Impact of a structured training program to enhance skills in phacoemulsification surgery

Abstract

Purpose: The aim of this study was to determine whether the introduction of a structured short-term phacoemulsification training program improved the ICO-OSCAR (International Council of Ophthalmology’s Ophthalmology Surgical Competency Assessment Rubric) score and the learning curve of the trainees and decreased the complication rates of the cases. Methods: This study was a retrospective, observational study conducted in a tertiary eye care hospital in India. The study was conducted from March 2018 to October 2019 based on a structured phacoemulsification training program introduced in January 2019. The trainees enrolled in the phacoemulsification training program were divided into two groups: Group 1 ( n = 33), who underwent training before the introduction of the structured program, and Group 2 ( n = 29), who underwent the training after the introduction of the structured training program. Each trainee performed 20 cases. Group 1 training consisted of wet-lab and phacoemulsification surgeries. Group 2 training program comprised three modules over 5 weeks and a preassessment examination. Premodule 1 imparted cognitive skills; Module 1 was on structured wet-lab, Module 2 was about phacoemulsification step surgery, and Module 3 had independent complete surgeries. Group 2 also underwent compulsory Observation of cases being performed in the operation theater, surgical video recording review, and formative feedback. Mean OSCAR score comparison was done for both the groups. The OSCAR score was also calculated case-wise to obtain the learning curve with respect to the entry and exit levels, by classifying the trainees in each group as Novice, Beginner, Advanced Beginner, or Competent. A comparison of the posterior capsular rupture (PCR) rates and vision at discharge of all the cases was done. Results: Group 2 had a significantly better mean OSCAR score than Group 1 (4.03 and 3.43, respectively; P < 0.001). The PCR rate of the cases was significantly lower in Group 2 than in Group 1 (9.14% and 20.30%, respectively; P < 0.001). Group 2 had a significantly better visual acuity outcome of the cases than Group 1. Group 1 started as Novice (OSCAR score: 2), whereas Group 2 started as Beginner (OSCAR score: 3). Group 2 reached the Advanced Beginner level eight to 10 cases prior to Group 1. Conclusion: A structured training curriculum can make a significant difference in the training experience of the trainees and enable better surgical outcomes and a decrease in the complication rates.

Utility of real-time 3D visualization system in the early stage of phacoemulsification training

“…Learning to accurately evaluate the performance of cataract surgery by reviewing videos is an integral part of ophthalmology residency education [23][24] . Trainees are expected to make rigorous self-evaluations as an index of professional competence [25] . As to simulated surgery, Cheon et al [15] found expert scores were higher than self-scores in the following items: viscoelastic, capsulorhexis (commencement of flap and follow through), and capsulorhexis (formation and circular completion).…”

“…Besides, observational learning activates were reported to occupy the same cortical motor regions as physical practice [25] . Real-time observation using a 3D visualization system would bridge theoretical learning and clinical practices [26][27] .…”

Surgical skills empowerment of ophthalmology residents in India – Are they future-ready?

“…A didactic module providing adequate background knowledge, curriculum-based wet lab exposure to develop microsurgical and tissue-handling skills, staged rubric-based supervised surgical training, regular video recording of partially supervised and unsupervised resident surgeries and posthoc discussion and analysis leading to constant improvement are believed to be the best approach for optimal training. [ 6 - 8 ]…”

Recording the direct surgeon’s view with an operating microscopic view improves microscopic ophthalmic surgery training

“…T here is no doubt that recording surgical procedures is important for education, quality improvement, and research [1][2] . However, since the microscopic surgeon's view lacks information such as the motion and position of the surgeon's hands, surgeons-in-training often fail to reproduce expert surgeons' procedures from microscopic movies.…”