A review of teaching methods and outcomes of resident phacoemulsification

Kaplowitz, Kevin; Yazdanie, Mohammad; Abazari, Azin

doi:10.1016/j.survophthal.2017.09.006

Cited by 42 publications

(47 citation statements)

References 113 publications

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“…Our UDVA results with ATIOLs are comparable to the UDVA results of resident-performed standard cataract surgery reported in several studies. [6][7][8] Among the studied ATIOLs, AIOLs had good UIVA but did not perform as well for UDVA and UNVA at POM3+, which is similar to experienced surgeons' results in the literature. 15 This may also explain residents' lower preferences for this model.…”

Section: Discussionsupporting

confidence: 76%

“…Multiple studies have shown that quality visual outcomes after standard cataract surgery can be obtained throughout residency training, especially when coupled with a teaching curriculum and increased surgical volume. [5][6][7][8] We hypothesized that a step-wise ATIOL curriculum could enhance a standard cataract surgery curriculum without negatively affecting primary teaching objectives or resident surgical case volumes. Here we describe our ATIOL surgical curriculum, and report the experiences of residents who completed the curriculum and the results of resident-performed ATIOL surgery for four residency classes.…”

Section: Introductionmentioning

confidence: 99%

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Surgical Curriculum for Presbyopia-Correcting Intraocular Lenses: Resident Experiences and Surgical Outcomes

Riaz¹,

Williams²,

Farooq³

et al. 2020

OPTH

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Point your SmartPhone at the code above. If you have a QR code reader the video abstract will appear. Or use: https://youtu.be/OHbPTPD6Kjw Objective: To describe a stepwise surgical curriculum that was implemented to teach novice surgeons about currently available advanced technology intraocular lenses (ATIOLs) for correction of presbyopia and to report the experiences and surgical results of ATIOL surgery performed by residents who engaged in the curriculum. Design, Setting, and Participants: Third-year ophthalmology residents participated in a curriculum incorporating didactic lectures (with objective assessment and wet-lab practice) and observation of attending-performed ATIOL surgeries prior to performing ATIOL surgery as primary surgeon under direct supervision. Post-operative outcomes studied were best corrected distance visual acuity (BCDVA) and uncorrected distance (UDVA), intermediate (UIVA) near (UNVA) visual acuity and correction of astigmatism with at least 3 months of follow-up (POM3+). Residents were also given a survey to assess experiences with the surgical curriculum, preparedness for use of ATIOLs post-residency, and ATIOL practice pattern post-residency. Results: A total of 12 residents from four consecutive classes completed the curriculum. Residents overall had a favorable opinion of the curriculum and felt well prepared to use ATIOLs after training. Graduates who currently perform cataract surgery felt comfortable using all available ATIOLs. A total of 100 eyes from 72 patients met the inclusion criteria for analysis in the study. At the POM3+ timepoint, 88% of eyes had UDVA of 20/30 or better, 93% had UIVA of 20/30 or better, and 71.2% had UNVA of 20/30 (J2) or better. Among eyes that received an astigmatism-correcting ATIOL, 91% had <1 diopter of astigmatism after surgery. Conclusion: Resident surgeons learned to perform ATIOL surgery (medical knowledge) and achieve strong surgical outcomes (patient care) with all currently available ATIOLs after completion of a stepwise curriculum. Educators may be encouraged to incorporate an ATIOL curriculum based on the results of this study. The curriculum presented is a prototype and may be further improved with future experiences and studies.

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Section: Discussionsupporting

confidence: 76%

Section: Introductionmentioning

confidence: 99%

Surgical Curriculum for Presbyopia-Correcting Intraocular Lenses: Resident Experiences and Surgical Outcomes

Riaz¹,

Williams²,

Farooq³

et al. 2020

OPTH

View full text Add to dashboard Cite

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“…Studies on residents' learning curve in performing phacoemulsification showed that achieving surgical competency and efficiency required 70-80 phacoemulsification cases to obtain expert surgical skills. 1,2 According to Saudi board ophthalmology curriculum, a minimum of 80 cases, as a main surgeon, are required to complete residency training. 3 Teaching cataract surgery remains an ongoing challenge, considering both attaining a high level of training and maintaining patient safety.…”

Section: Introductionmentioning

confidence: 99%

“…A stepwise introduction to surgical training usually begins with giving residents some steps of the surgery that can be in a sequential order, reverse order, or modular order (where mastering only one surgical step per case is mandatory before moving to the next step). 2 Additionally, a selective order can be undertaken starting from the easiest steps to the most difficult one. Upon completion of all the steps, the resident is given the chance to do a full case surgery.…”

Section: Introductionmentioning

confidence: 99%

“…10 Even though there are several grading systems, none of them has proved to be superior to the other at improving the phacoemulsification learning curve. 2 The aim of this study was to prospectively determine the proficiency of the program residents' performance of phacoemulsification surgery and to identify the most difficult steps to learn, at the same time intraoperative complications were monitored. This assessment is thought to help in evaluating and improving residents' surgical training.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of Learning Curve in Phacoemulsification Surgery Among the Eastern Province Ophthalmology Program Residents

Aljindan¹,

Almarshood²,

Yassin³

et al. 2020

OPTH

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Purpose: To assess residents' performance of phacoemulsification surgery and determine which steps of the procedure are most difficult to learn, and to measure rate of intraoperative complications. Design: This was a prospective observational study. Methods: Phacoemulsification surgery was divided into steps and each step was given a proficiency grade by the attending consultant. All intraoperative complications were recorded and analyzed. Results: 200 cases performed by the Eastern Province ophthalmology program residents were evaluated. The most commonly encountered difficulty factors were hard nucleus (20.7%), small pupil (12.6%), and white cataract (10.3%). Capsulorhexis, nucleus disassembly and removal, and cortex removal were the most difficult steps to learn. General complication rate was 17.5%, and posterior capsular rupture was the most common complication (40%). Proficiency more than 90% of the time in each step was noted in residents with prior experience of more than 40 cases, except for nucleus disassembly. Conclusion: The study showed that nucleus disassembly remained the major obstacle in the residents' exponential learning curve of phacoemulsification surgery. Majority of complications occurred at level of capsulorhexis and cortical removal steps.

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