Eyeworld

EW RESIDENTS 87 Lana Srur, MD Assistant professor of clinical ophthalmology Bascom Palmer Eye Institute University of Miami Miller School of Medicine This study is commendable for addressing a signifi cant need in our ophthalmology training programs, and even on a larger scale in our professional community, to assess surgical skill and ability and redirect our focus away from volume of cases alone. This study aims to create assessment questions and evaluate them for reliability and accurateness in assessing surgical skill. Interobserver variability was a major factor in determining validity of assessment questions. However, despite higher variability, certain challenging and fundamental steps in cataract surgery should still be assessed to accurately depict a sur- geon's skill level. Perhaps establish- ing minimum standards or grading guidelines for these steps would decrease interobserver variability and allow these steps to also be eval- uated. Additionally, a larger number of surgeons should be assessed in the future to better evaluate the validity of this tool. The author's plan to use video image processing in the future as a more objective tool may be bene- fi cial as part of an assessment tool. It is important to keep in mind, however, that there are likely im- portant steps that would not lend themselves to this method of anal- ysis that should not be neglected in evaluation of surgical skill. Cataract surgery instructors are typically profi cient at performing cataract surgery themselves, how- ever, providing instruction and guidance to a surgeon-in-training is a different skill altogether. The abili- ty to give instruction effectively and with patience and composure likely increases signifi cantly with experi- ence as well. There currently are no widely used guidelines on teaching surgical technique. Establishing such a tool and delineating which specifi c teaching points need to be conveyed in resident training would also likely improve the quality of instruction, and subsequently produce better surgeons out of residency. This study focused solely on the hydrodissection and phacoemulsifi - cation portions of cataract surgery. The assessment questions, which were derived from internationally approved surgical assessment tools, brought to light specifi c skills that warrant close attention during resi- dent cataract surgery training. These include: • Ease and stability of instrument handling, including the hydrodis- section cannula, phaco probe, and second instrument, maintaining good tip visibility and avoiding awkward/inappropriate move- ments, and minimizing entries into the eye • Effective hydrodissection, with a free fl uid wave and minimal resistance with nucleus rotation • Effi ciency of phacoemulsifi cation energy, with appropriate groove dimensions and centration, with ease of nucleus cracking • Ease and safety in nucleus segment engagement • Effective and safe nucleus chopping, without engaging adjacent tissue • Maintenance of anterior chamber stability and good globe position throughout the case I look forward to the further development of an assessment tool for use in resident cataract surgery training and feel it will be of great benefi t in improving the skills of our residents and in our community. EW Contact information Boghani: Shobha_Boghani@urmc.rochester.edu Sikder: ssikder1@jhmi.edu Srur: LSrur@med.miami.edu September 2014 Evaluating teaching methods: Validation of an evaluation tool for hydrodissection and phacoemulsifi cation portions of cataract surgery Validating the use of videography to assess performance by non-supervising surgeons may become an important component of resident surgical training (the secret sauce) and serve as an additional method to evaluate resident cataract surgical training progress. Ronald J. Smith, MD, MPH, Colin A. McCannel, MD, Lynn K. Gordon, MD, PhD, David A. Hollander, MD, JoAnn A. Giaconi, MD, Sadiqa K. Stelzner, MD, Uday Devgan, MD, John Bartlett, MD, Bartly J. Mondino, MD J Cataract Refract Surg (Sept.) 2014;40:1506–1513 Purpose: To develop and assess the validity of an evaluation tool to assess quantitatively the hydrodissection and phacoemulsifi cation portions of cataract surgery performed by residents. Setting: Jules Stein Eye Institute, the Olive View-UCLA Medical Center, and the VA Medical Center, Los Angeles, Calif. Design: Masked assess ment, prospective case series. Methods: UCLA ophthalmology faculty members were surveyed and literature reviewed to develop a grading tool consisting of 15 questions to evaluate surgical technique, including questions from the Global Rating Assessment of Skills in Intraocular Surgery (GRASIS) and from the International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubric (ICO-OSCAR). Video clips of the hydrodissection and phacoemulsifi cation portions of cataract surgery performed by one PGY2, one PGY3, two PGY4 residents and an advanced surgeon were independently graded in a masked fashion by an eight- member faculty panel. Results: Eleven of the 15 questions had a signifi cant association with surgical experience level (ANOVA p<0.05). Interobserver variability in grading yielded intraclass correlation coeffi cients between 0.28 and 0.72. The questions with the lowest interobserver variability were hydrodissection questions on instrument handling, fl ow of operation, and nucleus rotation. Nucleus cracking also had low variability. Less directly visible tasks especially three-dimensional tasks had wider interobserver variability between graders. Conclusions: Surgical performance can be validly measured using an evaluation tool. Improved videography and studies to identify the best questions for evaluating each step of cataract surgery may help ophthalmic educators more precisely measure training outcomes for improving teaching interventions.

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