OCT 2013

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

Issue link: https://digital.eyeworld.org/i/194331

Contents of this Issue


Page 104 of 134

102 EW RESIDENTS October 2013 Cataract tips from the teachers Rising to the occasion Frank M. Bishop, MD, CAPT, MC, USN Chairman, Department of Ophthalmology, Naval Medical Center San Diego Sherleen Chen, MD Assistant professor of ophthalmology Harvard Medical School Director of Cataract and Comprehensive Ophthalmology Massachusetts Eye and Ear Infirmary Roberto Pineda, MD Assistant professor of ophthalmology Harvard Medical School Director of Refractive Surgery Massachusetts Eye and Ear Infirmary A s requests from our professional organizing bodies demand more metrics and quantitative data, ophthalmic residency programs are challenged more than ever to find effective ways to address these requirements. Perhaps one of the most challenging areas is that of surgical training. Here, several of our faculty comment on recent studies and issues surrounding this topic. Sherleen Chen, MD, and Roberto Pineda, MD To comply with the Accreditation Council for Graduate Medical Education (ACGME)-mandated shift from traditional to competency based standards, ophthalmology residencies are implementing structured surgical programs combining traditional methodologies with new tools such as the virtual reality (VR) simulator and cognitive simulator training.1-3 While the benefits of VR simulation training in novice surgeons have been validated in numerous procedural specialties,4 the efficacy of VR in ophthalmology remains largely unexplored. In the November issue of the Journal of Cataract & Refractive Surgery, Daly et al. report on the efficacy of the VR simulator versus traditional wet lab training on performance of the capsulorhexis in cataract surgery. Capsulorhexis was selected as the focus of the study as it is consistently considered the most challenging step for residents to master.5 Study summary This institutional review board-approved, prospective randomized study evaluated surgical performance of second-year ophthalmology residents rotating through the Veterans Affairs (VA) Boston Ophthalmology service. Residents were randomized to receive continuous curvilinear capsulorhexis (CCC) training in the wet lab using silicone eyes (10 residents) or on the simulator (11 residents) before performing their first CCC. The same attending physician supervised all training and procedures. Data included pre-practice questionnaires, intraoperative video records, and post-procedure questionnaires evaluating satisfaction with the preoperative training program and its perceived value. Two independent attending surgeons graded case videos. Individual performance was determined as the mean score between the two evaluators for each of 12 criteria. Overall score was calculated as the sum of the 12 individual criteria. There was no significant difference between the overall scores between the two training method- ologies (P=.608). Evaluation of the 12 individual variables revealed only one significant difference, with wet lab participants taking less time to complete the CCC in the operating room (OR) (P=.038). Simulator subgroup analysis demonstrated that residents who took longer to complete the course were slower at CCC in the OR (P=.012) with significantly lower overall performance scores (P=.034). Resident satisfaction with preoperative programs revealed that residents who found their training to be less helpful had significantly lower overall scores (P=.05), and those who reported more enjoyment of their training had higher overall performance scores (P=.03).6 Comment In this study, the authors assert that 1) preoperative simulator training effectively prepared residents for the OR compared with the wet lab, and 2) the time to pass the simulator curriculum was predictive of overall surgical performance and time in the OR.6 While the power of this study is limited due to its small sample size, the authors' assumptions appear both valid and supported by the literature. In 2010, Privett et al. published a study validating the construct of VR simulation as a model for CCC training.7 Additional studies have sought to further establish the value of VR simulation to actual OR performance of the entire cataract surgery.8,9 These studies provide the basis with which residencies can build objective outcomes-driven programs. Further efforts, by collaborative teams like the International Forum of Ophthalmic Simulation, are necessary to develop surgical curricula that are both objective and Efficacy of surgical simulator training versus traditional wet-lab training on operating room performance of ophthalmology residents during the capsulorhexis in cataract surgery Mary K. Daly, MD, Efren Gonzalez, MD, Donna Siracuse-Lee, MD, Paul A. Legutko, PhD J Cataract Refract Surg (Nov) 2013 Purpose: To compare the operating room performance of ophthalmology residents trained by traditional wet-lab versus surgical simulation on the continuous curvilinear capsulorhexis (CCC) portion of cataract surgery. Setting: Academic tertiary referral center. Design: Prospective randomized study. Methods: Residents who chose to participate and provided informed consent were randomized to preoperative CCC training in the wet lab or on a simulator. Residents completed pre-practice demographic questionnaires including habits of daily living. After completion of their preoperative training (wet lab versus simulator), residents performed their first CCC of the clinical rotation under the direct supervision of an attending physician as part of their standard training at the facility. Residents then completed satisfaction questionnaires regarding their preoperative training. Two attending surgeons reviewed and graded each video of operating room performance. The mean score between the two attending physicians was used as the individual performance score for each of the 12 performance criteria. The overall score was calculated as the sum of these 12 individual performance scores (standardized). Results: Ten residents trained in the wet lab and 11 on the simulator. There was no significant difference in overall score between the two groups (P=.608). There was no significant difference in any individual score except time (wet-lab group faster than simulator group) (P=.038). Conclusions: Preoperative simulator training effectively prepared residents for the operating room compared with the wet lab. The time to pass the simulator curriculum was predictive of the time and overall performance in the operating room. Financial disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Articles in this issue

Archives of this issue

view archives of Eyeworld - OCT 2013