Programa de ensino de facoemulsificação CBO/ALCON: resultados do Hospital de Olhos do Paraná

Fischer, Ana Flávia de Castro; Pires, Eduardo Machado Estevão; Klein, Fernando; Bisneto, Otávio Siqueira; Soriano, Eduardo; Moreira, Hamílton

doi:10.1590/s0004-27492010000600010

Cited by 4 publications

(4 citation statements)

References 16 publications

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“…Because capsulorrhexis and lens nucleus cracking and chopping are among the initial steps of phacoemulsification cataract extraction surgery which have a steep learning curve, some attending physicians would prefer to teach phacoemulsification starting from reverse order: the trainee surgeon performs I/A and IOL insertion after the supervisor completes capsulorrhexis and phacoemulsification of the lens. 28 , 32 , 33 This reverse teaching approach could deprive the chances of novice surgeons to practice performing the tasks that have the steepest learning curves, but this approach is better for patient care and safety.…”

Section: Discussionmentioning

confidence: 99%

Impact of virtual reality simulation on learning barriers of phacoemulsification perceived by residents

Ng¹,

Sun²,

Young³

et al. 2018

OPTH

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ObjectiveTo identify residents’ perceived barriers to learning phacoemulsification surgical procedures and to evaluate whether virtual reality simulation training changed these perceptions.DesignThe ophthalmology residents undertook a simulation phacoemulsification course and proficiency assessment on the Eyesi system using the previously validated training modules of intracapsular navigation, anti-tremor, capsulorrhexis, and cracking/chopping. A cross-sectional, multicenter survey on the perceived difficulties in performing phacoemulsification tasks on patients, based on the validated International Council of Ophthalmology’s Ophthalmology Surgical Competency Assessment Rubric (ICO-OSCAR), using a 5-point Likert scale (1 = least and 5 = most difficulty), was conducted among residents with or without prior simulation training. Mann–Whitney U tests were carried out to compare the mean scores, and multivariate regression analyses were performed to evaluate the association of lower scores with the following potential predictors: 1) higher level trainee, 2) can complete phacoemulsification most of the time (>90%) without supervisor’s intervention, and 3) prior simulation training.SettingThe study was conducted in ophthalmology residency training programs in five regional hospitals in Hong Kong.ResultsOf the 22 residents, 19 responded (86.3%), of which 13 (68.4%) had completed simulation training. Nucleus cracking/chopping was ranked highest in difficulty by all respondents followed by capsulorrhexis completion and nucleus rotation/manipulation. Respondents with prior simulation training had significantly lower difficulty scores on these three tasks (nucleus cracking/chopping 3.85 vs 4.75, P = 0.03; capsulorrhexis completion 3.31 vs 4.40, P = 0.02; and nucleus rotation/manipulation 3.00 vs 4.75, P = 0.01). In multivariate analyses, simulation training was significantly associated with lower difficulty scores on these three tasks.ConclusionResidents who had completed Eyesi simulation training had higher confidence in performing the most difficult tasks perceived during phacoemulsification.

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Section: Discussionmentioning

confidence: 99%

Impact of virtual reality simulation on learning barriers of phacoemulsification perceived by residents

Ng¹,

Sun²,

Young³

et al. 2018

OPTH

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“…was slightly different where the progress of three 2 nd -year resident surgeons was monitored at five “checkpoints.” The incidence of PCR in this study was 13.1%. 14 India has a large pool of young ophthalmologists who need phacoemulsification training. 17 The feedback from residency training programs showed that surgical training for residents was considered inadequate by many of the respondents.…”

Section: Discussionmentioning

confidence: 99%

“… 7 10 11 12 13 A novel technique of “reverse” method of training, in which the final steps of the surgical technique are taught first, and the initial steps are taught last was attempted in Brazil. 14 However, it has never been compared to the traditional “start to finish” supervised method of teaching phacoemulsification surgery. The aim of the study was to compare “start to finish” or conventional method to the reverse method of training with regards to posterior capsular rupture (PCR) in phacoemulsification surgery at a teaching institute.…”

Section: Introductionmentioning

confidence: 99%

Comparison of the posterior capsule rupture rates associated with conventional (start to finish) versus reverse methods of teaching phacoemulsification

Suryawanshi¹,

Gogate

Kulkarni³

et al. 2016

Middle East Afr J Ophthalmol

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Purpose:Comparison of the rates of posterior capsule rupture (PCR) associated with conventional versus a reverse method of teaching phacoemulsification.Methods:Trainees were taught conventional (start-to-finish) phacoemulsification beginning with an incision (tunnel construction) to capsulorhexis, sculpting, nucleus cracking, segment removal, cortex aspiration, intraocular lens implantation, and viscoelastic removal. In the reverse method, after incision and capsulorhexis, the trainees were progressively taught viscoelastic wash, cortex aspiration, segment removal, nucleus cracking, sculpting, and intraocular lens implantation. Trainees from a Tertiary Eye Care Centre were classified as beginners, for their first 30 cases and then trainees for their next 70 surgeries. Data were collected on posterior capsular rent and vitreous loss during each step of training.Results:Thirty-two ophthalmic surgeons learning phacoemulsification surgery on 609 cataracts cases were supervised by 3 trainers. Fifteen beginners performed 287 surgeries using the conventional method, and 17 beginners performed 322 surgeries with the reverse method. The incidence of PCR was 18/287 (6.2%) with the conventional method and 15/322 (4.6%) with the reverse method (P = 0.38). PCR occurred during cortex aspiration (8/287, 2.8%) and segment removal (5/287, 1.7%) in the conventional method. PCR occurred during nucleus cracking, segment removal, and cortex aspiration (4/322 surgeries for each step, 1.2%). In the follow, 70 cases (trainees) there was no difference in PCR with either method (4.7% vs. 4.3%, P = 0.705).Conclusion:Conventional and reverse method for training phacoemulsification were both safe in a supervised setting.

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“…It is important that all procedures are documented in a control logbook. In 2008, a group of doctors with an interest in cataract surgery teaching improved the method and attempted to extend it to residency programs affiliated with the Brazilian Council of Ophthalmology in collaboration with a pharmaceutical company (3) . Although all stakeholders had an interest in the project, demands on time, people, and costs requirements prevented the maintenance of this project.…”

mentioning

confidence: 99%

Cataract surgery teaching

Soriano¹

2015

Arquivos Brasileiros De Oftalmologia

Self Cite

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Similar to any educational process, surgical teaching should follow a methodology that can be reproduced and compared. In accordance with scientific methodology, goals should be established and results measured with the use of progress indicators and complication rates as evaluation elements.Teaching strategies may differ; however, methodologies must be standardized rather than different instructors teaching in different ways based on what they feel is best (1,2) . In 2004, the Federal University of São Paulo established a teaching methodology we termed, "backward, " as teaching institutions in Japan were using a similar instructional model. The term "backward" refers to the idea that complications at the end of surgery are less morbid than those occurring at the beginning of surgery. In 2007, this methodology was successfully introduced at the teaching hospital, Santa Casa de São Paulo, leading to a decrease in the number of documented complications.The "backward" methodology involves dividing surgery into five stages: the instructor performs the first four stages and the student performs the last stage. As the student gains mastery of the last stage, successfully completing at least five procedures, the student is then allowed to move backward and gradually assume responsibility for the performance of earlier stages in a retrograde manner. It is important that all procedures are documented in a control logbook. In 2008, a group of doctors with an interest in cataract surgery teaching improved the method and attempted to extend it to residency programs affiliated with the Brazilian Council of Ophthalmology in collaboration with a pharmaceutical company (3) . Although all stakeholders had an interest in the project, demands on time, people, and costs requirements prevented the maintenance of this project.First-year residents are exposed to theoretical and some practical experience in cataract surgery. The largest acquisition of competence occurs in the second year, and residents continue to refine their skills and gain confidence in the third year. Students wishing to advance in the field of ophthalmology can specialize in cataract surgery, gain experience of more complex cases, and pursue fellowship programs.The balance between quantity and quality presents a substantial dilemma. The best synopsis is the completion of a large quantity of quality procedures; however, if I had to pick one, it would be the latter. As in sports activity, improvement comes with repetition, and proper guidance shortens the learning curve, avoids the development of poor habits, minimizes complications, and saves resources. However, providing an environment that ensures both quantity and quality is challenging, particularly when considering that the main teaching theaters in Brazil are in academic centers, supported by a public service structure. Resources are often lacking, leading to an inadequate supply of good quality equipment and materials. Further, funding aimed at ensuring the presence of qualified instructors in a 1:1 teaching...

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Programa de ensino de facoemulsificação CBO/ALCON: resultados do Hospital de Olhos do Paraná

Cited by 4 publications

References 16 publications

Impact of virtual reality simulation on learning barriers of phacoemulsification perceived by residents

Impact of virtual reality simulation on learning barriers of phacoemulsification perceived by residents

Comparison of the posterior capsule rupture rates associated with conventional (start to finish) versus reverse methods of teaching phacoemulsification

Cataract surgery teaching

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