Eyeworld

14 | EYEWORLD | MARCH 2021 time that was two standard deviations longer than the mean (58 minutes). The authors chose to exclude these cases because the objective of the study was to measure baseline surgical performance in non-extenuating circumstances (i.e., intraoperative complications or unusually complex procedures). Operative time was defined as the time elapsed between initial incision and final wound closure and was selected as a proxy for surgical competency due to its objective nature, ability to be easily measured and proven correlation with surgical proficiency. 6–8 Mixed-effect linear regression models were used to evaluate chang- es in operative time as a function of sequential case number. The slope for the association was modeled as three consecutive splines with cut points at the 40th and 150th cases. The authors found a considerable, progressive decrease in operative time for case number one through 39 (mean change of –0.17 minutes per additional case, 95% CI –0.21, –0.12; p<0.001). A smaller but still significant reduction in operative time was identified for cases 40 through 149 (mean change of –0.05 minutes per additional case, 95% CI –0.07, –0.04; p<0.001). For cases 150 and beyond, there was no significant improve- ment in operative time. To examine individual resident learning patterns, each resident's operative time was mapped as a function of consecutive case num- ber and modeled with best fit second-degree polynomial curves. The authors were able to identify three distinct resident learning "phe- notypes." One group of trainees demonstrated operative times indicative of early, above-aver- age surgical performance with steady progress. A second group included residents with a slow start but rapid progress midway through their total caseload. Lastly, a smaller, third group of residents showed prolonged, inconsistent performance that continued beyond their 100th case. Discussion The authors make a valuable contribution to the literature by modeling the resident learning curve in cataract surgery in order to identify a case threshold beyond which trainees may expect diminishing educational return. The results of this study are congruent with pri- or research showing a benefit to performing a greater number of cataract surgeries than somewhat or very comfortable with managing loose zonular fibers. 5 A better understanding of the educational value of cataract surgery cases beyond the ACGME minimum may allow residency programs to provide a more balanced clinical and surgical experience by redistribut- ing some of the additional time and resources currently devoted to teaching cataract surgery to other training opportunities. Liebman et al. offer insights into this challenging situation through their quantification of the resident cata- ract surgery learning curve and identification of the case threshold at which residents experience marginal educational benefit. Summary This retrospective consecutive case series includ- ed cataract surgical cases performed by resident physicians as primary surgeon at a large U.S. residency training program (Massachusetts Eye and Ear). A total of 6,228 cases performed by 40 residents between July 1, 2010, and June 30, 2015, were eligible for study; of these, 2,096 cases (33.7%) had operative time data available and were analyzed. Cases for which operative time data was not available were maintained as placeholders to ensure accurate case number count. Of the analyzed cases, five were per- formed by PGY-2 residents, 324 by PGY-3 resi- dents, and 1,709 by PGY-4 residents. Fifty-nine cases (2.8%) were excluded due to operative ASCRS NEWS continued from page 13 References 1. ACGME Case Log Informa- tion: Ophthalmology; Review Committee for Ophthalmology. www.acgme.org/Portals/0/ PFAssets/ProgramResources/ OPH_CaseLogInfo.pd- f?ver=2021-01-28-153137-763. Accessed January 14, 2021. 2. Chadha N, et al. Trends in ophthalmology resident surgical experience from 2009 to 2015. Clin Ophthalmol. 2016;10:1205– 1208. 3. Abdelfattah NS, et al. Perspective of ophthalmology residents in the United States about residency programs and competency in relation to the International Council of Ophthalmology guidelines. J Curr Ophthalmol. 2016;28:146–151. 4. Yeu E, et al. Resident surgical experience with lens and corneal refractive surgery: survey of the ASCRS Young Physicians and Residents Membership. J Cataract Refract Surg. 2013;39:279–284. 5. Schallhorn JM, et al. Resident and young physician experience with complex cataract surgery and new cataract and refractive technology: Results of the ASCRS 2016 Young Eye Surgeons survey. J Cataract Refract Surg. 2017;43:687–694. The ASCRS Journal Club is a virtual, compli- mentary CME offering exclusive to ASCRS members that brings the experience of a lively discussion of two current articles from the Journal of Cataract & Refractive Surgery to the viewer. Co-moderated by Nick Mamalis, MD, and Leela Raju, MD, the December session, the inaugural session, featured a presentation by Samuel Masket, MD, lead author of "Surgical management of positive dysphotopsia: US perspective." The second manuscript, "Quantifying the benefit of additional cataract surgery cases in ophthalmology residency," was presented by Alexa Thibodeau, MD, resident, Kellogg Eye Center, University of Michigan. To view the December Journal Club session, visit: https://ascrs.org/clinical-education/ journal-club/schedule/december-2020.

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