Cataract surgery teaching

Abstract

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...

New approach to quantifying acute stress in cataract surgeons to investigate the relationship between surgeon experience and intraoperative stress

“…Literature on the learning curve of cataract surgery states that, although basic competency is achieved after 70 to 100 performed procedures, complication rates, vitreous loss rates, and surgical efficiency continue to improve beyond 200 or even 1000 cases. 4,20,25–28 Our HRV stress index data suggest that the continuous gain in competence during the first 1000 or more surgeries goes hand in hand with a decrease in stress. This is consistent with the underlying psychology that stress is caused by a perceived demand that outweighs one's abilities.…”

“…Complications can have devastating effects on the patient's long-term quality of life. 4 Performing a technically difficult procedure under these high-stake circumstances is naturally stressful, especially if the surgeon is inexperienced. 3 In addition, patients' high expectations of having a good outcome may induce even more stress on the surgeon.…”

Reverse order method for teaching cataract surgery to residents

“…This new method features well-defined steps that are performed in the reverse order to that of actual surgery, such that residents learn the easiest step first. We believe that any educational programme for surgery should follow a systematic methodology that is reproducible and can be compared with other methods in terms of clinical results,8 with the aim of standardising the teaching procedure. The current method should be easily reproducible.…”

“…Training for phacoemulsification is ‘step-dependent’,8 9 that is, acquiring surgical skill depends on the mastery of previous steps. However, the training method for this technique has traditionally been based on teaching young physicians the surgical steps in the temporal order applied during real surgery; that is, from the first to the last step 9…”

A review of “cataract surgery teaching”

“…Dear Editor: I read with great interest the editorial entitled "Cataract surgery teaching" by Soriano (1) , wherein he described features of surgical training in Brazil. We congratulate the author on his extensive experience and ideas.…”