International Council of Ophthalmology-Small Incision Cataract Surgery rubric: A roadmap to evaluate cataract surgical skill acquisition during residency training

Abstract

Purpose: The International Council of Ophthalmology-Small Incision Cataract Surgery (ICO-SICS) rubric is a tool to grade SICS steps from novice to competent. The study aimed to evaluate the progress of residents’ surgical skills by using the ICO-SICS rubric and the perceptions of residents and faculties about its use. Methods: This prospective educational interventional study, done in the Ophthalmology department between September 2019 and February-2020 included 14 residents and five faculties. Faculties scored residents’ SICS by ICO-SICS-rubric (four sessions/resident) and helped them identify three steps as “area of focus” to work upon. Feedback was taken using a semi-structured pretested questionnaire. Focus group discussion was done for residents. Data were entered in MS Excel and analyzed using SPSS. Perception analysis presented as percentage of written responses. Results: Step-wise rubric score showed improvement for initial SICS steps and wound closure ( P < 0.05). Critical surgical steps and scores for three areas of focus steps showed no statistically significant improvement. Three steps as an area of focus changed partly for 11 residents and completely for three residents at the end of 6 months. Perception analysis of faculty and residents showed that the ICO-SICS rubric is a good tool to record surgical performance, identify steps needing improvement and provide structured feedback hence opined to continue it. Residents considered it as an effective learning and assessment tool. Conclusion: ICO-SICS rubric is a good teaching tool and helps to assess the progress of surgical skills. Identification of areas of poor performance and feedback given motivates them to focus on those areas leading to continuous professional development, resulting in competent surgeons performing SICS surgery independently at the end of the residency.

Evaluation of the impact of short term manual small incision cataract surgery (MSICS) training program on trainees with varying prior surgical experience using International Council of Ophthalmology- Ophthalmology Surgical Competency Assessment Rubrics (ICO-OSCAR)

“…Similar observation was made by Jariwala et al, where surgical skill acquisition for the 2nd and 3rd year residents were observed for 6 months, with periodical feedbacks and focus group surgical discussions. It was found that the 3rd year residents showed improvement by a minimum of one level for all steps and majority of them had the same level of performance, when compared to 2nd year residents who had higher change in overall scores [10].…”

“…The focus has now shifted to a more objective assessment of surgical competence along with surgical knowledge, decision making and con dence in surgery and communication skills, in addition to surgical skill assessment. International Council of ophthalmology's Ophthalmology Surgical Competency Assessment Rubrics (ICO-OSCAR) MSICS which is an internationally valid, reliable, and objective surgical competency assessment tool, was used to assess the surgical competency of the trainees in this study, in spite of other objective surgical skill assessment tools being available [10][11][12][13]. Our study is aimed at objectively evaluating each of the steps in MSICS, in groups of trainees having varying levels of microsurgical experience, during their microsurgical training program, using the ICO-OSCAR scoring system.…”

Surgical skills empowerment of ophthalmology residents in India – Are they future-ready?

“…A didactic module providing adequate background knowledge, curriculum-based wet lab exposure to develop microsurgical and tissue-handling skills, staged rubric-based supervised surgical training, regular video recording of partially supervised and unsupervised resident surgeries and posthoc discussion and analysis leading to constant improvement are believed to be the best approach for optimal training. [ 6 - 8 ]…”

Wet laboratory training in ophthalmology as a tool for formative assessment

“…[ 21 ] Thus, rubrics help to train in the right direction. [ 22 ] It is helpful to outline the teaching plan for the term and how feedback will be given so that both trainer and trainee have the same expectations. [ 14 ]…”