Trabeculectomy training in England: are we safe at training? Two year surgical outcomes

Abstract

The outcomes of supervised trainee trabeculectomy compare favourably with consultant cases after 2 year follow up. Trainee cases had higher complication rates than consultant cases. Bleb leaks are a common complication of trainee cases, where closer supervision may be required. There is potential for surgical simulation to help increase the success of such cases. These findings may encourage trainee participation in glaucoma surgery.

<p>Trabeculectomy Training: Review of Current Teaching Strategies</p>

“…One of the largest studies of trainee surgery from the UK analysed over three hundred cases, and found supervised trainee trabeculectomy outcomes to compare favourably with those of consultants in terms of qualified and unqualified success rates. 13 Of note, trainee outcomes were similar to those reported in large national landmark studies. 11,12 Other studies from the UK and the US reinforce the notion that acceptable supervised trainee surgical outcomes can be achieved.…”

“…5,[14][15][16][17] As would be expected, trainee groups have been reported to have significantly higher complication rates when compared with consultant cases, with bleb leaks and hypotony being the most frequent complications. 13,15 Bleb closure and suturing techniques have therefore been suggested as an area to be specifically targeted in terms of improving trainee outcomes, echoing previous suggestions from the literature that this may be a result of suturing skills being encountered less frequently in modern surgical training. 5,13,15 It is difficult to directly compare the outcomes of these studies as different definitions of success are used in conjunction with varying lengths of follow up data and trainee surgical experience.…”

“…13,15 Bleb closure and suturing techniques have therefore been suggested as an area to be specifically targeted in terms of improving trainee outcomes, echoing previous suggestions from the literature that this may be a result of suturing skills being encountered less frequently in modern surgical training. 5,13,15 It is difficult to directly compare the outcomes of these studies as different definitions of success are used in conjunction with varying lengths of follow up data and trainee surgical experience. It must also be stressed that trainees are more likely to undertake less complicated "training cases" which makes direct comparison with consultant outcomes difficult.…”

“…The trainee can revisit difficult surgical steps in a simulated setting prior to returning to a real life environment, for example conjunctival closure, which has been suggested as an area to be targeted in order to improve trainee outcomes. 13,15 This creates a "hybrid" of real life and virtual experience, which summate to a stronger learning experience. It must be noted that for this to occur, the virtual reality experience needs to be accurate enough to recreate real life surgical scenarios, which these methods certainly do.…”

Augmented trabeculectomy-outcomes of first hundred versus second hundred surgeries of a fellowship-trained glaucoma surgeon

“…The majority of the cases in fellowship as a trainee are closely supervised by senior glaucoma surgeons and hence not a true reflection of the complications we face as a new independent surgeon. Walkden et al 30 found no significant difference in success rates between consultant and supervised trainee trabeculectomy surgeries. However, trainees had higher complication rates with bleb leaks being common, an indication that closer supervision may be required.…”