Objective Structured Assessment of Cataract Surgical Skill

Abstract

Methods: An objective performance rating tool was devised. This instrument is comprised of standardized criteria with global rating and operation-specific components, each rated on a 5-point Likert scale. The total potential score was 100. Complete phacoemulsification cataract extraction operations were recorded through the operating microscope of surgeons with a range of experience (group A, Ͻ50 procedures; group B, 50-249 procedures; group C, 250-500 procedures, and group D, Ͼ500 procedures). These were then scored by independent expert reviewers masked to the grades of the surgeons. The U test was used to evaluate statistical significance. Results: We evaluated 38 surgical videotapes of 38 surgeons (group A, 11 surgeons; group B, 10 surgeons; group C, 5 surgeons; and group D, 12 surgeons). Mean±SD overall scores were as follows: group A, 32.0±5.3; group B, 55.0±12.6; group C, 89.0±4.7; and group D, 90.0±11.1. Statistically significant differences were found between groups A and B (P=.002) and groups B and C (P=.003), but not between groups C and D (PϾ.99). Conclusion: The Objective Structured Assessment of Cataract Surgical Skill scoring system seems to have construct validity with cataract surgery and, thus, may be valuable for assessing the surgical skills of junior trainees.

The development of a virtual reality training programme for ophthalmology: repeatability and reproducibility (part of the International Forum for Ophthalmic Simulation Studies)

“…It clearly demonstrates a variable pattern among the different attempts and tasks while all juniors perform roughly similarly. Previous studies in the wet lab environment 7,8 and those scoring actual cataract surgery 5 have also suggested a broader spread of scores in a novice cohort. However, the internal numerical variance and its statistical significance have not been analysed in detail before and this is relevant for the trainers, the individual trainees but also for the design of a training syllabus.…”

“…4 In ophthalmology, evidence has emerged for a wider spread of performance in the early stages of training. This has been demonstrated for a range of tasks including cataract surgery, 5 corneal suturing in a wet lab, 6 in oculoplastic surgery, 7 and in motion tracking studies both for phacoemulsification 8 and for skin suturing. 6,9 However, no specific analysis was ever undertaken with regard to the repeatability, reproducibility, or variability among novice trainees but rather these subjects were compared with more senior colleagues.…”

“…6,9 However, no specific analysis was ever undertaken with regard to the repeatability, reproducibility, or variability among novice trainees but rather these subjects were compared with more senior colleagues. 5,6,[8][9][10][11][12][13][14][15] What we therefore do not know is how an individual with minimal experience scores when undertaking the same task on several occasions (variability and reproducibility).…”

Human Reliability Analysis of Cataract Surgery

“…Having established such associations, this information can be used to guide assessment tool design, as was done when constructing the Objective Structured Assessment of Cataract Surgical Skill tool. 14 The HRA process has also aided in enhancing surgical tool design in other specialties. 12 A further application of this information would be in the process of surgical skills training, in which methods to lower the executional error rate could target steps with higher error probability, of which nucleus engagement, sculpting, and manipulation seem to be paramount among junior surgeons.…”

Identification of surgeon–individual treatment profiles to support the provision of an optimum treatment service for cataract patients

“…and (3) 'How can these SiTPs be used to derive advanced training strategies for the surgeon? ' The major focus of publications on the education and the training of cataract surgery was on the design and the evaluation of training programs for residents, such as the training of residents by a virtual mentor system [5], the training of complication management [6], the impact of the residents' curriculum design on complication rates [7] or the use of models to teach residents surgical work steps in eye surgery [8,9] .Furthermore, a number of works have focused on the objective assessment of surgical skills with advanced methods [10][11][12] or on data acquisition strategies in ophthalmology training [13,14].…”