The Cusum score. A tool for evaluation of clinical competence

INTRODUCTION: The cusum analysis (cummulative summation) is a statistical technique used to assess the competence of medical trainees. We wanted to re-examine the validity of the test as a technique for qualitative assessment of competence, as well as a technique for monitoring the level of specialists' competence. METHODS: Doctors in two anaesthetic departments were asked to plot the cusum as they performed the following procedures: epidural and spinal analgesia, insertion of central venous and arterial cannulae. RESULTS: Data were collected over a year. Thirty-five doctors were asked to plot the cusum. The plots were returned by 75% (9/12) of the first year trainees, 50% (4/8) of the second- and third-year trainees, and 20% (1/5) of the four- and five-year trainees. From the specialists and consultants on the staff, we received 66% (4/6) and 50% (2/4). The correlation, according to the level of competence respecting spinal and epidural techniques, is shown in Figures 1 and 2. DISCUSSION: We found, that the cusum analysis is a valid and practical technique for the qualitative assessment of clinical competence as well as a tool for monitoring continuous professional development. The technique can be used in a number of settings. With the increasing demand in health care for continuous quality assurance, the analysis can be used both in personal professional monitoring and in monitoring of performance during training.