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Yinin Hu, MD, Varun Puri, MD, Traves D

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1 Attaining proficiency with endobronchial ultrasound-guided transbronchial needle aspiration 
Yinin Hu, MD, Varun Puri, MD, Traves D. Crabtree, MD, Daniel Kreisel, MD, PhD, Alexander S. Krupnick, MD, Alexander G. Patterson, MD, Bryan F. Meyers, MD, MPH  The Journal of Thoracic and Cardiovascular Surgery  Volume 146, Issue 6, Pages e1 (December 2013) DOI: /j.jtcvs Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

2 Figure 1 Example risk-adjusted cumulative sum (Cusum) graphs. Positive deflections indicate failed attempts, negative deflections indicate successful attempts. Horizontal lines demarcate unacceptable and acceptable thresholds. From left to right, graphs depict a subpar performer, a performer in the process of training, and a learner reverting to inadequacy after a period of proficiency. The Journal of Thoracic and Cardiovascular Surgery  , e1DOI: ( /j.jtcvs ) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

3 Figure 2 Institutional risk-adjusted cumulative sum (Cusum). Left, Unadjusted Cusum shows that an unacceptable threshold (red lines) was crossed at 32 cases (indicated by *), and only acceptable thresholds (gray lines) are crossed in subsequent cases, indicating proficient performance beyond 32 cases. Right, Risk-adjusted Cusum shows an unacceptable threshold crossed at 22 cases (indicated by *) with subsequent proficiency. The Journal of Thoracic and Cardiovascular Surgery  , e1DOI: ( /j.jtcvs ) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

4 Figure 3 Individual risk-adjusted cumulative sum (Cusum) curves. A, Operator 1 demonstrated proficiency throughout the study period. B, Operator 2 crosses an unacceptable threshold at 27 cases, and then maintains proficiency thereafter. C, Operator 3 has yet to be demonstrate proficiency after 22 cases. The Journal of Thoracic and Cardiovascular Surgery  , e1DOI: ( /j.jtcvs ) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

5 Figure E1 Observed sensitivity of endobronchial ultrasound-guided transbronchial needle aspiration on an institution level compared with an expected sensitivity of 90%. The Journal of Thoracic and Cardiovascular Surgery  , e1DOI: ( /j.jtcvs ) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

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