===== Learning Curve Evaluation =====

The evaluation of the **surgical learning curve** is essential to ensure safe patient care while trainees or newly appointed surgeons acquire proficiency in complex procedures.

CUSUM analysis provides a sensitive and objective method to monitor learning progression by identifying inflection points in performance over time.

In the context of ICP monitor placement, CUSUM enables:

  * **Case-by-case tracking** of complications or technical success.
  * **Visual representation** of performance trends, distinguishing between early learning phases and plateau.
  * **Quantitative assessment** of the number of procedures required to achieve competence.

A typical learning curve may be characterized by:
  - An initial upward slope in the CUSUM chart (reflecting higher complication rates).
  - A turning point indicating skill acquisition.
  - A downward or stable plateau as proficiency is reached.

This analysis helps determine:
  * When a trainee can perform procedures independently.
  * If additional training or supervision is needed.
  * The impact of changes in technique, supervision, or tools on outcomes.

Tracking learning curves using CUSUM fosters a culture of **data-driven education**, promotes **patient safety**, and supports **evidence-based credentialing** in neurosurgical practice.