Eyeworld

MARCH 2021 | EYEWORLD | 15 Contact Tannen: btannen@med.umich.edu Thibodeau: althibod@med.umich.edu two-thirds of eligible cases. Even so, Liebman et al.'s analysis of more than 2,000 cases from 40 residents during a 5-year academic peri- od serves as one of the largest studies ever to assess the resident cataract surgery learning curve. 6,10 A final limitation of this study is that data was limited to cataract cases by residents of a single residency program. Thus, the results may not be generalizable to residents at train- ing programs with a different structure and approach to teaching cataract surgery. Overall, this study supports creation of per- sonalized cataract surgery caseloads based upon resident operative performance and learning phenotype. This individualized approach, the authors suggested, may optimize each resident's limited time in training by devoting adequate time to achieve proficiency in cataract surgery without sacrificing other opportunities for pro- fessional growth. Further research is essential to assess the external validity of such findings across a diverse range of residency programs and to determine predictors of surgical perfor- mance so that residents who may benefit from early additional guidance may be recognized. the ACGME-mandated minimum of 86 cas- es. 6,7,9 The findings also correlate with those of other studies evaluating surgical efficiency and complication rate as a function of sequential case number. Randelman et al. found similar improvements in adjusted phacoemulsification time (total phacoemulsification time multiplied by phacoemulsification power) as surgical expe- rience increased and identified a plateau in the rates of both posterior capsule tear and vitreous loss around a similar case threshold of 160. 7 A significant limitation of this study is that operative time is not a perfect proxy for surgical proficiency; operative time may be influenced by case complexity, intraoperative complica- tions, attending teaching style, and phacoemul- sification technique (divide and conquer, stop and chop, phaco chop, etc.). While cases with operative time longer than two standard devia- tions above the mean were excluded to control for non-extenuating circumstances, the authors did not report any standardization with regard to nucleus density or phacoemulsification tech- nique. Another limitation of this study was that operative time data was unavailable for nearly Quantifying the educational benefit of additional cataract surgery cases in ophthalmology residency Daniel Liebman, MD, K. Matthew McKay, MD, Miriam Haviland, PhD, Giannis Moustafa, MD, Durga Borkar, MD, Carolyn Kloek, MD J Cataract Refract Surg. 2020;46(11):1495–1500. n Purpose: To quantify the resident learning curve for cataract surgery using operative time as an indicator of surgical competency, to identify the case threshold at which marginal additional educational benefit became equivocal, and to characterize heterogeneity in residents' pathways to surgical competency. n Setting: Academic Medical Center. n Design: Large-scale retrospective consecutive case series. n Methods: All cataract surgery cases performed by resident physicians as primary surgeon at Massachusetts Eye and Ear from July 1, 2010 through June 30, 2015 were reviewed. Data was abstracted from ACGME case logs and operative time measurements. A linear mixed- methods analysis was conducted to model changes in residents' cataract surgery operative times as a function of sequential case number, with resident identity included as a random effect in the model to normalize between-resident variability. n Results: A total of 2,096 cases were analyzed. A marked progressive decrease in operative time was noted for resident cases 1–39 (mean change –0.17 minutes per additional case, 95% CI –0.21, –0.12; p<.001). A modest, steady reduction in operative time was subsequently noted for case numbers 40–149 (mean change –0.05 minutes per additional case, 95% CI –0.07, –0.04; p<0.001). We found no statistically significant improvement in operative times beyond the 150th case. n Conclusion: Residents derive educational benefit from performing a greater number of cataract procedures than current minimum requirements. However, cases far in excess of this threshold may have diminishing educational return in residency. Educational resources currently employed for these cases may be more appropriately devoted to other training priorities. References (cont.) 6. Wiggins MN, Warner DB. Resident physician operative times during cataract surgery. Ophthalmic Surg Lasers Imaging. 2010;41:518–522. 7. Randleman JB, et al. The resident surgeon phacoemul- sification learning curve. Arch Ophthalmol. 2007;125:1215–1219. 8. Taravella MJ, et al. Charac- terizing the learning curve in phacoemulsification. J Cataract Refract Surg. 2011;37:1069–1075. 9. Ho J, Claoué C. Cataract skills: how do we judge competency? J R Soc Med. 2013;106:2–4. 10. Hosler MR, et al. Impact of resident participation in cataract surgery on operative time and cost. Ophthalmology. 2012;119:95–98.

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