Basic training module for vitreoretinal surgery and the Casey Eye Institute Vitrectomy Indices Tool for Skills Assessment

Abstract

BackgroundThe purpose of this study was to design and implement a vitreoretinal training module that would be useful for ophthalmology residents and fellows to learn the basic maneuvers required in vitreoretinal surgery.MethodsA prospective pilot study evaluating the training module was undertaken in 13 ophthalmology trainees (residents and vitreoretinal fellows) with varying levels of vitreoretinal training experience. A vitreoretinal training module was designed and consisted of a three-port vitrectomy setup (sclerotomy wound construction, infusion placement), intraocular tasks (core vitrectomy, driving the operating microscope, membrane peel, air–fluid exchange), and wound closure. Standard vitrectomy instrumentation, the VitRet eye (Phillips Studio, Bristol, UK) and vitreous-like fluid using dairy creamer and balanced saline were utilized. A five-point Likert scale, ie, the Casey Eye Institute Vitrectomy Indices Tool for Skills Assessment (CEIVITS), was devised to evaluate each component of the module. Vitreoretinal surgical maneuvers were digitally recorded and graded by an attending vitreoretinal surgeon. Linear regression and correlation were performed to evaluate the relationship between prior vitreoretinal experience and CEIVITS performance. The main outcome measures were correlation of vitreoretinal surgical experience and CEIVITS performance on simulated tasks using a basic vitreoretinal training module.ResultsThirteen participants from postgraduate year 2 to postgraduate year 6 levels were evaluated. Nine participants were male and four were female. The median age of participants was 32 (range 30–36) years and surgical experience was 0–410 prior vitreoretinal surgical procedures. A positive correlation (P < 0.05) was observed between vitreoretinal surgical experience and CEIVITS performance on the following tasks: total score (P = 0.021), sclerotomy wound construction (P = 0.047), infusion line placement (P = 0.012), air–fluid exchange (P = 0.004), and wound closure (P = 0.032). Post module surveys showed that the majority of trainees felt that the vitreoretinal training module improved their understanding of vitreoretinal surgery. The nonbiohazardous nature of the setup was advantageous from sanitation and cost perspectives.ConclusionThe implementation of our training module for residency and vitreoretinal fellowship was feasible and the CEIVITS adequately assessed basic vitrectomy maneuvers. Given that ophthalmologic and subspecialty instruction migrates from an apprenticeship to a competency-based model, the face and content validity makes the CEIVITS module a promising one in vitreoretinal surgical instruction.

A systematic review of simulation-based training tools for technical and non-technical skills in ophthalmology

“…The model was shown to discriminate between experienced and inexperienced surgeons in terms of operating time and the success rate of membrane peeling (relations to other variables) [ 113 ]. This was similarly tested in a study by Yeh et al where, using the artificial VitRet Eye Model (Phillips Studio, Bristol, UK) filled with vitreous-like fluid to simulate a variety of vitreoretinal surgery procedures, a positive correlation was observed between the trainees’ level of experience and total score [ 114 ]. In terms of effectiveness, the models by Yeh and Hirata showed internal acceptability and contained effects, respectively.…”

Simulation training in vitreoretinal surgery: a systematic review

“…The highest scoring domains on the MERSQI instrument were type of data and data analysis in which only Yeh et al [21] did not achieve maximum points, given that their data were non-objective and descriptively analyzed only. Lowest scoring domain was the validity of evaluation instrument.…”

“…Lowest scoring domain was the validity of evaluation instrument. Thomsen et al [22] was the only to fulfill the criterion for reporting internal structure by testing internal consistency across all modules with Cronbach’s α. Jonas et al, [23] Vergmann et al, [24] and Thomsen et al [22] adequately reported content and five studies (Rossi et al, [25] Solverson et al, [26] Yeh et al, [21] Vergmann et al, [24] and Thomsen et al [22]) reported relationships with other variables. Grodin et al [27] did not score any points in validity of evaluation instrument.…”

Optimal refinement of residents' surgical skills by training on induced goat's eye corneoscleral perforation

“…Quality surgical skill teaching is an important aspect of the resident training program, because the pattern of ocular injuries in pediatric and adult population may vary from simple to grievous injuries. [123456] In routine training programs, theoretical and examination skills are often dealt in detail; however, acquisition of finer surgical skills is often a tough task and it can only be obtained through continuous practice. There are reports in the literature which have evaluated the effect of surgical training on artificial eyes/goat's eye and other models for mainly cataract surgery skills’ enhancement.…”

“…Similarly, few other studies have evaluated the vitreoretinal surgical skill enhancement. [2345] In literature, there is a clear lack of surgical skill enhancement techniques under complex circumstances like traumatic globe injuries. In addition, the major limitation of these techniques is the lack of real tissue experience, which indeed is the most important aspect in enhancing the microscopic surgical skills.…”