Optimal refinement of residents' surgical skills by training on induced goat's eye corneoscleral perforation

Pujari, Amar; Sharma, Namrata; Chaniyara, Manthan Hasmukhbhai; Urkude, Jayanand; Singh, Rashmi; Yadav, Saumya; Mukhija, Ritika; Asif, Mohamed Ibrahime; Sidhu, Navneet

doi:10.4103/ijo.ijo_1474_18

Cited by 8 publications

(5 citation statements)

References 7 publications

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“…1,2 To achieve this goal, various easyto-adapt techniques to enhance necessary surgical skills in various ophthalmic subspecialities such as cornea, cataract, glaucoma, retina, and strabismus have been described previously by our group. 1,[3][4][5][6][7] These have now been implemented within our surgical simulation lab, hence, opening new horizons on ways to upgrade clinical and surgical skills of residents/fellows.…”

Section: Discussionmentioning

confidence: 99%

Gonioscopy and Angle-Based Glaucoma Surgical Training on Human Eyes in the Wet Lab

Pujari

Rakheja

Dada

et al. 2022

Journal of Glaucoma

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Précis: Human corneoscleral rims provide a low cost model and resource to enhance angle based glaucoma surgical training skills. Purpose: To understand the feasibility, utility, and efficacy of a low-cost model for performing anterior chamber angle gonioscopy and micro-surgery on human corneoscleral tissues in wet lab on resident skill enhancement. Methods: Post-keratoplasty residual corneoscleral rims and/or the expired donor corneoscleral buttons were included for the purpose of this study. Initially, inverted rims were used to demonstrate the basic angle anatomy on a slit lamp bio-microscope. Central hazy cornea was then replaced with an artificial cornea and an artificial anterior chamber to simulate indirect gonioscopy, direct gonioscopy, goniotomy, and other angle-based surgeries. Direct gonioscopy and goniotomy exercises (as a means to simulate intraoperative gonioscopy and other angle-based surgeries respectively) were evaluated quantitatively, and the rest qualitatively. Results: A total of 65 residents were included in the exercise. The mean age was 26.69±1.74 years. Amongst these, 55 ophthalmology residents performed the basic examination, that is, slit lamp mounted angle anatomy examination (n=55) and artificial chamber mounted indirect gonioscopic examination through artificial cornea (n=55). In the second exercise, 10 glaucoma fellows performed the direct gonioscopic and the goniotomy exercises on artificial chamber. The fellows demonstrated a statistically significant improvement in interpretation and surgical skill enhancement concurrent with reduction in time taken with increasing number of attempts (P<0.05). In the third simulation exercise, micro-stent placement within the Schlemm’s canal, subconjunctival space, and the suprachoroidal space was re-produced successfully on multiple occasions. Conclusions: The residual human corneoscleral rims proved to be an important resource for teaching both the basic examination skills and those required for transitioning to advanced intraoperative gonioscopy and goniotomy skills. These low cost, easy to adapt models can be incorporated within the curriculum for improved glaucoma training of both the residents and the glaucoma fellows.

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Section: Discussionmentioning

confidence: 99%

Gonioscopy and Angle-Based Glaucoma Surgical Training on Human Eyes in the Wet Lab

Pujari

Rakheja

Dada

et al. 2022

Journal of Glaucoma

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“…While diverse cornea models were used in this review, there have been several other models tested for training in corneal suturing. 26 27 Having one universally defined model might be of great help to ensure comparability between published results and should be designed as a close-to-reality corneal model.…”

Section: Discussionmentioning

confidence: 99%

Resident Skills Assessment in Corneal Suturing: A Comprehensive Review of Currently Proposed Educational Programs and Evaluation Tools

Dormegny

Neumann²,

Lejay

et al. 2021

Journal of Academic Ophthalmology

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Purpose This study aimed to perform a comprehensive review of publications proposing educational programs for resident skills assessment in corneal suturing. Methods An extensive online article search in PubMed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PISMA) reporting guidelines was performed to identify prospective comparative studies or prospective before/after studies published up to March 2021 and reporting the assessment of ophthalmology residents' skills in corneal suturing during dedicated training sessions. Results Three studies were identified for review. The first reported the efficiency of an electromagnetic tracking system placed on the surgeon's fingers coupled with a computer analysis of movements and time to identify surgeons with different backgrounds in corneal suturing. The second reported the efficiency of the reference system in assessing the improvement of corneal suturing conducted by residents after a training session, with video-based assessment for economy and confidence of movement, limiting tissue damage and precision of operative technique, reviewed by blind assessors. The third proposed an innovative remote corneal suturing training method using Zoom for direct feedback to the residents. The stitch quality was assessed for length, depth, radiality, and tension. The results were similar when compared with a group of residents without feedback. Conclusion This review underlines the rarity and disparity of available tools for corneal suturing assessment, justifying the need for more complete models to be designed. These should consider body ergonomics and stitch quality and time. Comparative studies involving novices and attendings may provide reliable evaluation of existing gaps and specific metrics to target, helping residents to approach their superiors' experience.

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“…The junior residents were taught incisions like side ports/main ports/sclerocorneal tunnels and partial-thickness scleral flaps. They were taught corneoscleral tear/open-globe injury repairs[ 13 ] and techniques like phacoemulsification with anterior and posterior capsulorhexis. Continuous curvilinear capsulorhexis is difficult in goat eyes due to the presence of a shallow anterior chamber.…”

Section: Wet Lab Trainingmentioning

confidence: 99%

Reworking protocols of ophthalmic resident surgical training in the COVID-19 era – Experiences of a tertiary care institute in northern India

Gupta

Singh

Khurana

et al. 2021

Indian Journal of Ophthalmology

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Purpose: Coronavirus Disease 2019 (COVID-19) pandemic has negatively impacted medical professionals in all fields of medicine and surgery in their academic, clinical and surgical training. The impact of surgical training has been described as ‘severe’ by most ophthalmology residents worldwide due to their duties in COVID-19 wards, disruption of outpatient and camp services. Methods: Ophthalmic surgery demands utmost accuracy and meticulousness. Fine motor proficiencies, stereoscopic skills and hand–eye coordination required can only be achieved by practice. So, a multileveled structured wet-lab teaching schedule was prepared for the residents and implemented to bridge this gap between theory and practice at our tertiary care institute. A semester-wise training schedule was made with the proper distribution of wet-lab and simulator training. Surgeries like phacoemulsification, scleral buckling, pars plana lensectomy and vitrectomy, trabeculectomy and intravitreal injections were practised by the residents on the goat eyes. Simulator training was provided for phacoemulsification and vitrectomy to increase the hand–eye coordination of the residents. Results: Residents noticed improvement in their surgical skills and ambidexterity post wet-lab and simulator training . It also increased their confidence and provided essential surgical skills required to be used in the operation theater later. Conclusion: It is imperative that wet-lab training be included in the residency training programme in this COVID-19 era.

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Optimal refinement of residents' surgical skills by training on induced goat's eye corneoscleral perforation

Cited by 8 publications

References 7 publications

Gonioscopy and Angle-Based Glaucoma Surgical Training on Human Eyes in the Wet Lab

Gonioscopy and Angle-Based Glaucoma Surgical Training on Human Eyes in the Wet Lab

Resident Skills Assessment in Corneal Suturing: A Comprehensive Review of Currently Proposed Educational Programs and Evaluation Tools

Reworking protocols of ophthalmic resident surgical training in the COVID-19 era – Experiences of a tertiary care institute in northern India

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