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

Ezra, Daniel G.; Chandra, Aman; Okhravi, Narciss; Sullivan, Paul; McDonnell, Peter J.; Js, Lee

doi:10.1038/eye.2010.54

Cited by 13 publications

(24 citation statements)

References 16 publications

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“…Those training outside London may fall short of what has been the national average cumulative cataract experience at the end of training for almost 20 years (500-600 cases). 9 This is not surprising as it has been estimated that UK surgical trainees worked 30 000 h before becoming a consultant under the previous training system. 10 11 This is considerably less than the 1096 days (less than 9000 h) of work-based experiential learning the over 7 year OST programme in which the Royal College of Ophthalmologists expects it will be possible for trainees to achieve the minimum surgical procedures and sufficient experience in clinical ophthalmology.…”

Section: Discussionmentioning

confidence: 99%

“…At their current rate, trainees are again likely to fall short of the numbers that doctors who completed their training only 3 years previously under the previous training system achieved. 9 It could be argued that the OST programme is designed to only produce general ophthalmologists with subspecialist training achieved though fellowships. However, the lack of experience gained in dealing with ocular trauma that our study has identified is a matter of concern.…”

Section: Discussionmentioning

confidence: 99%

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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%

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

View full text Add to dashboard Cite

show abstract

“…As a consequence, the findings may not be generalizable to all countries, especially due to large variances in the culture and traditions concerning specialist training between countries and regions. For example, cataract surgical training is not mandatory in ophthalmology specialist training in a majority of European countries, including Denmark, which is in contrast to other countries, where cataract surgical training is mandatory and may also be regulated by national health authorities (Ezra et al 2010;Chadha et al 2016;Muttuvelu & Andersen 2016). Aside from cataract surgery, some of the procedures that were eliminated in round 2 include vitrectomy, corneal transplantation, and refractive surgery.…”

Section: Incision Of Dacryocystitis 25mentioning

confidence: 99%

“…High heterogeneity in surgical exposure over time and across localizations is a current challenge in ophthalmology residency training (Zhou et al 2009;Ezra et al 2010;Bakri et al 2013;Chadha et al 2016). Similarly, the current approach of training technical skills in ophthalmology varies widely across regions.…”

Section: Introductionmentioning

confidence: 99%

Consensus on procedures to include in a simulation‐based curriculum in ophthalmology: a national Delphi study

Thomsen

Cour

Paltved

et al. 2018

Acta Ophthalmologica

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“…The performance of surgical procedures is a complex interaction of manual skills and the experience that surgeons gather in the course of their professional life [1,2]. The mediation of this accumulated knowledge to junior surgeons usually ensues by means of oral information, a one to one observation of the senior surgeons by the residents with subsequent practice, or other 'knowledge stores', such as clinical guidelines [3,4] or dedicated literature and videos for surgical education.…”

Section: Introductionmentioning

confidence: 99%

Identification of surgeon–individual treatment profiles to support the provision of an optimum treatment service for cataract patients

Neumuth

Wiedemann²,

Foja³

et al. 2010

j ocul biol dis inform

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One objective of ophthalmological departments is the optimization of patient treatment services. A strategy for optimization is the identification of individual potential for advanced training of surgeons based on their daily working results. The objective of this feasibility study was the presentation and evaluation of a strategy for the computation of surgeon-individual treatment profiles (SiTPs). We observed experienced surgeons during their standard daily performance of cataract procedures in the Ophthalmological Department of the University Medical Center Leipzig, Germany. One hundred five cases of cataract procedures were measured as Surgical Process Models (SPMs) with a detailed-to-the-second resolution. The procedures were performed by three different surgeons during their daily work. Subsequently, SiTPs were computed and analyzed from the SPMs as statistical 'mean' treatment strategies for each of the surgeons. The feasibility study demonstrated that it is possible to identify differences in surgeon-individual treatment profiles beyond the resolution of cut-suture times. Surgeon-individual workflows, activity frequencies and average performance durations of surgical activities during cataract procedures were analyzed. Highly significant (p<0.001) workflow differences were found between the treatment profiles of the three surgeons. Conclusively, the generation of SiTPs is a convenient strategy to identify surgeon-individual training potentials in cataract surgery. Concrete recommendations for further education can be derived from the profiles.

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

Abstract: These data demonstrate that although the cumulative experience of cataract surgery for trainees has remained stable, there has been a reduction in the median numbers of subspecialty procedures performed over the past 15 years.

Cited by 13 publications

References 16 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

Consensus on procedures to include in a simulation‐based curriculum in ophthalmology: a national Delphi study

Identification of surgeon–individual treatment profiles to support the provision of an optimum treatment service for cataract patients

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