Confidence of ophthalmology specialist trainees in the management of posterior capsule rupture and vitreous loss

Abstract

Purpose To ascertain ophthalmology trainee confidence in managing posterior capsule rupture (PCR) and vitreous loss. Methods An electronic survey was distributed to ophthalmology trainees in a single UK postgraduate training Deanery. Data collected included the stage of training, number of completed cataract operations, cumulative PCR rate, number of PCRs personally managed by the trainee, previous vitrectomy experience during vitreoretinal rotations, and attendance at advanced phacoemulsification courses. Trainees self-evaluated their confidence in managing PCR with vitreous loss, including the management of specific aspects of the procedure. Results Across training grades, only 9.1% (2/22) felt confident managing PCR without senior support. Respondents were most confident with fluidic parameters and IOL considerations, but 77.3% (17/22) lacked confidence in avoiding a dropped nucleus. Eleven respondents had completed 4350 cases (mean 576; range 383-1087). In this subgroup, mean cumulative PCR rate was 2.1% (range 0.9-4.9%), and trainees personally managed a mean 3.5 cases of PCR (range 1-7). Only 18.2% felt they could manage PCR and vitreous loss without senior support, and 45.5% stated they were not confident in avoiding a dropped nucleus. The most experienced trainee (1087 cases) had personally managed PCR just six times, and three trainees with 4350 cases had only managed PCR once each. Conclusions The Royal College of Ophthalmologists' requirement of 350 completed cases appears insufficient for independent cataract surgery, as opportunities to manage complications as a trainee are scarce. A competency-based assessment framework may be preferable, with a more targeted approach to training incorporating surgical simulation within the formal curriculum.

Posterior capsular complication rates with femtosecond laser-assisted cataract surgery: a consecutive comparative cohort and literature review

“…These findings are replicated elsewhere with trainee surgeons, albeit with reduced incidence ( Table 3 ). Turnbull and Lash 25 found a cumulative PCR rate of 2.1% in a survey of ophthalmology trainees, a value that approaches general registry findings.…”

Clinical Investigation into Posterior Capsule Rupture in Phacoemulsification Operations Performed by Surgery Trainees

“…In the hospital in which this study was conducted, surgery trainees are able to complete the entire operation without the supervision of an experienced surgeon after 200 completed cases. Similarly, the Royal College of Ophthalmologists requires trainees to complete 350 of these operations before a certificate of completion of training can be issued [18]. However, it is important to note that in the event of PCR, the supervising surgeon usually takes over from the surgery trainees.…”

Quantifying the real-world cost saving from using surgical adjuncts to prevent complications during cataract surgery

“…In light of this, many authors have recommended the use of prior simulation to guide the surgeon in these rare but predictable surgical scenarios, through low-cost surveys of trainee experience, wet and dry laboratory facilities and computer simulation [9][10][11][12][13][14][15][16][17]. Ease of access to a pre-prepared Anterior Vitrectomy Kit with associated adjuncts (AntVitKit) to help with the prompt and appropriate management of VL has been previously described [18].…”