Reverse order method for teaching cataract surgery to residents

Abstract

ObjectiveTo implement a method to train residents in the performance of phacoemulsification surgery, with the steps completed in reverse chronological order and with the easiest step being undertaken first.Methods and analysisWe created a method for training ophthalmology residents in which we taught phacoemulsification surgery in a series of steps learnt in reverse order. Each resident advanced through the teaching modules only after being approved in the final step and then progressed to the complete performance of surgeries. We analysed the rates of complications in the 2 years after introducing the new method.ResultsThe new method allowed for a standardised approach that enabled replicated teaching of phacoemulsification regardless of instructor or student. After implementing the new method, residents performed 1817 phacoemulsification surgeries in the first year and 1860 in the second year, with posterior capsule rupture rates of 8.42% and 7.9%, respectively.ConclusionsTeaching residents to perform the steps of phacoemulsification in a standardised reverse order resulted in low rates of complications.

To study the learning curve of capsulorhexis in manual small incision cataract surgery among postgraduate residents in central India

“…suggested the reverse way of teaching cataract surgery and obtained low rates of complications. [ 16 ] In the reverse way of learning, trainees perform less step-dependent procedures first such as viscoelastic clearance from the AC, cortex wash, and nucleus management, followed by IOL implantation. However, Suryawanshi et al .…”

“…The PCR rate in trainees performing cataract surgery is variable and ranges from 4.9% to 10%. [ 2 9 16 21 23 27 29 ] The variability in the occurrence of PCR in various studies is probably due to the differing trainee experience, methods followed to assess the teaching method and stage of intervention by the supervisor.…”

“…[ 13 14 ] The complication rate associated with CCC is variable and reported between 3.1% and 6.5%. [ 4 8 15 16 ] There are several issues related to CCC learning such as the extension of the rhexis and very small or large CCC. The aim of any teaching program is surgical training with minimal or no complications.…”

“…The residents are usually trained in a step-wise manner either from the first to the last step[ 17 ] or in a reverse direction. [ 16 ] Most studies on the learning of cataract surgery are performed by residents who have adequate cataract surgery training[ 3 4 7 8 11 15 16 17 18 19 20 ] and focus on extracapsular, phacoemulsification, or femtosecond cataract surgery. [ 13 ] The present study deals with the learning curve of junior residents in the ophthalmology department of a tertiary eye care center in central India on capsulorhexis, the most vital aspect of cataract surgery.…”

How to maintain equilibrium between the quantum and quality of cataract surgery training and patient safety measures

“…It is a good proposition to follow reverse order with the easiest step practiced first followed by crucial and complex steps. [ 9 ] If a resident performs one surgical step multiple times in a single sitting, it undoubtedly enhances competency, rather than performing the entire surgery infrequently during the initial phase. Practice makes the surgeon proficient; hence, revision of the repetition of steps is an ideal proposition.…”