Course ups trainee skill and patient safety

Providing intensive simulation-based cataract surgical training as an adjunct to conventional training could be an effective way of improving cataract surgery competence among trainees.

According to a randomized clinical educational-intervention trial conducted in four African countries, an intensive 5-day simulation-based cataract surgical education course successfully improved surgical competence and improved patient safety, reported William H. Dean, PhD, Med, International Centre for Eye Health, Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, and colleagues in JAMA Ophthalmology.

About one out of every three cases of blindness worldwide is caused by cataracts. Surgery remains the only effective treatment for cataracts with an estimated 14 million cataract surgeries performed annually. Dean and colleagues pointed out that while cataract surgery usually restores vision and is safe and cost-effective, in many areas of the world, the rate of cataract surgery is insufficient to address the problem of blindness caused by cataracts.

One particular concern is the lack of ophthalmic care available in developing countries — particularly sub-Saharan Africa. According to this study, there are just 2.5 ophthalmologists per 1 million persons in that part of the world compared to a global estimate of 31.7 per 1 million population, and many ophthalmologists do not perform cataract surgery. Thus, Dean and colleagues suggested, “[t]here is an urgent need to train and equip more ophthalmic surgeons to address the burden of surgically treatable blindness.”

Here, the authors designed and conducted the Ophthalmic Learning and Improvement Initiative in Cataract Surgery (OLIMPICS) Trial, the aim of which was to assess whether adding intensive surgical training to conventional training improved those skills among trainees, and how that intensive training affects surgery output and outcomes.

The trial included 50 trainees, half of whom were randomized to undergo a 5-day simulation-based cataract surgical training course in addition to standard surgical training (intervention group), while the other half underwent standard training only (control). The main outcome was surgical competency at 3 months, while secondary outcomes included surgical competence at 1 year, as well as surgical output and outcomes performed during that 1-year period.

Based on a 40-point competency assessment rubric score, trainees in the intervention group had scores 16.6 points higher at 3 months than the trainees in the control group.

As for the secondary outcomes, the intervention group trainees performed a mean of 21.5 surgeries in the year after training compared to a mean of 8.5 among the trainees in the control group. The proportion of good outcomes (based on patient postoperative visual acuity) was 36.8% in the intervention group compared to 25.6% in the control group, while the proportion of poor outcomes was 10.1% and 12.8%, respectively.

In addition, posterior capsule rupture (PCR) rates, which are an important complication of cataract surgery, were 7.8% for the intervention group and 26.6% for the control group. This represents “a dramatic 70.7% reduction in surgical complication rates in the cases performed as primary surgeon in the first year of conventional training,” wrote Dean and colleagues, and has implications for patient safety that are “ethically imperative.”

“The implications for real-world training programs are compelling,” the authors wrote. “Trainee eye surgeons should be afforded the opportunity to participate in focused, intense simulation training courses.”

In a commentary accompanying the study, Shahzad I. Mian, MD, W. K. Kellogg Eye Center, University of Michigan, Ann Arbor, noted that in the United States teaching and assessing resident surgical performance in ophthalmology is challenging and involves a steep learning curve.

“Efforts to reduce the learning curve, including with simulation, can reduce challenges with surgical training and improve clinical outcomes,” Mian wrote. “However, simulation and preclinical course work must be incorporated into curriculum design, which needs to also include competency-based requirements to allow for early identification of deficiencies in skill development and focus on lifelong learning.” Mian added that simulation training needs to be offered in the context of the overall surgical curriculum and should be complemented with active mentorship.

“The lessons of the OLIMPICS Trial are applicable to all surgical curriculum planning with supplementation of traditional training with simulation-based courses to provide safe, effective, and efficient care for patients globally,” Mian concluded.

  1. Intensive simulation-based surgical education helped ophthalmologists in training improve their competence in performing cataract surgery.

  2. Outcomes and patient safety were also improved with the intensive simulation training.

Michael Bassett, Contributing Writer, BreakingMED™

None of the authors quoted disclosed any relevant relationships.

Cat ID: 240

Topic ID: 92,240,282,494,192,255,925,240,460,160