# Learning curves for itinerant nurses to master the operation skill of Ti-robot-assisted spinal surgery equipment by CUSUM analysis: A pilot study

## TL;DR

This pilot study determines how many surgeries itinerant nurses need to master Ti-robot-assisted spinal surgery equipment, using learning curves and CUSUM analysis.

## Contribution

The study provides a data-driven basis for training and qualification criteria for nurses using Ti-robot-assisted spinal surgery equipment.

## Key findings

- Itinerant nurses need at least eight cases to master Ti-robot-assisted spinal surgery equipment.
- The image acquisition and surgical spine screw planning phases were the most challenging for nurses.
- Learning curves showed individual and general skill improvement patterns across four operational phases.

## Abstract

This study aimed to investigate the minimum number of operations required for itinerant nurses in the operating room to master the skills needed to operate the Ti-robot-assisted spinal surgery equipment. Additionally, we aimed to provide a corresponding basis for the development of qualification admission criteria and skill training for nurses who cooperate with this type of surgery. Nine operating room itinerant nurses independently performed Ti-robot equipment simulations using a spine model as a tool, with 16 operations per trainee. Four evaluation indices were recorded: time spent on equipment preparation and line connections, time spent on image acquisition and transmission, time spent on surgical spine screw placement planning, and time spent on robot arm operation. Individual and general learning curves were plotted using cumulative sum analysis. The number of cases in which the slope of the individual learning curves began to decrease was 3–11 cases, and the number of cases in which the slope of the general learning curve began to decrease was 8 cases. The numbers of cases in which the learning curves began to decrease in the four phases were the 5th, 8th, 11th, and 3rd cases. Itinerant nurses required at least eight cases to master the equipment operation skills of Ti-robot-assisted spinal surgery. Among the four phases, the image acquisition and transmission phases and the surgical spine screw placement planning phase were the most difficult and must be emphasized in future training.