Simulation-based surgical education for glaucoma versus conventional training alone: the GLAucoma Simulated Surgery (GLASS) trial. A multicentre, multicountry, randomised controlled, investigator-masked educational intervention efficacy trial in Kenya, South Africa, Tanzania, Uganda and Zimbabwe

Abstract

Background/AimGlaucoma accounts for 8% of global blindness and surgery remains an important treatment. We aimed to determine the impact of adding simulation-based surgical education for glaucoma.MethodsWe designed a randomised controlled, parallel-group trial. Those assessing outcomes were masked to group assignment. Fifty-one trainee ophthalmologists from six university training institutions in sub-Saharan Africa were enrolled by inclusion criteria of having performed no surgical trabeculectomies and were randomised. Those randomised to the control group received no placebo intervention, but received the training intervention after the initial 12-month follow-up period. The intervention was an intense simulation-based surgical training course over 1 week. The primary outcome measure was overall simulation surgical competency at 3 months.ResultsTwenty-five were assigned to the intervention group and 26 to the control group, with 2 dropouts from the intervention group. Forty-nine were included in the final intention-to-treat analysis. Surgical competence at baseline was comparable between the arms. This increased to 30.4 (76.1%) and 9.8 (24.4%) for the intervention and the control group, respectively, 3 months after the training intervention for the intervention group, a difference of 20.6 points (95% CI 18.3 to 22.9, p<0.001). At 1 year, the mean surgical competency score of the intervention arm participants was 28.6 (71.5%), compared with 11.6 (29.0%) for the control (difference 17.0, 95% CI 14.8 to 19.4, p<0.001).ConclusionThese results support the pursuit of financial, advocacy and research investments to establish simulation surgery training units and courses including instruction, feedback, deliberate practice and reflection with outcome measurement to enable trainee glaucoma surgeons to engage in intense simulation training for glaucoma surgery.Trial registration numberPACTR201803002159198.

Experiences and Perceptions of Ophthalmic Simulation-Based Surgical Education in Sub-Saharan Africa

“…The trial was conducted between October 2017 and July 2019 (trial protocol available as online annex). 9 , 10 The details of the intensive glaucoma SBSE curriculum can be found in Appendix A . Trainees participating in the trial (from the intervention and control arms) were identified using purposeful sampling.…”

“…The OLIMPICS and GLASS trials conducted by Dean et al between 2017 and 2019 examined the efficacy of intensive, high-fidelity surgical simulation training on cataract and glaucoma surgical competency in residents based in Eastern, Central and Southern Africa. 8 , 9 These trials demonstrated the superiority of SBSE in improving surgical competency compared to conventional training alone. Yet, whilst these results are promising, further research is needed to explore the acceptability of this newer educational method in ophthalmology, along with the perceived barriers to its implementation in sub-Saharan training institutions.…”

Modern Educational Simulation-Based Tools Among Residents of Ophthalmology: A Narrative Review

“…In a randomized, controlled, investigatorblinded multi-centre study Dean et al [39] aimed to evaluate if an intense 5-day simulation-based training course improved simulated glaucoma surgery (trabeculectomy) competence at 3 months as assessed on the Ophthalmic Simulation Surgical Competency Assessment Rubric (SIM-OSSCAR) by two masked graders. Synthetic simulation eyes were used (PS-OS-010, Philips Studio, Bristol, UK).…”

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

“…Published reports in literature stress the importance of simulator-based training to facilitate the rapid acquisition of surgical skills and improve patient safety profiles. [ 16 17 ] The simulator consists of a model eye mounted on a mannequin head, which is connected to a microscope with a camera and a computer interface. Internal sensors are present to track the movements and positions of the surgical instruments, which produces a virtual image that is seen on both the microscope and the touch screen.…”