Resident involvement in cataract surgery at the Veterans Health Administration: complications, case complexity, and the role of experience

Aggarwal, Sahil; Wisely, C. Ellis; Pepin, Marc J; Bryan, William; Raghunathan, Karthik; Challa, Pratap

doi:10.1097/j.jcrs.0000000000001092

Cited by 5 publications

(2 citation statements)

References 30 publications

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“…Third, because the "hydromaneuver" step has the least valid learning curve, it cannot be used to assess a student's progression. Fourth, the rate of posterior capsular rupture decreased linearly throughout the training program, but remained abnormally high at the end when compared to the incidence reported in the literature [10]. The dynamics of the curves and capsular rupture rate suggest that more than four EyeSi training sessions would be bene cial for obtaining better scores and fewer surgical complications.…”

Section: Discussionmentioning

confidence: 73%

“…This procedure under operating microscope demands a high level of expertise due to the risk of surgical complications, notably rupture of the posterior capsule, which is the main vision-threatening intraoperative complication [3]. In fact, the incidence of posterior capsular rupture is higher in patients operated on by ophthalmology residents (5 to 19%) [4][5][6][7][8][9][10] than by experienced surgeons (0.5 to 3.5%) [11]. While these complication rates seem relatively minor, they nally impact many patients.…”

Section: Introductionmentioning

confidence: 99%

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Learning curves of novice residents on cataract surgery simulator: the E3CAPS pedagogic study

Ducloyer,

Poinas,

Duchesne

et al. 2024

Preprint

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Introduction Training novice ophthalmology residents on the EyeSi® simulator increases cataract surgery safety. However, there is no consensus regarding how much training residents should perform before their first time on patients. We evaluated the French national training program through the analysis of the learning curves of novice residents. Methods Prospective multicentric pedagogic study conducted with French novice residents. Each resident completed the recommended four two-hour training sessions and performed a standardized assessment simulating standard cataract surgery before the first session (A0), at the end of the first (A1), second (A2), third (A3) and fourth (A4) sessions. For each surgical step of each attempt, the following data were collected: score, odometer, completion time, posterior capsular rupture and ultrasounds delivered. Results Sixteen newly nominated ophthalmology residents were included. Median score progressively increased from 95 [IQR 53; 147]) at A0 to 425 [IQR 411; 451] at A4. Despite a significant progression, the “emulsification” step had the lowest A4 scores 86 [IQR 60; 94] without reduction in completion time, odometer or ultrasounds delivered. The rate of posterior capsular rupture decreased linearly from 75% at A0 to 13% at A4 during “emulsification” and from 69–0% during “irrigation and aspiration”. At A4, only 25% [8; 53] of residents had > 80 at each step and only 75% [47; 92] had > 400/500 overall. Conclusion A training program consisting of four two-hour sessions on the EyeSi simulator over four consecutive days effectively enhances the surgical skills of novice ophthalmology residents. Undergoing more training sessions may improve scores and decrease the incidence of surgical complications, particularly at the emulsification step of cataract surgery. The learning curves presented here can reassure residents who are progressing normally and help identify those who need a further personalized training program. ClinicalTrials registration number: NCT05722080 (first registration 10/02/2023)

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Section: Discussionmentioning

confidence: 73%