Phacoemulsification skills training and assessment

Abstract

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.

The development of a virtual reality training programme for ophthalmology: repeatability and reproducibility (part of the International Forum for Ophthalmic Simulation Studies)

“…6,9 However, no specific analysis was ever undertaken with regard to the repeatability, reproducibility, or variability among novice trainees but rather these subjects were compared with more senior colleagues. 5,6,[8][9][10][11][12][13][14][15] What we therefore do not know is how an individual with minimal experience scores when undertaking the same task on several occasions (variability and reproducibility).…”

Development of a virtual reality training curriculum for phacoemulsification surgery

“…It is important to use technical skills rating scales and to integrate such scales into the simulator software. 2 It is crucial to disseminate this curriculum to other users of VR simulation, to enable external validation of the curriculum in terms of ease of use and feasibility, and to define learning curves to determine the minimum amount of repetitions necessary to establish proficiency. One could then ultimately confirm whether its use does actually lead to the notion of the pretrained novice who can operate with greater dexterity and skill on patients undergoing phacoemulsification surgical procedures.…”

“…1 There are many tools currently available for training and assessment in phacoemulsification surgery (PS) outside the theatre. 2 Laboratory practice allows surgeons to acquire skills in a controlled environment, free of the pressures of operating on real patients according to Piaget's and Vygotsky's pedagogical philosophy of 'learning by doing'. Wet labs use cadaveric human or animal models, or synthetic eyes (designed specifically for performing phacoemulsification) to rehearse the steps of cataract extraction.…”

The future of surgical assessment

“…We took great interest in the review by Spiteri et al 1 regarding the teaching and assessment of cataract surgery skills. We have recently employed the Kitaro wet and dry lab system at the University of Rochester and have found the accuracy of the simulation to be excellent.…”