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limit.  All 10 users started at the same point because perfor­  FIGURE 5  Learning curve cumulative sum (LC-CUSUM) results for
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              mances were anchored to the zero point at the left of the graph   another metric.
              (Figure 4). At that point, the LC­CUSUM score was zero. For
              this LC­CUSUM tool, the metric chosen was a composite of
              effectiveness and ≤60s. From the start, the tool stratified per­
              formances along the lines moving to the right through the data
              points. A downward slope for a line segment represented a
              pass for a use, whereas an upward sloped segment represented
              a failure. Performances of individuals occurred in only two
              strata among their first three uses. Among 10 users, there were
              seven different learning curves (pathways) to reach four end­
              points. No gap occurred between any of the endpoints. End­
              points ranged narrowly (i.e., 3 [−5.9 to −2.9] on the y­axis).
              Seven pathways to only four endpoints indicated that three of
              10 performances overlapped and did not separate from others.
              Identical pathways occurred among the three users (users 1, 3,
              and 4) in the lowest pathway as they crossed below the lower
              decision limit (the black dashed line at −1.59 on the y­axis in
              Figure 4) to become proficient at use 6. Here, they could be
              identified to stop and learn something else. All users crossed
              the lower decision limit by use 16 to become proficient. For in­
              stance, user 9 crossed the lower decision limit and became pro­
              ficient at use number 16. No user neared the upper decision
              limit (the gray dashed line at 2.83 on the y­axis in Figure 4),   line and marker in Figure 5) is of user 2, who performed worst
              and if this had occurred, a user could be stopped to remediate.  and crossed the upper decision limit (the gray dashed line at
                                                                 2.83 on the y­axis in Figure 5) at use 5, so that user, mathe­
              FIGURE 4  Learning curve cumulative sum (LC-CUSUM) scores for   matically, could not become proficient because the user could
              one performance metric.
                                                                 not recover to cross the lower decision limit by the last use.
                                                                 So at use 5, user 2 could be identified to stop and remediate.
                                                                 The bottom pathway is of user 1, who performed best without
                                                                 failure and became proficient first (tied with user 8) at use
                                                                 6, having crossed the lower decision limit. At this point, user
                                                                 1 could be stopped and could learn something else. Users 4
                                                                 through 9 had few failures and also became proficient at use
                                                                 numbers 16, 13, 9, 13, 6, and 16, respectively. Users 3 and
                                                                 10 had mixed results, which recovered to begin trending well,
                                                                 but, ultimately, they could not cross the lower decision limit
                                                                 by the last use. Users 3 and 10 may have become proficient if
                                                                 allowed to carry on beyond the 20th use.

                                                                 In comparing two metrics, effectiveness and ≤60s versus ef­
                                                                 fectiveness and ≤30s, the choice effect on the count of path­
                                                                 ways for LC­CUSUM was only 1.4­fold (10/7). In comparing
                                                                 these metrics, the choice effect on the count of endpoints
                                                                 with LC­CUSUM was twofold (8/4). By merely changing the
                                                                 threshold from ≤60s to ≤30s of the time component within the
                                                                 metric chosen, the LC­CUSUM tool stratified all 10 users into
                                                                 different pathways to tell a different story for each user. This
              This score (i.e., the LC­CUSUM with this metric) did not tell   was the first LC­CUSUM we analyzed, and it had a startling
              a different story for each user, but it presented more details   capacity to detail the story of performance both for the group
              about individual learning curves than the prior CUSUM did   and for each of its 10 members. The degree of stratification (10
              (Figure 3). The metric of effectiveness and ≤60s was less chal­  pathways, eight endpoints) indicated that the performances of
              lenging with this score as it had been with the tool of cumula­  all users had been differentiable beforehand and was later dif­
              tive number of failures (Figure 2).                ferentiated with the right choice of metric. Individual uses for
                                                                 individual users showed incremental changes to performance
              LC-CUSUM Trends for a More Challenging Metric      during the learning process. Thus, this tool may help instruc­
              Figure 5 presents findings for the LC­CUSUM with a more   tors determine how to stratify users, especially for those who
              challenging  metric:  effectiveness  and  ≤30s.  Performances  of   need remediation early and for those who become proficient
              individuals were seen in the maximum number of strata pos­  early. Such early detection may aid in redirecting specific
              sible for each of the first four uses (Figure 5). Each user took   learners to activities that are more personally pertinent.
              their own pathway to reach eight different endpoints. One gap
              occurred among the endpoints, which ranged widely (i.e., 12   For an LC­CUSUM of the five metrics for one user, user 2 by
              [−5.9 to 6.1] on the y­axis), and this range was fourfold (12/3)   effectiveness became proficient first (tied with others) whereas
              wider than in that seen in Figure 4. The top pathway (purple   by ≤60s, user 2 was worst. That the same performances can

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