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:

1. An initial upward slope in the CUSUM chart (reflecting higher complication rates).
2. A turning point indicating skill acquisition.
3. 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.