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

Au, Leon; Saha, Konal; Fernando, Bertie; Ataullah, S; Spencer, Fiona

doi:10.1038/sj.eye.6702512

Cited by 15 publications

(9 citation statements)

References 5 publications

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“…16 It is an issue that is likely to worsen with reduced budgets and greater efficiency targets affecting the NHS. There is the additional impact of independent sector treatment centres 17 and, more specific to ophthalmology, visual acuity thresholds that primary care trusts are increasingly imposing, which may further reduce the already low proportion of cases within NHS hospitals that are suitable for junior trainees. 15 The effect of this may differ considerably throughout the country.…”

Section: Discussionmentioning

confidence: 99%

Ophthalmic surgical training following modernising medical careers: regional variation in experience across the UK

Rodrigues¹,

Symes²,

Turner

et al. 2013

BMJ Open

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ObjectivesTo evaluate surgical experience among current doctors appointed into ophthalmology training posts since the introduction of the Modernising Medical Careers programme. Additionally, to identify regional variations in surgical experience and training programme delivery.DesignA cross-sectional survey.SettingThe UK's four largest deaneries (Schools of Ophthalmology).ParticipantsTrainee ophthalmologists, all having completed three or more years of training, who were appointed to the new ophthalmic specialty training programme.Primary and secondary outcome measuresThe mean annual surgical rate for each deanery in phacoemulsification cataract extractions and experience in other common elective and emergency surgical operations. Second, to calculate the mean timetabled clinical activity.ResultsThe responses of 40 doctors were analysed, with a response rate of 83%. Overall, the phacoemulsification rate was 73.52±29.24 operations/year. This was significantly higher in the South Thames Deanery (99.69±26.16, p=0.0005) and significantly lower in the North Western Deanery (48.08±19.72, p=0.0008). The annual mean complex cataract rate was 5.21±4.38. Only 40% were confident in dealing with the most common complication of cataract surgery (vitreous loss). The mean trabeculectomy (surgery for glaucoma) rate was 0.47±1.16 and for squint surgery it was 3.54±2.82 operations/year. Regarding the common ocular trauma surgery, 42.5% had not sutured a corneal laceration and 60% a globe rupture. 50% thought the training programme would adequately prepare them surgically. The timetabled clinical activity was highest in the South Thames Deanery (48.17 h/week) and lowest in the North Western Deanery (40.82 h/week) due to variations in the European Working Time Directive implementation and on-call commitments.ConclusionsSignificant regional variations in surgical training experience exist between UK deaneries, particularly with respect to cataract surgery, and they appear to be correlated to timetabled activity. Experience and confidence levels in managing complex cataract surgery and complications were low and experience with previously commonly performed elective and emergency operations was minimal. Although doctors from all the regions surveyed were very likely to achieve the minimum cataract extractions required for specialist training completion, we have identified shortcomings of the current training programme that need attention.

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Section: Discussionmentioning

confidence: 99%

Ophthalmic surgical training following modernising medical careers: regional variation in experience across the UK

Rodrigues¹,

Symes²,

Turner

et al. 2013

BMJ Open

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“…The public's unprecedented high expectations and demands for safety are fuelled by readily accessible information on hospital performances such as the Electronic Cataract National Dataset 4. In addition, consultant-led care provided by Independent Treatment Centres and the further reduction of working hours (to 48 h a week by 2009), imposed by the European Working Time Directive, are leading to concerning reports5 6 about the reduced overall training opportunities.…”

Section: Challenges In Phacoemulsification Trainingmentioning

confidence: 99%

Phacoemulsification skills training and assessment

Spiteri¹,

Aggarwal

Kersey

et al. 2009

British Journal of Ophthalmology

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BACKGROUND The quality of ophthalmic surgical training is increasingly challenged by an untimely convergence of several factors. This article reviews the tools currently available for training and assessment in phacoemulsification surgery. METHODS Medline searches were performed to identify articles with combinations of the following words: phacoemulsification, training, curriculum, virtual reality and assessment. Further articles were obtained by manually searching the reference lists of identified papers. RESULTS Thus far phacoemulsification training outside the operating room include wet labs and micro-surgical skills courses. These methods have been criticised for being unrealistic, inaccurate and inconsistent. Virtual reality simulators have the ability to teach phacoemulsification psychomotor skills, as well as to carry out objective assessment. Other ophthalmic surgical skill assessment tools such as Objective Assessment of Skills in Intraocular Surgery (OASIS) and Global Rating Assessment of Skills in Intraocular Surgery (GRASIS) are emerging. Assessor bias is minimised by using video-based assessments, which have been shown to reduce subjectivity. Dexterity analysis technology such as the Imperial College Surgical Assessment Device (ICSAD) and virtual reality simulators can be used as objective assessment devices. CONCLUSION Improvements in technology can be utilised in ophthalmology and will help to address the increasingly limited opportunities for training and assessment during training and throughout a subsequent career (re-training and re-validation). This will inevitably translate into enhanced patient care.

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“…11,12 There has been some suggestion also that the numbers of surgical cases being performed by SpRs has been decreasing in some areas. 13 Despite these concerns, there is little evidence describing how surgical training has been affected. Such analysis is difficult to formulate, as detailed data would need to be collected on different surgical procedures over long periods of time.…”

Section: Introductionmentioning

confidence: 99%

Higher surgical training in ophthalmology: trends in cumulative surgical experience 1993–2008

Ezra

Chandra

Okhravi

et al. 2010

Eye

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

Cited by 15 publications

References 5 publications

Ophthalmic surgical training following modernising medical careers: regional variation in experience across the UK

Ophthalmic surgical training following modernising medical careers: regional variation in experience across the UK

Phacoemulsification skills training and assessment

Higher surgical training in ophthalmology: trends in cumulative surgical experience 1993–2008

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