉制备时间及不良事件等数据．利用SPSS19．0进行统计学分析，并用Matlab R2012b进行多项式曲线拟合描绘CUSUM。结果在手术技术操作密度得到保障和操作例数达到25例左右时，有此技术操作经验的外科医生的多项式拟合曲线曲率可达到0，成功跨越学习曲线，CUSUM累积和值在66～76。而不能保证操作密度的情况下，无此手术经验的外科医生，即便CUSUM累积和值达到70左右，多项式拟合曲线曲率亦无法达到0，即无法跨越学习曲线。结论CUSUM绘制为临床医师培养明确了量化指标，使带教教师能了解年轻医师的学习进程，及时更改教学方案，帮助年轻医师尽快跨越学习曲线。

Objective To investigate the application of CUSUM （cumulative sum control chart） curve in cardiac clinical teaching of resident surgeon education. Methods We chose a surgeon of 10 years work experience of attending the preparation operation of internal mammary artery as control reference （standard group, 28 patients） and a resident engaged in professional clinical cardiac work no more than 5 years as group 1, a professional training physician engaged in cardiac surgery clinical work more than 5 years as group 2 and took 40 patients＇ data respectively from the two groups＇ preparation of internal mammary artery operation. And then we recorded the postoperative mammary artery flow, internal mammary artery preparation time and adverse events data and made statistics analysis with SPSS 19.0, and CUSUM curve with Matlab R2012b polynomial curve. Results When the density of operate interval and the operate numbers came to about 25 cases, the polynomial eurve＇s slope rate went up to 0, regardless the surgeons＇ experience, CUSUM value was accumulated from 66 to 76, and overcame the learning curve successfully. However, when the density of operate interval did no reach the standard, the surgeon＇s CUSUM ploynomial curve slope rate never reached to 0, and can＇t overcome the learning curve. Conclusion CUSUM curve gives a clear quantitative indicator to the cultivation of clinical physician, and makes teaching teachers can understand the young physicians＇ learning process, so as to change the teaching plan, help young physicians cross the learning curve as soon as possible.