Resident Skills Assessment in Corneal Suturing: A Comprehensive Review of Currently Proposed Educational Programs and Evaluation Tools

Abstract

Purpose This study aimed to perform a comprehensive review of publications proposing educational programs for resident skills assessment in corneal suturing. Methods An extensive online article search in PubMed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PISMA) reporting guidelines was performed to identify prospective comparative studies or prospective before/after studies published up to March 2021 and reporting the assessment of ophthalmology residents' skills in corneal suturing during dedicated training sessions. Results Three studies were identified for review. The first reported the efficiency of an electromagnetic tracking system placed on the surgeon's fingers coupled with a computer analysis of movements and time to identify surgeons with different backgrounds in corneal suturing. The second reported the efficiency of the reference system in assessing the improvement of corneal suturing conducted by residents after a training session, with video-based assessment for economy and confidence of movement, limiting tissue damage and precision of operative technique, reviewed by blind assessors. The third proposed an innovative remote corneal suturing training method using Zoom for direct feedback to the residents. The stitch quality was assessed for length, depth, radiality, and tension. The results were similar when compared with a group of residents without feedback. Conclusion This review underlines the rarity and disparity of available tools for corneal suturing assessment, justifying the need for more complete models to be designed. These should consider body ergonomics and stitch quality and time. Comparative studies involving novices and attendings may provide reliable evaluation of existing gaps and specific metrics to target, helping residents to approach their superiors' experience.

Multiple metrics assessment method for a reliable evaluation of corneal suturing skills

“…The Zhang score efficiently differentiated between stitch quality between groups. Current assessment tools for corneal stitches quality remain underdeveloped and sometimes fail to differentiate between experienced and non-experienced surgeons 3 , 8 . The Zhang score enables an exhaustive assessment of corneal wound closure quality by precisely rating the completion of each consecutive stitch, fluency of movements, time required, geometry of the stitches, and efficacy of the wound closure 9 .…”

“…Such programs circumvent the need for novices to begin their practice on real patients. However, actual training programs greatly diverge with regard to both the parameters and methods of assessment 2 , 3 . Careful selection of these latter is of major importance for the reproducibility and reliability of surgical skills assessments 4 .…”

“…Therefore, anticipatory training for its practice should be promoted to improve surgical outcome and reduce the risk of complications in many ophthalmic procedures 5 . Whilst few studies report dedicated training programs 3 , assessment tools for corneal suturing remain underdeveloped 6 , 7 .…”