ArticleProficiency in oocyte retrieval assessed by the learning curve cumulative summation test
Introduction
Oocyte retrieval is a common surgical procedure in assisted reproduction treatment and one that is considered to be easily mastered. However, the number of procedures required for a trainee to learn the procedure is not well defined.
Various methods can be used to determine whether a trainee has reached proficiency. Although standard practice is currently to perform a recommended number of procedures under supervision, this approach is not well tailored to the individual. A statistical tool, the learning curve–cumulative summation test (LC-CUSUM), has been developed to help decide when the learning curve for a procedure is complete by indicating when it has reached a predefined level of performance (Biau and Porcher, 2010). Cumulative summation (CUSUM) techniques have simple formulations, intuitive graphical representations and are capable of detecting small persistent changes (Biau et al., 2008b, Montgomery, 2008).
The purpose of the present study was to evaluate LC-CUSUM as a tool to monitor the learning curve of oocyte retrieval.
Section snippets
Patients
Over a 6-month period, this study prospectively evaluated the first oocyte retrievals performed by three first-year residents in reproduction medicine in the university IVF centre in Nantes, France. Their performances were compared with that of a senior gynaecologist, each patient being her own control. All the patient data, records of clinical and biological procedures and the programme results were entered in a registered database on a daily basis.
The patients consisted of consecutive women
Results
The trainees and the senior gynaecologist were all right handed.
Trainee 1, 2 and 3 performed 70, 70 and 50 oocyte retrievals, respectively, representing 32% of the 587 procedures performed in this department during the study period. Indeed, trainee 3 was included later in the study and was evaluated over 4 months. Table 1 summarizes the clinical characteristics of the patients, stimulation protocols and the results of ovarian stimulation according to trainee. Trainee 1 successfully completed all
Discussion
The present study shows that LC-CUSUM can be used for tailored quantitative monitoring of the learning curve of oocyte retrieval. Although, on average, the number of oocytes collected by the trainees did not differ from that of the senior operator, the number of oocyte retrievals required for a trainee to learn the procedure depended on the trainee and there was large variation of the learning curves in the three trainees. Comparable observations have been published in the field of surgery (
Dr Lionel Dessolle graduated in 1992 from Pitié-Salpétrière Medical School in Paris, France. Between 1993 and 2001, he performed his residency in obstetrics and gynaecology and a fellowship in gynaecological surgery in Paris University Hospitals. He also obtained a Master degree in reproduction physiology. He is currently working in the department of obstetrics and gynaecology of Brest University Hospital. His main research interests concern how the development of prediction models and the use
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Dr Lionel Dessolle graduated in 1992 from Pitié-Salpétrière Medical School in Paris, France. Between 1993 and 2001, he performed his residency in obstetrics and gynaecology and a fellowship in gynaecological surgery in Paris University Hospitals. He also obtained a Master degree in reproduction physiology. He is currently working in the department of obstetrics and gynaecology of Brest University Hospital. His main research interests concern how the development of prediction models and the use of innovative statistical tools might help improving cares and outcomes in infertility patients.
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Present address: CHU Brest, service de gynécologie obstétrique, Hôpital Morvan, 2, Avenue Foch, 29200 Brest, France.