Surgical Simulation Training Reduces Intraoperative Cataract Surgery Complications Among Residents

Staropoli, Patrick; Gregori, Ninel Z.; Junk, Anna K.; Galor, Anat; Goldhardt, Raquel; Goldhagen, Brian E.; Shi, Wei; Feuer, William J.

doi:10.1097/sih.0000000000000255

Cited by 85 publications

(70 citation statements)

References 30 publications

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“…Only the study from Staropoli et al 14 had all bias items identified as low risk. The study by Staropoli et al was also the only study that had a protocol which enabled appraisal of its reporting bias.…”

Section: Risk Of Biasmentioning

confidence: 99%

Can simulators be applied to improve cataract surgery training: a systematic review

2020

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ObjectiveThe purpose of this paper was to conduct a systematic review of existing literature on simulation-based training of cataract surgery. Available literature was evaluated and projections on how current findings could be applied to cataract surgery training were summarised. The quality of included literature was also assessed.Methods and analysisThe PubMed, Embase and Cochrane Library databases were searched for articles pertaining to simulation training in cataract surgery on 18 November 2019. Selected articles were qualitatively analysed.ResultsA total of 165 articles were identified out of which 10 met inclusion criteria. Four studies reported construct validity of the EyeSi simulator. Six studies demonstrated improved surgical outcomes corresponding to training on the simulator. Quality assessment of included studies was satisfactory.ConclusionCurrent studies on simulation training in cataract surgery all point towards it being an effective training tool with low risk of study biases confounding this conclusion. As technology improves, surgical training must embrace and incorporate simulation technology in training.

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Section: Risk Of Biasmentioning

confidence: 99%

Can simulators be applied to improve cataract surgery training: a systematic review

2020

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“…Regarding patient outcomes, five studies demonstrated the transfer effects of Eyesi with reduced complications in live cataract surgery following training [ 12 , 21 , 29 , 35 , 38 ]. Of note, a multi-centre retrospective study involving 265 ophthalmology trainees across the UK showed that complication rates dropped from 4.2 to 2.6% (38% reduction) following the introduction of Eyesi simulators into training programmes [ 35 ].…”

Section: Resultsmentioning

confidence: 99%

A systematic review of simulation-based training tools for technical and non-technical skills in ophthalmology

Lee

Raison

Lau

et al. 2020

Eye

104

100

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To evaluate all simulation models for ophthalmology technical and non-technical skills training and the strength of evidence to support their validity and effectiveness. A systematic search was performed using PubMed and Embase for studies published from inception to 01/07/2019. Studies were analysed according to the training modality: virtual reality; wet-lab; dry-lab models; e-learning. The educational impact of studies was evaluated using Messick’s validity framework and McGaghie’s model of translational outcomes for evaluating effectiveness. One hundred and thirty-one studies were included in this review, with 93 different simulators described. Fifty-three studies were based on virtual reality tools; 47 on wet-lab models; 26 on dry-lab models; 5 on e-learning. Only two studies provided evidence for all five sources of validity assessment. Models with the strongest validity evidence were the Eyesi Surgical, Eyesi Direct Ophthalmoscope and Eye Surgical Skills Assessment Test. Effectiveness ratings for simulator models were mostly limited to level 2 (contained effects) with the exception of the Sophocle vitreoretinal surgery simulator, which was shown at level 3 (downstream effects), and the Eyesi at level 5 (target effects) for cataract surgery. A wide range of models have been described but only the Eyesi has undergone comprehensive investigation. The main weakness is in the poor quality of study design, with a predominance of descriptive reports showing limited validity evidence and few studies investigating the effects of simulation training on patient outcomes. More robust research is needed to enable effective implementation of simulation tools into current training curriculums.

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“…An overall increase in operative volume will not overcome these deficiencies occurring at an early stage of surgical training, but rather additional supervision and reassurance are most effective. Parikh et al have cited interesting articles from the ophthalmic 3 and nonophthalmic literature 4,5 showing that surgeons with higher case volumes have better surgical outcomes. However, each of these studies evaluated the outcomes of independent experienced practitioners, and they may not be directly applicable to residents operating under the direct supervision of attending surgeons.…”

Section: Ravi Parikh MD Mph 12 Grayson W Armstrong Md Mph 3 Alementioning

confidence: 99%

“…Last, trainee use of virtual reality simulation has been found to be helpful in avoiding future surgical complications, thus adding to the evidence that increased levels of surgical practice, be it real cases or virtual, are useful in building surgical skill. 5 It may be difficult for programs to increase surgical case volume for struggling residents. Residency programs must ensure that all trainees receive adequate surgical numbers, therefore limiting the amount of surgeries any program can reassign from skilled to less skilled trainees.…”

mentioning

confidence: 99%

Re: Gedde et al.: Ophthalmology resident surgical competence: a survey of program directors (Ophthalmology. 2020;127(8):1123-1125)

2020

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was chosen based on the Brusini system 3 owing to concerns the Hodapp-Parish-Anderson criteria may underestimate early glaucomatous damage. Diagnosis based on glaucoma progression could only be achieved by a longitudinal prospective design and was outside the scope of our study. Generally, in our clinic, open-angle glaucoma is diagnosed if a person has nonoccludable angles on gonioscopy, glaucomatous optic nerve appearance on fundus exam, and a corresponding defect on imaging (OCT or Heidelberg retinal tomography [HRT]) and/or visual field. When in doubt, patients are followed to determine whether progression occurs. As per standard of care, visual fields are repeated until patients achieve acceptable reliability indices to rule out a learning effect. Although not part of the data collection procedures for this study, patients in the clinic repeatedly undergo ophthalmic imaging in the form of OCT or HRT as part of their follow-up. Third, using a cutoff of e4d B allowed us to include glaucoma patients with all stages of disease: early, moderate, and severe. As Sen and Saxena requested, when we examined whether those with more severe glaucoma had worse cognitive scores, there does seem to be a trend such that the cognitive scores on the verbal digit span tests and the immediate and delayed story tests are worse with worsening glaucoma severity. Finally, the point of using the Mini-Mental State Examination Blind score was to exclude participants for whom we thought their self-reported data might not be reliable or who could not by themselves give informed consent owing to cognitive impairment. We did not attempt to identify mild cognitive impairment in our participants, although it would be likely that some of our participants had it given the low scores on some of the cognitive tests.

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Surgical Simulation Training Reduces Intraoperative Cataract Surgery Complications Among Residents

Cited by 85 publications

References 30 publications

Can simulators be applied to improve cataract surgery training: a systematic review

Can simulators be applied to improve cataract surgery training: a systematic review

A systematic review of simulation-based training tools for technical and non-technical skills in ophthalmology

Re: Gedde et al.: Ophthalmology resident surgical competence: a survey of program directors (Ophthalmology. 2020;127(8):1123-1125)

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