Cataract Video Coaching: Surgical Curriculum Enhancement in a U.S. Residency Program

Abstract

Medical and surgical training has long followed an apprenticeship model with the historical teaching of "See one, do one, teach one." 1,2 As medicine has advanced, both technologically and in the ability to measure patient outcomes, there has been a push toward competency-based assessment. Starting in 1998, the American Council on Graduate Medical Education (ACGME) developed six areas of competency that residents had to meet: patient care, medical knowledge, practice-based learning, interpersonal and communication skills, professionalism, and systems-based practice. The ACGME has also recently instituted the CLER (Clinical Learning Environment Review) Pathways to Excellence. Rather than simply counting cases, monitoring training outcomes became required and expectations on topics such as patient safety, health care quality, and supervision were increased. [3][4][5][6] More than 3 million cataract surgeries are performed in the United States annually 7 and cataract surgery is the most commonly performed intraocular surgery by residents during residency training. Currently, the minimum number of cataract surgeries required by the ACGME is 86 with most programs easily exceeding this number. 8 After the ACGME mandate, there were many studies performed to evaluate resident outcomes, methods of teaching cataract surgery, and the cost of resident educational modalities. 3,9-13 There was a demonstrable learning curve for phacoemulsification cataract surgery with reductions in complications and improvements in efficiency with more experience. 14 Newer methodologies of training and learning include wet laboratory curricula, 9,12 virtual reality training, 15,16 surgical simulators such as EyeSi, and tools to evaluate progression, 3,10,11 all with the goal of having surgeons master the learning Keywords ► resident education ► cataract surgery ► video coaching ► curriculum ► surgical curriculum AbstractThe aim of this study was to examine the perceived utility of a video-coaching curriculum in cataract surgery training. This study took place in a conference room at the Emory University School of Medicine. This is an evaluation study using questionnaires after each resident's presentation. A curriculum was developed with a resident presenting surgical cases to a group of students, residents, and faculty. All participants filled out a survey focused on video coaching, performance, and an Objective Structured Assessment of Technical Skill (OSATS) evaluation. Thirteen presenting residents, 99 observing residents, and 35 faculty provided responses for 12 video-coaching sessions. The average OSATS score was lower for presenting residents (3.32) compared with observing residents (4.14) and faculty (4.20) (p < 0.01). All 13 presenting and 99 observing residents as well as all 35 faculty found benefit in video coaching with the subcategories of avoiding errors and overall performance rated as the most beneficial. All 13 presenting and 99 observing residents felt comfortable presenting cases with zero preferring an alternative setting...