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An application of the learning curve–cumulative summation test to evaluate training for endotracheal intubation in emergency medicine
  1. Sangmo Je1,
  2. Youngsuk Cho2,
  3. Hyuk Joong Choi3,
  4. Boseung Kang3,
  5. Taeho Lim3,
  6. Hyunggoo Kang3
  1. 1Department of Paediatrics, Paediatric Emergency Centre, Cha University Bundang Hospital, Gyunggi-do, Republic of Korea
  2. 2Department of Emergency Medicine, School of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
  3. 3Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Republic of Korea
  1. Correspondence to Professor H Kang, Department of Emergency Medicine, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-ku, Seoul 135-270, Republic of Korea; emer0905{at}


Objective The learning curve–cumulative summation (LC-CUSUM) test allows for quantitative and individual assessments of the learning process. In this study, we evaluated the process of skill acquisition for performing endotracheal intubation (ETI) in three emergency medicine (EM) residents over a 2 year period in their first 2 years of their EM residency.

Methods We evaluated 342 ETI cases performed by three EM residents using the LC-CUSUM test according to their rate of success or failure of ETI. A 90% success rate (SR) was chosen to define adequate performance and an SR of 80% was considered inadequate. After the learning phase, the standard CUSUM test was applied to ensure that performance was maintained.

Results The mean number of ETI cases required to reach the predefined level of performance was 74.7 (95% CI 62.0 to 87.3). CUSUM tests confirmed that performance was maintained after the learning phase.

Conclusions By using the LC-CUSUM test, we were able to quantitatively monitor the acquisition of the skill of ETI by EM residents. The LC-CUSUM could be useful for monitoring the learning process for the training of airway management in the practice of EM.

  • Airway
  • Education

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