Decline in surgical training

Spitz, Lewis; Em, Kiely; Peirro, Agostino; Drake, DP; McAndrew, Fiona

doi:10.1016/s0140-6736(02)07307-5

Cited by 20 publications

(13 citation statements)

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“…3 A cognitive skills module is also essential at the front end of any training programme, such as that available from the Royal College of Ophthalmologists microsurgical skills course. Furthermore, completion of this curriculum is based on the dexterity, rather than safety scores or clinical outcome measurements.…”

Section: Discussionmentioning

confidence: 99%

“…Wet labs use cadaveric human or animal models, or synthetic eyes (designed specifically for performing phacoemulsification) to rehearse the steps of cataract extraction. However, these methods have been criticised for being unrealistic 3 with inaccurate simulation of tissue consistency and anatomy 4 and also lacking any form of objective assessment. Simulation in the form of virtual reality (VR) and synthetic models have been proposed for technical skills training at the early part of the learning curve in other fields of surgery.…”

Section: Introductionmentioning

confidence: 99%

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Development of a virtual reality training curriculum for phacoemulsification surgery

Spiteri

Aggarwal

Kersey

et al. 2013

Eye

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Purpose Training within a proficiency-based virtual reality (VR) curriculum may reduce errors during real surgical procedures. This study used a scientific methodology to develop a VR training curriculum for phacoemulsification surgery (PS). Patients and methods Ten novice-(n) (performed o10 cataract operations), 10 intermediate-(i) (50-200), and 10 experienced-(e) (4500) surgeons were recruited. Construct validity was defined as the ability to differentiate between the three levels of experience, based on the simulator-derived metrics for two abstract modules (four tasks) and three procedural modules (five tasks) on a high-fidelity VR simulator. Proficiency measures were based on the performance of experienced surgeons. Results Abstract modules demonstrated a 'ceiling effect' with construct validity established between groups (n) and (i) but not between groups (i) and (e)-Forceps 1 (46, 87, and 95; Po0.001). Increasing difficulty of task showed significantly reduced performance in (n) but minimal difference for (i) and (e)-Anti-tremor 4 (0, 51, and 59; Po0.001), Forceps 4 (11, 73, and 94; Po0.001). Procedural modules were found to be construct valid between groups (n) and (i) and between groups (i) and (e)-Lenscracking (0, 22, and 51; Po0.05) and Phacoquadrants (16, 53, and 87; Po0.05). This was also the case with Capsulorhexis (0, 19, and 63; Po0.05) with the performance decreasing in the (n) and (i) group but improving in the (e) group (0, 55, and 73; Po0.05) and (0, 48, and 76; Po0.05) as task difficulty increased. Conclusion Experienced/intermediate benchmark skill levels are defined allowing the development of a proficiency-based VR training curriculum for PS for novices using a structured scientific methodology.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Development of a virtual reality training curriculum for phacoemulsification surgery

Spiteri

Aggarwal

Kersey

et al. 2013

Eye

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“…There has been concern among trainees and trainers that surgical training opportunities are diminishing and a new generation of less-skilled consultant may arise. [8][9][10][11][12][13] Our study aimed to evaluate the impact of changes in the provision of cataract surgery, particularly the shift of care to a DTC, on surgical training on trainees based at the MREH. Our DTC has been opened for 6 months since 1 April 2005 and thus we have compared this 6-month period with the same period over the past 6 years.…”

Section: Discussionmentioning

confidence: 99%

“…5,6 The increasing number of high-volume cataract centres manned by experienced surgeons has led to questions regarding the feasibility of continuing to train junior ophthalmologists in cataract surgery, in that the opportunity for them to undertake surgery may be considerably reduced. [7][8][9][10][11][12][13] Many experienced ophthalmologists and trainees have voiced their concerns over the impact on surgical training of the introduction of new policies such as 'Action on Cataracts'. [7][8][9][10][11][12] Although the benefit of such policies on current patient care are obvious, for example, by reducing waiting times and improving the quality of care overall from diagnosis to surgery, the impact on the patient of the future has not been considered.…”

Section: Introductionmentioning

confidence: 99%

‘Fast-track’ cataract services and diagnostic and treatment centre: impact on surgical training

Saha

Fernando

et al. 2006

Eye

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“…Shift work, combined with fewer years as a trainee, has reduced overall hours of training and number of operations performed. [1][2][3] The pressure to maintain throughput on busy lists, increased public expectations and the lack of a consistent trainee/trainer relationship may reduce senior house officers' access to operative training even when in theatre. 4,5 Operations which form the bulk of early experience in a graduated training programme, such as repair of an inguinal hernia, are increasingly allocated to staff grade lists or evening 'Waiting List Initiative' (WLI) lists to which trainees do not usually have access.…”

mentioning

confidence: 99%

An evaluation of operative training lists for senior house officers in a district general hospital

Feldman¹,

Nasmyth²

2005

Ann R Coll Surg Engl

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INTRODUCTIONTo address concerns about reduced opportunities for operative training, a programme of training operating lists for senior house officers was established. The entire patient pathway was used as a learning resource so that training was offered in a range of areas including development of knowledge, communication skills and attitudes as well as operative technique.PATIENTS AND METHODS The programme was evaluated using a stakeholder approach, considering the impact on patients, the trainees and the host institution, including costs. Forty-two operations were performed during the 6-month evaluation period and the patients were compared with control patients undergoing the same procedure during a consultant-run operating list within 4 weeks.RESULTS There was no difference in the patients' experience or overall satisfaction when comparing the trainees' patients with controls. Senior house officers performed only six other supervised operations on routine lists during the period; the programme increased their experience by 700%. Costs were increased by 12% per patient.CONCLUSIONS There is an imperative to find new, efficient ways to train surgeons. Dedicated training operating lists with an appropriately controlled case-mix can both address a service need and provide a high intensity learning experience.

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Decline in surgical training

Cited by 20 publications

References 0 publications

Development of a virtual reality training curriculum for phacoemulsification surgery

Development of a virtual reality training curriculum for phacoemulsification surgery

‘Fast-track’ cataract services and diagnostic and treatment centre: impact on surgical training

An evaluation of operative training lists for senior house officers in a district general hospital

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