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Institutional learning curve. CUSUM scores for all surgeons in the institution over the study period adjusted for dates of operation. To adjust for time, each event (the operation) was replaced by actual date of the operation. The vertical line denotes Phase 1 (Case number 74) for Surgeon 1. Note that Surgeon 1 completed phase 1 (vertical line) before the remaining surgeons made any significant progress in their learning experience. CUSUM—cumulative sum technique
