Corneal Laser Refractive Surgery Curriculum Development in the Military: Using the Nominal Group Technique

Abstract

Introduction Corneal laser refractive surgery (CRS) has emerged over the past three decades as a surgical method for correcting or improving vision. In the military, CRS helps warfighters achieve weapon grade vision, which offers a tactical advantage in the deployed environment. As refractive surgery has become more prevalent in both the military and civilian sector, more ophthalmologists need to learn about treatment options as well as management of complications in order to meet increasing patient demand. Currently, little is known about the most effective curriculum for teaching refractive surgery in training programs, and a standardized curriculum does not exist. Since unification of training programs is a Defense Health Agency priority, this study aimed to collect expert consensus on a standardized curriculum for CRS training in the military. Materials and Methods To achieve this goal, the Nominal Group Technique (NGT) was used wherein a panel of experts, currently practicing refractive surgeons involved in military refractive surgery training programs, arrived at consensus on a standardized CRS curriculum. The framework for developing this curriculum is based on Kern’s Six-Step Approach to Curriculum Development. The International Council of Ophthalmology refractive surgery curriculum, National Curriculum for Ophthalmology Residency Training, Accreditation Council for Graduate Medical Education competencies and surgical minimums, and American Academy of Ophthalmology Refractive Surgery Preferred Practice Guidelines were used as the starting materials from which panelists’ consensus was drawn. This consensus-building method allowed for equal representation of experts’ ideas and fostered collaboration to aid in the creation of a robust and standardized curriculum for refractive surgery training programs in the military. Results The panelist experts from this NGT were able to reach consensus on the components of a standardized military refractive surgery curriculum to include generalized and targeted needs assessment, goals and objectives, educational strategies, and curriculum implementation. Conclusion A standardized CRS curriculum is warranted in military training programs. This NGT achieved expert consensus on the goals, objectives, educational methods, and implementation strategies for a standardized CRS curriculum in military ophthalmology residency.

The use of virtual nominal groups in healthcare research: An extended scoping review

“…A minority of studies defined consensus a priori (16%; 5/32). Four of the articles used a percentage score ranging from 50% to 75% agreement as the cut-off value [ 31 , 48 , 49 , 54 ].…”

“…Studies employed a diverse array of modalities depending on the NGT stage. In idea generation, which predominantly comprises one-way input, several studies [ 29 , 31 , 35 , 36 , 44 , 48 , 53 , 54 ] adopted asynchronous modalities such as e-surveys or emails. On the other hand, discussion and clarification phases were conducted synchronously as demonstrated in all studies in our review with two also providing asynchronous additional options [ 29 , 31 ].…”

The evolution of refractive surgery training

“…In 2018, Grover et al published a national curriculum for ophthalmology residency in India derived from an All-India Ophthalmological Society workshop, and based off the International Council of Ophthalmology residency curriculum [5 ▪▪ ]. By postgraduate year 2, they recommend that residents have a strong understanding of complex corneal optics and refraction.…”

“…In 2021, Evangelista et al proposed a standard curriculum for corneal refractive surgery utilizing the nominal group technique to create a series of proposed standards, through the lens of military need [5 ▪▪ ]. Even though there was an established minimum required cases for refractive surgery, LASIK and PRK were deemed a priority for wartime fighters to reduce spectacle dependance and improve combat readiness, with a recommendation of increasing surgical minimums of 5 to 10 PRK and 21 to 25 LASIK procedures.…”

Untitled

“…Demographic information can be found in Table 2. The largest number of studies were published in 2022 (50%; 16/32) [6, 28-42], followed by 2021 [43][44][45][46][47][48][49][50][51][52][53][54] and 2020 (13%; 4/32) [19,[55][56][57]. As seen in Table 2 geographic distribution, virtual studies were predominantly carried out at the national level (53%; 17/32), followed by intercontinental (19%; 6/32), international (16%; 5/32), and local settings (6%; 2/32).…”