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Mlambo VC, Kirsch MJ, Masimbi O, Gasakure M, Alayande B, Lin Y. Teaching With the GlobalSurgBox: Trainer Perceptions of a Portable Surgical Simulator. JOURNAL OF SURGICAL EDUCATION 2024; 81:1331-1338. [PMID: 39153328 DOI: 10.1016/j.jsurg.2024.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 07/26/2024] [Accepted: 07/28/2024] [Indexed: 08/19/2024]
Abstract
OBJECTIVES Evaluate the utility of a low cost, portable surgical simulator (GlobalSurgBox) for surgical teaching and its ability to dismantle barriers faced by trainers when attempting to use surgical simulation. DESIGN An anonymous survey was administered to surgical trainers who were involved in leading simulation events using the GlobalSurgBox in the past 2 years. The survey was designed to understand current barriers to using simulation as a trainer, and the utility of the GlobalSurgBox in overcoming these barriers. SETTING Academic medical training centers or conferences in the United States, Rwanda and Kenya. PARTICIPANTS 10 practicing surgeons, 3 practicing physicians, 11 surgical residents, 15 medical students and 1 anesthesia resident. RESULTS The top 3 barriers for effective teaching were lack of convenient access to the simulator (50%), lack of trainer time (43%) and cost (28%). After using the GlobalSurgBox, 100% and 98% of respondents felt that it encourages more practice and offers significant advantages over current simulators in their program. About 90%, 88% and 70% of respondents believed that the GlobalSurgBox makes surgical simulation more convenient, affordable, and compatible with trainer time limitations, respectively. 83% of trainers agreed that it is a good replica of the operating room experience, and 85% practicing physicians were more likely to give autonomy to trainees after demonstrating competence on the GlobalSurgBox. CONCLUSION The GlobalSurgBox mitigates several barriers surgical educators experience when practicing surgical skills with trainees. The convenience of the GlobalSurgBox can help facilitate the development of foundational surgical skills outside of the operating room.
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Affiliation(s)
- Vongai C Mlambo
- School of Medicine, Stanford University, Stanford, California.
| | - Michael J Kirsch
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Ornella Masimbi
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
| | | | - Barnabas Alayande
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Rwanda
| | - Yihan Lin
- Department of Cardiothoracic Surgery, Stanford University, Stanford, California
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Yaïci R, Martinez-Costa Pérez R, Lefebvre F, Muñoz Negrete F, Dhubhghaill SN, Sanogo M, Aclimandos W, Asoklis R, Atilla H, Creuzot-Garcher C, Curtin D, Cvenkel B, Flanagan L, Kivelä TT, Maino A, Priglinger S, Prior Filipe H, Stopa M, Strong B, Sturmer J, Tassignon MJ, Ivekovic R, Bourcier T. Training in cataract surgery in Spain: analysis of the results of a survey of the European Board of Ophthalmology in a Spanish cohort. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2024; 99:373-382. [PMID: 38909893 DOI: 10.1016/j.oftale.2024.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 05/05/2024] [Indexed: 06/25/2024]
Abstract
INTRODUCTION A survey conducted by the European Board of Ophthalmology (EBO) revealed significant differences in the surgical training of the ophthalmology residents in Europe, including a disparity between the sexes and a variation in the experience on cataract surgery (CC) between them. This study is about the Spanish sub-cohort of the survey, and its objective is to present and analyse the peculiarities of ophthalmology training in Spain within the European context, as well as discussing ways to harmonise and improve that training throughout the EU. METHODS We analyse data of the Spanish participants in the EBO exams, defining subgroups by the Autonomous Communities existing in Spain. RESULTS 93 of 135 requested participants (68.9%) responded. A 60.2% passed the EBO exam between 2021 and 2022, being mostly women (65.59%) aged 31 years old on average. The 91.4% were right-handed, coming from 13 of the 17 Spanish autonomous communities, although mostly from the Community of Valencia, Madrid and Catalonia. Respectively, 16.1%, 3.2% and 8.7% of the respondents said they have completed 10 or more training sessions on animal eyes, synthetic eyes and through the virtual reality simulator. This training was correlated with greater self-confidence in the management of a posterior capsular tear during surgery (p .025). All respondents manifested to have already performed stages of the CC. The average number of operations reported was 181.6 with regional disparities. A significant difference is observed between the sexes against women (-28.3%, p 0.03). DISCUSSION Ophthalmologists in Spain, much more than other European countries, have greater opportunities for surgical training, with surgical procedures during the residency, that nearly triples those made by the others. Spanish women refer, like their European colleagues, to be in disadvantage in learning opportunities about cataract surgery. The Simulation Based Medical Education (SBME) allows to respond to the training deficit and complements the training on the patient. Although we demonstrate a significant correlation between the number of procedures carried out and self-confidence to operate simple cases, the SBME would be a complementary tool in self-confidence in front of a complication like capsular rupture. CONCLUSION Spain massively adopts the model named by us "surgery for all", despite the underrepresentation of women in this area, emphasising a need for cultural change that the SBME could facilitate.
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Affiliation(s)
- R Yaïci
- Servicio de Oftalmología, Hospitales Universitarios de Estrasburgo, NHC, FMTS, Universidad de Estrasburgo, Strasbourg, France.
| | - R Martinez-Costa Pérez
- Servicio de Oftalmología, Hospital Universitario y Politécnico La Fe. Facultad de Medicina, Universidad de Valencia, Valencia, Spain
| | - F Lefebvre
- Servicio de Bioestadística, Hospitales Universitarios de Estrasburgo, Hospital Civil, FMTS, Universidad de Estrasburgo, Strasbourg. France
| | - F Muñoz Negrete
- Servicio de Oftalmología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá de Henares, Facultad de Medicina, Madrid, Spain
| | - S Ní Dhubhghaill
- Departamento de Oftalmología, Universidad de Bruselas, Brussels, Belgium
| | - M Sanogo
- Servicio de Oftalmología, Hospitales Universitarios de Estrasburgo, NHC, FMTS, Universidad de Estrasburgo, Strasbourg, France
| | | | - R Asoklis
- Servicio de Oftalmología, Centro de Enfermedades Oculares, Hospital Universitario de Vilnius Santaros Klinikos, Vilnius, Lithuania
| | - H Atilla
- Departamento de Oftalmología, Universidad de Ankara Facultad de Medicina, Ankara, Turkey
| | - C Creuzot-Garcher
- Servicio de Oftalmología, CHU de Dijon, Universidad de Dijon, Dijon, France
| | - D Curtin
- Consultant Ophthalmologist, Docente Clínica, Royal College of Surgeons en Irlanda, Dublin, Ireland
| | - B Cvenkel
- Departmento de Oftalmología, Centro Médico Universitario de Ljubljana, Facultad de Medicina de la Universidad de Ljubljana, Ljubljana, Slovenia
| | | | - T T Kivelä
- Departamento de Oftalmología, Universidad de Helsinki y Hospital Universidad de Helsinki, Helsinki, Finland
| | - A Maino
- Hospital Royal Eye Manchester, Manchester, UK
| | | | - H Prior Filipe
- Servicio de Oftalmología, Hospitales Oeste de Lisboa Centro, Hospital Egas Moniz, Portugal
| | - M Stopa
- Departamento de Oftalmología, Hospital Universitario de Poznan, Universidad de Ciencias Médicas de Poznan, Poland
| | - B Strong
- Servicio de Oftalmología, CHU de Dijon, Universidad de Dijon, Dijon, France
| | - J Sturmer
- Servicio de Oftalmología, Hospital Cantonal de Winterthur, Universidad de Zurich, Switzerland
| | - M J Tassignon
- Departamento de Oftalmología, Universidad de Amberes y Hospital Universitario de Amberes, Amberes, Belgium
| | - R Ivekovic
- Departamento de Oftalmología, Centro Médico Universitario Sestre Milosrdnice, Zagreb, Croatia
| | - T Bourcier
- Servicio de Oftalmología, Hospitales Universitarios de Estrasburgo, NHC, FMTS, Universidad de Estrasburgo, Strasbourg, France
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Yilmaz R, Bakhaidar M, Alsayegh A, Abou Hamdan N, Fazlollahi AM, Tee T, Langleben I, Winkler-Schwartz A, Laroche D, Santaguida C, Del Maestro RF. Real-Time multifaceted artificial intelligence vs In-Person instruction in teaching surgical technical skills: a randomized controlled trial. Sci Rep 2024; 14:15130. [PMID: 38956112 PMCID: PMC11219907 DOI: 10.1038/s41598-024-65716-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 06/24/2024] [Indexed: 07/04/2024] Open
Abstract
Trainees develop surgical technical skills by learning from experts who provide context for successful task completion, identify potential risks, and guide correct instrument handling. This expert-guided training faces significant limitations in objectively assessing skills in real-time and tracking learning. It is unknown whether AI systems can effectively replicate nuanced real-time feedback, risk identification, and guidance in mastering surgical technical skills that expert instructors offer. This randomized controlled trial compared real-time AI feedback to in-person expert instruction. Ninety-seven medical trainees completed a 90-min simulation training with five practice tumor resections followed by a realistic brain tumor resection. They were randomly assigned into 1-real-time AI feedback, 2-in-person expert instruction, and 3-no real-time feedback. Performance was assessed using a composite-score and Objective Structured Assessment of Technical Skills rating, rated by blinded experts. Training with real-time AI feedback (n = 33) resulted in significantly better performance outcomes compared to no real-time feedback (n = 32) and in-person instruction (n = 32), .266, [95% CI .107 .425], p < .001; .332, [95% CI .173 .491], p = .005, respectively. Learning from AI resulted in similar OSATS ratings (4.30 vs 4.11, p = 1) compared to in-person training with expert instruction. Intelligent systems may refine the way operating skills are taught, providing tailored, quantifiable feedback and actionable instructions in real-time.
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Affiliation(s)
- Recai Yilmaz
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, 300 Rue Léo Pariseau, Suite 2210, Montreal, QC, H2X 4B3, Canada.
| | - Mohamad Bakhaidar
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, 300 Rue Léo Pariseau, Suite 2210, Montreal, QC, H2X 4B3, Canada
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmad Alsayegh
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, 300 Rue Léo Pariseau, Suite 2210, Montreal, QC, H2X 4B3, Canada
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Nour Abou Hamdan
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, 300 Rue Léo Pariseau, Suite 2210, Montreal, QC, H2X 4B3, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Ali M Fazlollahi
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, 300 Rue Léo Pariseau, Suite 2210, Montreal, QC, H2X 4B3, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Trisha Tee
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, 300 Rue Léo Pariseau, Suite 2210, Montreal, QC, H2X 4B3, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Ian Langleben
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, 300 Rue Léo Pariseau, Suite 2210, Montreal, QC, H2X 4B3, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Alexander Winkler-Schwartz
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, 300 Rue Léo Pariseau, Suite 2210, Montreal, QC, H2X 4B3, Canada
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Denis Laroche
- National Research Council Canada, Boucherville, QC, Canada
| | - Carlo Santaguida
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
| | - Rolando F Del Maestro
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute, McGill University, 300 Rue Léo Pariseau, Suite 2210, Montreal, QC, H2X 4B3, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, QC, Canada
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Malcolm J, Dodd A, Shaikh M, Cassels-Brown A, Buchan JC. Reducing the carbon footprint of cataract surgery: co-creating solutions with a departmental Delphi process. Eye (Lond) 2024; 38:1349-1354. [PMID: 38155328 PMCID: PMC11076634 DOI: 10.1038/s41433-023-02902-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 12/05/2023] [Accepted: 12/12/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND Climate change is arguably the greatest threat to global health of the 21st century. Although cataract surgery is a major contributor to global greenhouse gas emissions, recent literature review identified a paucity of evidence-based strategies for improving the environmental impact of cataract services. Our study aimed to assess the effectiveness of a departmental Delphi process for improving cataract services' environmental sustainability. METHODS All members of ophthalmology theatre teams in a UK teaching hospital were invited to participate in a three-stage Delphi process. Team members were surveyed for suggestions for reducing the department's environmental impact. Suggested interventions were refined during a plenary face-to-face discussion and ranked. The highest ranked interventions were combined into a mutually agreed action plan. Data on the economic and environmental cost of cataract services was collected prior to and six months after the Delphi process using the Eyefficiency mobile application. RESULTS Twenty-three interventions were suggested by a range of staff cadres. Interventions were ranked by 24 team members. The 2nd, 4th, 5th, 8th and 11th ranked interventions were combined into an "Eco-packs" project in collaboration with suppliers (Bausch + Lomb), saving 675 kg of waste and 350 kg of CO2 equivalent annually. CONCLUSIONS The Delphi process is an effective method for provoking departmental engagement with the sustainability agenda that we would encourage all ophthalmology departments to consider utilising. The baseline per case CO2 equivalent measured in our department was reproducible and could serve as a maximum benchmark to be improved upon.
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Affiliation(s)
- Jonathan Malcolm
- Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK.
| | - Amy Dodd
- Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK
| | - Mohammad Shaikh
- Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK
| | | | - John C Buchan
- Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Royal College of Ophthalmologists' National Ophthalmology Database, 18 Stephenson Way, London, NW1 2HD, UK
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Venkatesh R, Dean W. Developing the skills needed for successful manual small-incision cataract surgery. COMMUNITY EYE HEALTH 2023; 36:10-11. [PMID: 38178825 PMCID: PMC10762713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Affiliation(s)
| | - William Dean
- Assistant Clinical Professor: ICEH, LSHTM, UK. Honorary Associate Professor: University of Cape Town, South Africa
- Consultant: Speciality Director, Gloucestershire Hospitals NHS Foundation Trust, UK
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Ng DS, Yip BHK, Young AL, Yip WWK, Lam NM, Li KK, Ko ST, Chan WH, Aryasit O, Sikder S, Ferris JD, Pang CP, Tham CC. Cost-effectiveness of virtual reality and wet laboratory cataract surgery simulation. Medicine (Baltimore) 2023; 102:e35067. [PMID: 37800761 PMCID: PMC10552957 DOI: 10.1097/md.0000000000035067] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 08/14/2023] [Indexed: 10/07/2023] Open
Abstract
PURPOSE To evaluate the cost-effectiveness of phacoemulsification simulation training in virtual reality simulator and wet laboratory on operating theater performance. METHODS Residents were randomized to a combination of virtual reality and wet laboratory phacoemulsification or wet laboratory phacoemulsification. A reference control group consisted of trainees who had wet laboratory training without phacoemulsification. All trainees were assessed on operating theater performance in 3 sequential cataract patients. International Council of Ophthalmology Surgical Competency Assessment Rubric-phacoemulsification (ICO OSCAR phaco) scores by 2 masked independent graders and cost data were used to determine the incremental cost-effectiveness ratio (ICER). A decision model was constructed to indicate the most cost-effective simulation training strategy based on the willingness to pay (WTP) per ICO OSCAR phaco score gained. RESULTS Twenty-two trainees who performed phacoemulsification in 66 patients were analyzed. Trainees who had additional virtual reality simulation achieved higher mean ICO OSCAR phaco scores compared with trainees who had wet laboratory phacoemulsification and control (49.5 ± standard deviation [SD] 9.8 vs 39.0 ± 15.8 vs 32.5 ± 12.1, P < .001). Compared with the control group, ICER per ICO OSCAR phaco of wet laboratory phacoemulsification was $13,473 for capital cost and $2209 for recurring cost. Compared with wet laboratory phacoemulsification, ICER per ICO OSCAR phaco of additional virtual reality simulator training was US $23,778 for capital cost and $1879 for recurring cost. The threshold WTP values per ICO OSCAR phaco score for combined virtual reality simulator and wet laboratory phacoemulsification to be most cost-effective was $22,500 for capital cost and $1850 for recurring cost. CONCLUSIONS Combining virtual reality simulator with wet laboratory phacoemulsification training is effective for skills transfer in the operating theater. Despite of the high capital cost of virtual reality simulator, its relatively low recurring cost is more favorable toward cost-effectiveness.
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Affiliation(s)
- Danny S. Ng
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong, China
- Hong Kong Baptist Hospital, Hong Kong, China
| | - Benjamin H. K. Yip
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Alvin L. Young
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Prince of Wales Hospital, Hong Kong, China
| | - Wilson W. K. Yip
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Prince of Wales Hospital, Hong Kong, China
| | - Nai M. Lam
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong, China
| | - Kenneth K. Li
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- United Christian Hospital, Hong Kong, China
| | - Simon T. Ko
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | | | | | - Shameema Sikder
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD
| | - John D. Ferris
- Ophthalmology, Gloucestershire Hospitals, National Health Service Foundation Trust, Cheltenham, United Kingdom
| | - Chi P. Pang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Clement C. Tham
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong, China
- Prince of Wales Hospital, Hong Kong, China
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Fazlollahi AM, Yilmaz R, Winkler-Schwartz A, Mirchi N, Ledwos N, Bakhaidar M, Alsayegh A, Del Maestro RF. AI in Surgical Curriculum Design and Unintended Outcomes for Technical Competencies in Simulation Training. JAMA Netw Open 2023; 6:e2334658. [PMID: 37725373 PMCID: PMC10509729 DOI: 10.1001/jamanetworkopen.2023.34658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/06/2023] [Indexed: 09/21/2023] Open
Abstract
Importance To better elucidate the role of artificial intelligence (AI) in surgical skills training requires investigations in the potential existence of a hidden curriculum. Objective To assess the pedagogical value of AI-selected technical competencies and their extended effects in surgical simulation training. Design, Setting, and Participants This cohort study was a follow-up of a randomized clinical trial conducted at the Neurosurgical Simulation and Artificial Intelligence Learning Centre at the Montreal Neurological Institute, McGill University, Montreal, Canada. Surgical performance metrics of medical students exposed to an AI-enhanced training curriculum were compared with a control group of participants who received no feedback and with expert benchmarks. Cross-sectional data were collected from January to April 2021 from medical students and from March 2015 to May 2016 from experts. This follow-up secondary analysis was conducted from June to September 2022. Participants included medical students (undergraduate year 0-2) in the intervention cohorts and neurosurgeons to establish expertise benchmarks. Exposure Performance assessment and personalized feedback by an intelligent tutor on 4 AI-selected learning objectives during simulation training. Main Outcomes and Measures Outcomes of interest were unintended performance outcomes, measured by significant within-participant difference from baseline in 270 performance metrics in the intervention cohort that was not observed in the control cohort. Results A total of 46 medical students (median [range] age, 22 [18-27] years; 27 [59%] women) and 14 surgeons (median [range] age, 45 [35-59] years; 14 [100%] men) were included in this study, and no participant was lost to follow-up. Feedback on 4 AI-selected technical competencies was associated with additional performance change in 32 metrics over the entire procedure and 20 metrics during tumor removal that was not observed in the control group. Participants exposed to the AI-enhanced curriculum demonstrated significant improvement in safety metrics, such as reducing the rate of healthy tissue removal (mean difference, -7.05 × 10-5 [95% CI, -1.09 × 10-4 to -3.14 × 10-5] mm3 per 20 ms; P < .001) and maintaining a focused bimanual control of the operative field (mean difference in maximum instrument divergence, -4.99 [95% CI, -8.48 to -1.49] mm, P = .006) compared with the control group. However, negative unintended effects were also observed. These included a significantly lower velocity and acceleration in the dominant hand (velocity: mean difference, -0.13 [95% CI, -0.17 to -0.09] mm per 20 ms; P < .001; acceleration: mean difference, -2.25 × 10-2 [95% CI, -3.20 × 10-2 to -1.31 × 10-2] mm per 20 ms2; P < .001) and a significant reduction in the rate of tumor removal (mean difference, -4.85 × 10-5 [95% CI, -7.22 × 10-5 to -2.48 × 10-5] mm3 per 20 ms; P < .001) compared with control. These unintended outcomes diverged students' movement and efficiency performance metrics away from the expertise benchmarks. Conclusions and Relevance In this cohort study of medical students, an AI-enhanced curriculum for bimanual surgical skills resulted in unintended changes that improved performance in safety but negatively affected some efficiency metrics. Incorporating AI in course design requires ongoing assessment to maintain transparency and foster evidence-based learning objectives.
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Affiliation(s)
- Ali M. Fazlollahi
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Recai Yilmaz
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Alexander Winkler-Schwartz
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Nykan Mirchi
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Nicole Ledwos
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
| | - Mohamad Bakhaidar
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmad Alsayegh
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rolando F. Del Maestro
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
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Zhang Z, Li S, Sun L, Yan W, Huang L, Lu J, Wang Q, Li M, Zheng D, Liu Y, Ding X. Skills assessment after a grape-based microsurgical course for ophthalmology residents: randomised controlled trial. Br J Ophthalmol 2023; 107:1395-1402. [PMID: 35701080 PMCID: PMC10447371 DOI: 10.1136/bjophthalmol-2022-321135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 05/19/2022] [Indexed: 11/04/2022]
Abstract
AIMS To introduce and assess a course using grapes as training models for ophthalmology residents to acquire basic microsurgical skills. METHODS Ophthalmology residents who were novices at microsurgery were included. Participants were randomised into a 1:1 ratio to a 4-hour training programme based on fruit models (group A) or virtual reality (VR) modulator and silicone suture pads (group B), respectively. Before and after training, questionnaires were designed to measure their self-confidence with ophthalmic operations and with their coming role as surgical assistants. After training, each participant provided their interest in further studying microsurgery and was assessed for their general competence of ophthalmic microsurgery on porcine eyes. RESULTS Eighty-three participants were included, with 42 ones in group A and 41 ones in group B. After training, participants in group A performed better in the uniformities of the suture span (p<0.05), suture thickness (p<0.05) and tissue protection (p<0.05) during the corneal suturing assessment. The overall scores of corneal suturing and circular capsulorhexis in the porcine eye in group A were comparable to those in group B (p=0.26 and 0.87, respectively). Group A showed a more positive attitude to withstand the training for more than 4 hours (p<0.001), as well as a higher willingness to receive more times of the training in the future (p<0.001). CONCLUSIONS Training models based on grapes are equal to VR simulators and silicon suture pads to provide solid training tasks for ophthalmology residents to master basic microsurgical skills, and might have advantages in lower economic cost, and easy availability. TRIAL REGISTRATION NUMBER ChiCTR2000040439.
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Affiliation(s)
- Zhaotian Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Songshan Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Limei Sun
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Wenjia Yan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Li Huang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Jinglin Lu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Qiong Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Mengke Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Danying Zheng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Yizhi Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Xiaoyan Ding
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
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Cardoso SA, Suyambu J, Iqbal J, Cortes Jaimes DC, Amin A, Sikto JT, Valderrama M, Aulakh SS, Ramana V, Shaukat B, Patel T. Exploring the Role of Simulation Training in Improving Surgical Skills Among Residents: A Narrative Review. Cureus 2023; 15:e44654. [PMID: 37799263 PMCID: PMC10549779 DOI: 10.7759/cureus.44654] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 09/04/2023] [Indexed: 10/07/2023] Open
Abstract
The role of simulation in medical education is crucial to the development of surgeons' skills. Surgical simulation can be used to improve surgical skills in a secure and risk-free environment. Animal models, simulated patients, virtual reality, and mannequins are some types of surgical simulation. As a result, feedback encourages students to reflect on their strengths and weaknesses, enabling them to focus on improvement. Healthcare simulation is a strong educational instrument, and the main goal of this is to give the students an opportunity to do a practical application of what they have learned through theory. Before taking it to the patients, they will already have certain tools they have previously acquired during the practice. This makes it easier for students to identify the knowledge gaps that they must fill to improve patient outcomes. Moreover, simulation brings a wonderful opportunity for students to acquire skills, gain confidence, and experience success before working with real patients, especially when their clinical exposure is limited. The use of simulation to teach technical skills to surgical trainees has become more prevalent. The cost of setting up a simulation lab ranges from $100,000 to $300,000. There are several ways to evaluate the effectiveness of simulation-based surgical training. Repetitive surgical simulation training can improve speed and fluidity in general surgical skills in comparison to conventional training. Few previous studies compared learners who received structured simulation training to a group of trainees who did not receive any simulation training in single-center randomized control research. Significantly faster and less time-consuming skill proficiency was noticeable in simulated trainees. Despite being anxious in the operating room for the first time, simulated trainees completed the surgery on time, demonstrating the effectiveness of surgical simulation training. Traditional surgical training involves senior-surgeon supervision in the operating room. In simulation-based training, the trainees have full control over clinical scenarios and settings; however, guidance and assessment are also crucial. Simulators allow users to practice tasks under conditions resembling real-life scenarios. Simulators can be compared with traditional surgical training methods for different reasons. For example, intraoperative bleeding may occasionally show up not only visibly on the screen but also by shaking the trocars erratically. Without haptics, training on virtual simulators can cause one's pulling and pushing forces, which are frequently greater than what the tissue needs, to be distorted. A good method of simulation training is using virtual reality simulators with haptics and simulated patients. The availability of these facilities is limited, though, and a typical session might include an exercise involving stacking sugar cubes and box trainers. The degree of expertise or competency is one area that needs clarification as medical education transitions to a competency-based paradigm. The article aims to provide an overview of simulation, methods of simulation training, and the key role and importance of surgical simulation in improving skills in surgical residents.
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Affiliation(s)
- Swizel Ann Cardoso
- Major Trauma Services, University Hospital Birmingham National Health Service (NHS) Foundation Trust, Birmingham, GBR
| | - Jenisha Suyambu
- Medical Education, Jonalta School of Medicine, University of Perpetual Help System Dalta, Laspinas City, PHL
| | | | - Diana Carolina Cortes Jaimes
- Epidemiology, Universidad Autónoma de Bucaramanga, Bucaramanga, COL
- Medicine, Pontificia Universidad Javeriana, Bogotá, COL
| | - Aamir Amin
- Cardiothoracic Surgery, Guy's and St Thomas National Health Service (NHS) Foundation Trust, London, GBR
| | - Jarin Tasnim Sikto
- College of Medicine, Jahurul Islam Medical College and Hospital, Kishoreganj, BGD
| | | | | | - Venkata Ramana
- Orthopedics, All India Institute of Medical Sciences, Mangalagiri, IND
| | | | - Tirath Patel
- College of Medicine, American University of Antigua, St. John, ATG
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10
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Bankar MN, Bankar NJ, Singh BR, Bandre GR, Shelke YP. The Role of E-Content Development in Medical Teaching: How Far Have We Come? Cureus 2023; 15:e43208. [PMID: 37692742 PMCID: PMC10488137 DOI: 10.7759/cureus.43208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 08/09/2023] [Indexed: 09/12/2023] Open
Abstract
With the advancements in technology, medical educators are now able to create and deliver content to students through digital platforms. Electronic content (e-content) development has allowed educators to incorporate multimedia, animations, simulations, and interactive elements which support verbal instruction, such as improved expression and comprehension, into their teaching materials. E-content development is a relatively new field, but it is growing very rapidly. Recent findings have indicated that the e-learning sector will likely experience a huge surge in the upcoming years. The Indian government has launched various initiatives for e-content development in medical education. E-content development has great potential and can be used in various learning scenarios. While it initially gained popularity in higher education, it has since been applied to many other sectors, including healthcare. It allows educators to create highly engaging learning experiences that are accessible by all students. Challenges in e-content development include availability of the internet, creating content that is engaging and relevant to a wide range of learners, and access. Still, it is expected that the use of e-content in medical teaching will continue to increase in the future. The future of e-content development in medical teaching is likely to see continued growth and innovation as technology advances and more educators and learners recognize the benefits of online and digital resources.
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Affiliation(s)
- Maithili N Bankar
- Anatomy, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Nandkishor J Bankar
- Microbiology, Jawarhal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Brij Raj Singh
- Anatomy, Datta Meghe Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Gulshan R Bandre
- Microbiology, Jawarhal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Yogendra P Shelke
- Microbiology, Bhaktshreshtha Kamalakarpant Laxman Walawalkar Rural Medical College, Ratnagiri, IND
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Asfaw ZK, Todd R, Abasi U, Marcela Bailez M, Narvaez J, Carrasquilla A, Hernandez Centeno R, Yanowsky Reyes G, Zhang LP. Use of virtual platform for delivery of simulation-based laparoscopic training curriculum in LMICs. Surg Endosc 2023; 37:1528-1536. [PMID: 35852623 DOI: 10.1007/s00464-022-09438-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/04/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Laparoscopic surgery is rapidly expanding in low-and middle-income countries (LMICs), yet many surgeons in LMICs have limited formal training in laparoscopy. In 2017, the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) implemented Global Laparoscopic Advancement Program (GLAP), an in-person simulation-based laparoscopic training curriculum for surgeons in LMICs. In light of COVID-19, SAGES adapted GLAP to a virtual format with telesimulation. This study explores the feasibility and efficacy of virtual laparoscopic simulation training in resource-limited settings. METHODS Participants from San Jose, Costa Rica, Leon, México, and Guadalajara, México enrolled in the virtual GLAP curriculum, meeting biweekly for 2-h didactic classes and 2-h hands-on live simulation practice. Surgical residents' laparoscopic skills were evaluated using the five Fundamentals of Laparoscopic Surgery (FLS) tasks during the initial and final weeks of the program. Participants also completed pre-and post-program surveys assessing their perception of simulation-based training. RESULTS The study cohort consisted of 16 surgical attendings and 20 general surgery residents. A minimum 70% response rate was recorded across all surveys in the study. By the end of GLAP, residents completed all five tasks of the FLS exam within less time relative to their performance at the beginning of the training program (p < 0.05). Respondents (100%) reported that the program was a good use of their time and that education via telesimulation was easily reproduced. Participants indicated that the practice sessions, guidance, and feedback offered by mentors were their favorite elements of the training. CONCLUSION A virtual simulation-based curriculum can be an effective strategy for laparoscopic skills training. Participants demonstrated an improvement in laparoscopic skills, and they appreciated the mentorship and opportunity to practice laparoscopic skills. Future programs can expand on using a virtual platform as a low-cost, effective strategy for providing laparoscopic skills training to surgeons in LMICs.
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Affiliation(s)
- Zerubabbel K Asfaw
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rachel Todd
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Unwana Abasi
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maria Marcela Bailez
- Hospital de Pediatría Dr. J.P. Garrahan, Buenos Aires, Argentina.,Society of American Gastrointestinal and Endoscopic Surgeons (SAGES): Global Affairs Committee, Los Angeles, USA
| | - Jacqueline Narvaez
- Society of American Gastrointestinal and Endoscopic Surgeons (SAGES): Global Affairs Committee, Los Angeles, USA
| | | | | | | | - Linda P Zhang
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Society of American Gastrointestinal and Endoscopic Surgeons (SAGES): Global Affairs Committee, Los Angeles, USA.
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12
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Felfeli T, Weisbrod DJ, Cao J, Cao KY, El-Defrawy SR, Chiu HH. University of Toronto's redesigned ophthalmology curriculum and eye dissection lab. CANADIAN JOURNAL OF OPHTHALMOLOGY 2022; 57:394-401. [PMID: 34303638 DOI: 10.1016/j.jcjo.2021.06.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 04/16/2021] [Accepted: 06/23/2021] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To present a multifaceted approach to ophthalmology undergraduate medical education and to assess the efficacy of an eye dissection laboratory in enhancing medical student learning. DESIGN Curriculum review, validation, and student feedback evaluations. PARTICIPANTS Year 2 medical students enrolled in the University of Toronto's Doctor of Medicine Program. METHODS Student feedback evaluations were compiled from the University of Toronto undergraduate medical education student surveys before 2012-2016 and following introduction of the redesigned foundations ophthalmology curriculum at the University of Toronto (2017-2018). Students who participated in the Eye Dissection Lab as part of the newly designed curriculum completed the pre- and postsession satisfaction and overall interest in ophthalmology questionnaires and a knowledge-based test. RESULTS Analysis of 1640 student evaluations demonstrated an increase in ophthalmology curriculum rating following the launch of the foundations ophthalmology curriculum (p = 0.015). Among the 335 students who completed the eye dissection lab, there was a significant increase in the average scores for the satisfaction questionnaire, knowledge-based test, and level of interest in the field of ophthalmology from before and after the session, with improvements in scores noted in 91%, 42%, and 36% of the educational parameters of the participants, respectively (p < 0.001). CONCLUSIONS The newly designed foundations ophthalmology curriculum and the eye dissection lab at the University of Toronto serve as effective means for enhancing ophthalmology teaching in medical schools across Canada.
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Affiliation(s)
- Tina Felfeli
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont.; Dalla Lana School of Public Health, University of Toronto, Toronto, Ont..
| | - Daniel J Weisbrod
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont.; Department of Ophthalmology, Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Jessica Cao
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont
| | - Kathy Y Cao
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont.; Department of Ophthalmology, Kensington Eye Institute, Toronto, Ont.; Department of Ophthalmology, Mount Sinai Hospital, Toronto, Ont
| | - Sherif R El-Defrawy
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont.; Department of Ophthalmology, Kensington Eye Institute, Toronto, Ont
| | - Hannah H Chiu
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ont.; William Osler Health System, Brampton, Ont.; Department of Ophthalmology, St. Michael's Hospital, Unity Health Toronto, Toronto, Ont..
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13
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Effective cataract surgical coverage in adults aged 50 years and older: estimates from population-based surveys in 55 countries. Lancet Glob Health 2022; 10:e1744-e1753. [PMID: 36240806 DOI: 10.1016/s2214-109x(22)00419-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/25/2022] [Accepted: 09/20/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Cataract is the leading cause of blindness globally. Effective cataract surgical coverage (eCSC) measures the number of people in a population who have been operated on for cataract, and had a good outcome, as a proportion of all people operated on or requiring surgery. Therefore, eCSC describes service access (ie, cataract surgical coverage, [CSC]) adjusted for quality. The 74th World Health Assembly endorsed a global target for eCSC of a 30-percentage point increase by 2030. To enable monitoring of progress towards this target, we analysed Rapid Assessment of Avoidable Blindness (RAAB) survey data to establish baseline estimates of eCSC and CSC. METHODS In this secondary analysis, we used data from 148 RAAB surveys undertaken in 55 countries (2003-21) to calculate eCSC, CSC, and the relative quality gap (% difference between eCSC and CSC). Eligible studies were any version of the RAAB survey conducted since 2000 with individual participant survey data and census population data for people aged 50 years or older in the sampling area and permission from the study's principal investigator for use of data. We compared median eCSC between WHO regions and World Bank income strata and calculated the pooled risk difference and risk ratio comparing eCSC in men and women. FINDINGS Country eCSC estimates ranged from 3·8% (95% CI 2·1-5·5) in Guinea Bissau, 2010, to 70·3% (95% CI 65·8-74·9) in Hungary, 2015, and the relative quality gap from 10·8% (CSC: 65·7%, eCSC: 58·6%) in Argentina, 2013, to 73·4% (CSC: 14·3%, eCSC: 3·8%) in Guinea Bissau, 2010. Median eCSC was highest among high-income countries (60·5% [IQR 55·6-65·4]; n=2 surveys; 2011-15) and lowest among low-income countries (14·8%; [IQR 8·3-20·7]; n=14 surveys; 2005-21). eCSC was higher in men than women (148 studies pooled risk difference 3·2% [95% CI 2·3-4·1] and pooled risk ratio of 1·20 [95% CI 1·15-1·25]). INTERPRETATION eCSC varies widely between countries, increases with greater income level, and is higher in men. In pursuit of 2030 targets, many countries, particularly in lower-resource settings, should emphasise quality improvement before increasing access to surgery. Equity must be embedded in efforts to improve access to surgery, with a focus on underserved groups. FUNDING Indigo Trust, Peek Vision, and Wellcome Trust.
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14
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Lockington D, Saleh GM, Spencer AF, Ferris J. Cost and time resourcing for ophthalmic simulation in the UK: a Royal College of Ophthalmologists' National Survey of regional Simulation Leads in 2021. Eye (Lond) 2022; 36:1973-1976. [PMID: 34616004 PMCID: PMC9499937 DOI: 10.1038/s41433-021-01796-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/16/2021] [Accepted: 09/24/2021] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Ophthalmic simulation is cost-effective in complication prevention. However, there is no consistent resource allocation to provide the necessary time and finance to sustain such activities. We wished to identify the current support for the regional Simulation Leads in the UK. METHODS An online SurveyMonkey questionnaire was sent to all 26 UK ophthalmic regional Simulation Leads in February 2021 regarding current simulation activity and the degree of time and resource support available. RESULTS There were 22 responses within 1 month (84.6% response rate). 72.7% run regular simulation induction events for new trainees. 60% run mandatory laser simulation events. 38.1% run immersive simulation (vitreous loss fire drill). 47.6% run yearly sub-specialty events. 45.5% were required to make additional work arrangements to run simulation events. 77.3% had no job plan time allocation for simulation. 59.1% dedicated >1 hr/week to simulation. 68.2% EYESI simulators were purchased via charity/endowments. 72.7% had access to dedicated dry lab simulation (40.9% wet lab). 40.9% used deanery funds to purchase initial model eyes (supplemented by charity (36.4%) and endowments (31.8%)). 65% used unspent study leave budgets for ongoing model eyes, yet 15% reported trainees purchasing their own. CONCLUSION Nearly all ophthalmic simulation in the UK is undertaken via goodwill and personal commitment to excellence by the regional Simulation Leads. There is minimal allowance of time or finance for these vital activities, which is sporadic at best, and unsustainable. We call for the necessary investment and dedicated time allocation to permit ophthalmic simulation to be supported and maintained.
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Affiliation(s)
- David Lockington
- Tennent Institute of Ophthalmology, Gartnavel General Hospital, Glasgow, UK.
| | - George M Saleh
- NIHR Biomedical Research Centre at Moorfields Eye Hospital and the UCL Institute of Ophthalmology, London, UK
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15
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Lowater SJ, Grauslund J, Vergmann AS. Modern Educational Simulation-Based Tools Among Residents of Ophthalmology: A Narrative Review. Ophthalmol Ther 2022; 11:1961-1974. [PMID: 36001249 DOI: 10.1007/s40123-022-00559-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 08/03/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION With no specific overview on simulation-based training for educational purposes among residents in ophthalmology, this narrative review attempts to highlight the current literature on modern educational simulation-based tools used to educate residents in ophthalmology. METHODS We searched databases Web of Science and PubMed between March 15 and July 21, 2022. Relevant and accessible articles and abstracts published after 2006 and in English only were included. RESULTS Simulation-based cataract surgery is associated with better outcomes in the operating room and faster surgeries. Construct validity has been established across different procedures and levels in simulation-based cataract surgery and simulation-based vitreoretinal surgery. Other simulation-based procedures indicate promising results but in general lack evidence-based validity. DISCUSSION This narrative review highlights and evaluates the current and relevant literature of modern educational simulation-based tools to train ophthalmology residents in different fundamental skills like simulation-based ophthalmoscopy and complex surgical procedures like simulation-based cataract surgery and vitreoretinal surgery. Some studies attempt to develop simulators for the use in education of ophthalmology residents. Other studies strive to establish validity of the respective procedures or modern education tools and some studies investigate the effect of simulation-based training. The most validated modern educational simulation-based tool is the Eyesi Surgical Simulator (VRmagic, Germany). However, other modern educational simulation-based tools have also been evaluated, including the HelpMeSee Eye Surgery Simulator (HelpMeSee Inc., New York, USA) and the MicroVisTouch Surgical Simulator (ImmersiveTouch, USA). CONCLUSION Simulation-based training has already been established for residents in ophthalmology to benefit the most from skill-demanding procedures resulting in better learning and better patient handling. Future studies should aim to validate more simulation-based procedures for the teaching of ophthalmology residents so that the evidence is kept at a high standard.
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Affiliation(s)
- Simon J Lowater
- Research Unit of Ophthalmology, Department of Ophthalmology, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense C, Denmark.
| | - Jakob Grauslund
- Research Unit of Ophthalmology, Department of Ophthalmology, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense C, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anna S Vergmann
- Research Unit of Ophthalmology, Department of Ophthalmology, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense C, Denmark
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Fazlollahi AM, Bakhaidar M, Alsayegh A, Yilmaz R, Winkler-Schwartz A, Mirchi N, Langleben I, Ledwos N, Sabbagh AJ, Bajunaid K, Harley JM, Del Maestro RF. Effect of Artificial Intelligence Tutoring vs Expert Instruction on Learning Simulated Surgical Skills Among Medical Students: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2149008. [PMID: 35191972 PMCID: PMC8864513 DOI: 10.1001/jamanetworkopen.2021.49008] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
IMPORTANCE To better understand the emerging role of artificial intelligence (AI) in surgical training, efficacy of AI tutoring systems, such as the Virtual Operative Assistant (VOA), must be tested and compared with conventional approaches. OBJECTIVE To determine how VOA and remote expert instruction compare in learners' skill acquisition, affective, and cognitive outcomes during surgical simulation training. DESIGN, SETTING, AND PARTICIPANTS This instructor-blinded randomized clinical trial included medical students (undergraduate years 0-2) from 4 institutions in Canada during a single simulation training at McGill Neurosurgical Simulation and Artificial Intelligence Learning Centre, Montreal, Canada. Cross-sectional data were collected from January to April 2021. Analysis was conducted based on intention-to-treat. Data were analyzed from April to June 2021. INTERVENTIONS The interventions included 5 feedback sessions, 5 minutes each, during a single 75-minute training, including 5 practice sessions followed by 1 realistic virtual reality brain tumor resection. The 3 intervention arms included 2 treatment groups, AI audiovisual metric-based feedback (VOA group) and synchronous verbal scripted debriefing and instruction from a remote expert (instructor group), and a control group that received no feedback. MAIN OUTCOMES AND MEASURES The coprimary outcomes were change in procedural performance, quantified as Expertise Score by a validated assessment algorithm (Intelligent Continuous Expertise Monitoring System [ICEMS]; range, -1.00 to 1.00) for each practice resection, and learning and retention, measured from performance in realistic resections by ICEMS and blinded Objective Structured Assessment of Technical Skills (OSATS; range 1-7). Secondary outcomes included strength of emotions before, during, and after the intervention and cognitive load after intervention, measured in self-reports. RESULTS A total of 70 medical students (41 [59%] women and 29 [41%] men; mean [SD] age, 21.8 [2.3] years) from 4 institutions were randomized, including 23 students in the VOA group, 24 students in the instructor group, and 23 students in the control group. All participants were included in the final analysis. ICEMS assessed 350 practice resections, and ICEMS and OSATS evaluated 70 realistic resections. VOA significantly improved practice Expertise Scores by 0.66 (95% CI, 0.55 to 0.77) points compared with the instructor group and by 0.65 (95% CI, 0.54 to 0.77) points compared with the control group (P < .001). Realistic Expertise Scores were significantly higher for the VOA group compared with instructor (mean difference, 0.53 [95% CI, 0.40 to 0.67] points; P < .001) and control (mean difference. 0.49 [95% CI, 0.34 to 0.61] points; P < .001) groups. Mean global OSATS ratings were not statistically significant among the VOA (4.63 [95% CI, 4.06 to 5.20] points), instructor (4.40 [95% CI, 3.88-4.91] points), and control (3.86 [95% CI, 3.44 to 4.27] points) groups. However, on the OSATS subscores, VOA significantly enhanced the mean OSATS overall subscore compared with the control group (mean difference, 1.04 [95% CI, 0.13 to 1.96] points; P = .02), whereas expert instruction significantly improved OSATS subscores for instrument handling vs control (mean difference, 1.18 [95% CI, 0.22 to 2.14]; P = .01). No significant differences in cognitive load, positive activating, and negative emotions were found. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, VOA feedback demonstrated superior performance outcome and skill transfer, with equivalent OSATS ratings and cognitive and emotional responses compared with remote expert instruction, indicating advantages for its use in simulation training. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04700384.
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Affiliation(s)
- Ali M. Fazlollahi
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Mohamad Bakhaidar
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmad Alsayegh
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Recai Yilmaz
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Alexander Winkler-Schwartz
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Nykan Mirchi
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Ian Langleben
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Nicole Ledwos
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Abdulrahman J. Sabbagh
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Clinical Skills and Simulation Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Khalid Bajunaid
- Department of Surgery, College of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Jason M. Harley
- Department of Surgery, McGill University, Montreal, Canada
- Research Institute of the McGill University Health Centre, Montreal, Canada
- Institute for Health Sciences Education, McGill University, Montreal, Canada
- Steinberg Centre for Simulation and Interactive Learning, McGill University, Montreal, Canada
| | - Rolando F. Del Maestro
- Neurosurgical Simulation and Artificial Intelligence Learning Centre, Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
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Lin JC, Yu Z, Scott IU, Greenberg PB. Virtual reality training for cataract surgery operating performance in ophthalmology trainees. Cochrane Database Syst Rev 2021; 12:CD014953. [PMID: 34931701 PMCID: PMC8689714 DOI: 10.1002/14651858.cd014953.pub2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Cataract surgery is the most common incisional surgical procedure in ophthalmology and is important in ophthalmic graduate medical education. Although most ophthalmology training programs in the United States (US) include virtual reality (VR) training for cataract surgery, comprehensive reviews that detail the impact of VR training on ophthalmology trainee performance are lacking. OBJECTIVES To assess the impact of VR training for cataract surgery on the operating performance of postgraduate ophthalmology trainees, measured by operating time, intraoperative complications, postoperative complications, supervising physician ratings, and VR simulator task ratings. SEARCH METHODS We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register), Ovid MEDLINE, Embase.com, PubMed, LILACS, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP). We did not use any date or language restrictions in the electronic search for trials. We last searched the electronic databases on 14 June 2021. SELECTION CRITERIA We included randomized controlled trials (RCTs) comparing VR training to any other method of training, including non-VR simulation training (e.g., wet laboratory training), didactics training, or no supplementary training in postgraduate ophthalmology trainees. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodology. Primary outcomes were operating times in the operating room and intraoperative complications. Secondary outcomes were operating times in simulated settings, simulator task ratings, and supervising physician ratings, either in the operating room or simulated settings. MAIN RESULTS We included six RCTs with a total of 151 postgraduate ophthalmology trainees ranging from 12 to 60 participants in each study. The included studies varied widely in terms of geography: two in the US, and one study each in China, Germany, India, and Morocco. Three studies compared VR training for phacoemulsification cataract surgery on the Eyesi simulator (VRmagic, Mannheim, Germany) with wet laboratory training and two studies compared VR training with no supplementary training. One study compared trainees who received VR training with those who received conventional training for manual small incision cataract surgery on the HelpMeSee simulator (HelpMeSee, New York, NY). Industry financially supported two studies. All studies had at least three domains judged at high or unclear risks of bias. We did not conduct a meta-analysis due to insufficient data (i.e., lack of precision measurements, or studies reported only P values). All evidence was very low-certainty, meaning that any estimates were unreliable. The evidence for the benefits of VR training for trainees was very uncertain for primary outcomes. VR-trained trainees relative to those without supplementary training had shorter operating times (mean difference [MD] -17 minutes, 95% confidence interval [CI] -21.62 to -12.38; 1 study, n = 12; very low-certainty evidence). Results for operating time were inconsistent when comparing VR and wet laboratory training: one study found that VR relative to wet laboratory training was associated with longer operating times (P = 0.038); the other reported that two training groups had similar operating times (P = 0.14). One study reported that VR-trained trainees relative to those without supplementary training had fewer intraoperative complications (P < 0.001); in another study, VR and conventionally trained trainees had similar intraoperative complication rates (MD -8.31, 95% CI -22.78 to 6.16; 1 study, n = 19; very low-certainty evidence). For secondary outcomes, VR training may have similar impact on trainee performance compared to wet laboratory and greater impact compared to no supplementary training, but the evidence was very uncertain. One study reported VR-trained trainees relative to those without supplementary training had significantly reduced operating time in simulated settings (P = 0.0013). Another study reported that VR-trained relative to wet laboratory-trained trainees had shorter operating times in VR settings (MD -1.40 minutes, 95% CI -1.96 to -0.84; 1 study, n = 60) and similar times in wet laboratory settings (MD 0.16 minutes, 95% CI -0.50 to 0.82; 1 study, n = 60). This study also found the VR-trained trainees had higher VR simulator ratings (MD 5.17, 95% CI 0.61 to 9.73; 1 study, n = 60). Results for supervising physician ratings in the operating room were inconsistent: one study reported that VR- and wet laboratory-trained trainees received similar supervising physician ratings for cataract surgery (P = 0.608); another study reported that VR-trained trainees relative to those without supplementary training were less likely to receive poor ratings by supervising physicians for capsulorhexis construction (RR 0.29, 95% CI 0.15 to 0.57). In wet laboratory settings, VR-trained trainees received similar supervising physician ratings compared with wet laboratory-trained trainees (MD -1.50, 95% CI -6.77 to 3.77; n = 60) and higher supervising physician ratings compared with trainees without supplementary training (P < 0.0001). However, the results for all secondary outcomes should be interpreted with caution because of very low-certainty evidence. AUTHORS' CONCLUSIONS: Current research suggests that VR training may be more effective than no supplementary training in improving trainee performance in the operating room and simulated settings for postgraduate ophthalmology trainees, but the evidence is uncertain. The evidence comparing VR with conventional or wet laboratory training was less consistent.
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Affiliation(s)
- John C Lin
- Program in Liberal Medical Education, Brown University, Providence, Rhode Island, USA
| | - Zane Yu
- The Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Ingrid U Scott
- Ophthalmology and Public Health Sciences, Penn State College of Medicine, State College, Hershey, Pennsylvania, USA
| | - Paul B Greenberg
- Division of Ophthalmology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Annoh R, Banks LM, Gichuhi S, Buchan J, Makupa W, Otiti J, Mukome A, Arunga S, Burton MJ, Dean WH. Experiences and Perceptions of Ophthalmic Simulation-Based Surgical Education in Sub-Saharan Africa. JOURNAL OF SURGICAL EDUCATION 2021; 78:1973-1984. [PMID: 33985925 PMCID: PMC8668871 DOI: 10.1016/j.jsurg.2021.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/19/2021] [Accepted: 04/12/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Simulation-based surgical education (SBSE) can positively impact trainee surgical competence. However, a detailed qualitative study of the role of simulation in ophthalmic surgical education has not previously been conducted. OBJECTIVE To explore the experiences of trainee ophthalmologists and ophthalmic surgeon educators' use of simulation, and the perceived challenges in surgical training. METHODS A multi-center, multi-country qualitative study was conducted between October 2017 and August 2020. Trainee ophthalmologists from six training centers in sub-Saharan Africa (SSA) (in Kenya, Uganda, Tanzania, Zimbabwe and South Africa) participated in semi-structured interviews, before and after an intense simulation training course in intraocular surgery. Semi-structured interviews were also conducted with experienced ophthalmic surgeon educators. Interviews were anonymized, recorded, transcribed and coded. An inductive, bottom-up, constant comparative method was used for thematic analysis. RESULTS Twenty-seven trainee ophthalmologists and 12 ophthalmic surgeon educators were included in the study and interviewed. The benefits and challenges of conventional surgical teaching, attributes of surgical educators, value of simulation in training and barriers to implementing ophthalmic surgical simulation were identified as major themes. Almost all trainees and trainers reported patient safety, a calm environment, the possibility of repetitive practice, and facilitation of reflective learning as beneficial aspects of ophthalmic SBSE. Perceived barriers in surgical training included a lack of surgical cases, poor supervision and limited simulation facilities. CONCLUSIONS Simulation is perceived as an important and valuable model for education amongst trainees and ophthalmic surgeon educators in SSA. Advocating for the expansion and integration of educationally robust simulation surgical skills centers may improve the delivery of ophthalmic surgical education throughout SSA.
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Affiliation(s)
- Roxanne Annoh
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Lena Morgon Banks
- International Centre for Evidence in Disability, Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - John Buchan
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Juliet Otiti
- Department of Ophthalmology, School of Medicine, Makerere University, Kampala, Uganda
| | - Agrippa Mukome
- Department of Ophthalmology, Parirenyatwa Hospitals, University of Zimbabwe, Harare
| | - Simon Arunga
- Mbarara University & Referral Hospital Eye Centre, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Matthew J Burton
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom; National Institute for Health Research Biomedical Research Centre for Ophthalmology at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, United Kingdom
| | - William H Dean
- International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom; Division of Ophthalmology, University of Cape Town, South Africa
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Gupta PC, Singh R, Khurana S, Behera RK, Thattaruthody F, Pandav SS, Ram J. Reworking protocols of ophthalmic resident surgical training in the COVID-19 era - Experiences of a tertiary care institute in northern India. Indian J Ophthalmol 2021; 69:1928-1932. [PMID: 34146058 PMCID: PMC8374778 DOI: 10.4103/ijo.ijo_566_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Purpose: Coronavirus Disease 2019 (COVID-19) pandemic has negatively impacted medical professionals in all fields of medicine and surgery in their academic, clinical and surgical training. The impact of surgical training has been described as ‘severe’ by most ophthalmology residents worldwide due to their duties in COVID-19 wards, disruption of outpatient and camp services. Methods: Ophthalmic surgery demands utmost accuracy and meticulousness. Fine motor proficiencies, stereoscopic skills and hand–eye coordination required can only be achieved by practice. So, a multileveled structured wet-lab teaching schedule was prepared for the residents and implemented to bridge this gap between theory and practice at our tertiary care institute. A semester-wise training schedule was made with the proper distribution of wet-lab and simulator training. Surgeries like phacoemulsification, scleral buckling, pars plana lensectomy and vitrectomy, trabeculectomy and intravitreal injections were practised by the residents on the goat eyes. Simulator training was provided for phacoemulsification and vitrectomy to increase the hand–eye coordination of the residents. Results: Residents noticed improvement in their surgical skills and ambidexterity post wet-lab and simulator training . It also increased their confidence and provided essential surgical skills required to be used in the operation theater later. Conclusion: It is imperative that wet-lab training be included in the residency training programme in this COVID-19 era.
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Affiliation(s)
- Parul Chawla Gupta
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ramandeep Singh
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Surbhi Khurana
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ranjan Kumar Behera
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Faisal Thattaruthody
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Surinder Singh Pandav
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jagat Ram
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Nair AG, Ahiwalay C, Bacchav AE, Sheth T, Lansingh VC, Vedula SS, Bhatt V, Reddy JC, Vadavalli PK, Praveen S, Wairagade NA, Pettey J. Effectiveness of simulation-based training for manual small incision cataract surgery among novice surgeons: a randomized controlled trial. Sci Rep 2021; 11:10945. [PMID: 34040056 PMCID: PMC8155014 DOI: 10.1038/s41598-021-90410-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 04/23/2021] [Indexed: 11/28/2022] Open
Abstract
This study was designed to determine the effect of a novel simulation-based training curriculum for scleral tunnel construction in manual small incision cataract surgery (MSICS) compared with traditional training. In this multicenter, investigator-masked, randomized clinical trial, resident surgeons within 3 months of matriculation with minimal or no prior experience with MSICS were assigned either to simulation-based training, the Experimental Group (EG), or to conventional training, the Control Group (CG). EG residents were trained to perform scleral tunnel construction using a simulation-based curriculum (HelpMeSee Eye Surgery Simulator), while residents in the CG followed institution-specific curriculum before progressing to live surgery. Surgical videos of the first 20 attempts at tunnel construction were reviewed by masked video raters. The primary outcome was the total number of any of 9 pre-specified errors. On average, the total number of errors was 9.25 (95% CI 0–18.95) in the EG and 17.56 (95% CI 6.63–28.49) in the CG (P = 0.05); the number of major errors was 4.86 (95% CI 0.13–9.59) in the EG and 10.09 (95% CI 4.76–15.41) in the CG (P = 0.02); and the number of minor errors was 4.39 (95% CI 0–9.75) in the EG and 7.47 (95% CI 1.43–13.51) in the CG (P = 0.16). These results support that novice surgeons trained using the novel simulation-based curriculum performed fewer errors in their first 20 attempts at tunnel construction compared to those trained with a conventional curriculum.
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Affiliation(s)
- Akshay Gopinathan Nair
- HelpMeSee Inc., 703 A, Supreme Business Park, Powai, Hiranandani, Mumbai, 400 076, India.
| | - Chetan Ahiwalay
- HelpMeSee Inc., 703 A, Supreme Business Park, Powai, Hiranandani, Mumbai, 400 076, India
| | - Ashish E Bacchav
- HelpMeSee Inc., 703 A, Supreme Business Park, Powai, Hiranandani, Mumbai, 400 076, India
| | - Tejas Sheth
- HelpMeSee Inc., 703 A, Supreme Business Park, Powai, Hiranandani, Mumbai, 400 076, India
| | | | - S Swaroop Vedula
- HelpMeSee Inc., 703 A, Supreme Business Park, Powai, Hiranandani, Mumbai, 400 076, India
| | - Venudhar Bhatt
- HelpMeSee Inc., 703 A, Supreme Business Park, Powai, Hiranandani, Mumbai, 400 076, India
| | | | | | | | | | - Jeff Pettey
- John A. Moran Eye Center, Salt Lake City, UT, USA
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Subudhi P, Patro S, Subudhi BNR, Sitaram S, Khan Z, Mekap C. Resident Performed Sutureless Manual Small Incision Cataract Surgery (MSICS): Outcomes. Clin Ophthalmol 2021; 15:1667-1676. [PMID: 33907380 PMCID: PMC8071211 DOI: 10.2147/opth.s290968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 04/01/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To show the surgical and visual outcomes of a resident-performed manual small incision cataract surgery. Study Type Retrospective observational case series. Study Setting Ruby Eye Hospital. Materials and Methods Manual small incision cataract surgery was performed on 339 uncomplicated cataract cases by three in-house residents. Preoperative visual acuity and vision with a pinhole were meticulously noted in the record sheets. All patients underwent thorough preoperative evaluation with the help of a slit lamp. Eyes with corneal guttae, un-dilated pupils, pseudo-exfoliation, raised intraocular pressure and posterior segment abnormalities were excluded from the study. The mean patient age was 59 years (min: 47 years and max: 85 years). Forty-seven percent were males, and the rest were females. The mean uncorrected preoperative visual acuity recorded was 1.3 logMAR units (max: 1 and min: 1.6, Std dev: 0.4). Forty-two percent of the eyes had dense nuclear cataracts (≥ Nuclear Sclerosis grade III from LOCS II). Results The mean postoperative visual acuity recorded was 0.4 logMAR units [standard deviation 0.3 logMAR units (max: 1 and min: 0.1 p-value <0.001)]. Forty-three cases (12.6%) had tunnel-related complications (premature entry/button hole). Thirty-six cases (10.6%) had iatrogenic prolapse of the iris tissue. Eight cases (2.3%) had a runaway capsulorhexis, while 18 cases (5.3%) had iatrogenic posterior capsular rupture. Two cases (0.58%) had a large zonular dialysis. Ten cases (2.9%) were retaken to the operating room again for repeat intervention. Conclusion The ophthalmic resident learning curve for manual small incision cataract surgery is steep, unlike what is reported in the literature. A good training program with a special emphasis on wound construction is of paramount importance for future residents.
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Affiliation(s)
- Praveen Subudhi
- Cataract Department, Ruby Eye Hospital, Berhampur, Ganjam, Odisha, India
| | - Sweta Patro
- Cataract Department, Ruby Eye Hospital, Berhampur, Ganjam, Odisha, India
| | - B Nageswar Rao Subudhi
- Cataract Department, Ruby Eye Hospital, Berhampur, Ganjam, Odisha, India.,Ophthalmology Department, Hitech Medical College, Bhubaneswar, India
| | - Silla Sitaram
- Cataract Department, Ruby Eye Hospital, Berhampur, Ganjam, Odisha, India
| | - Zahiruddin Khan
- Ophthalmology Department, Hitech Medical College, Bhubaneswar, India
| | - Chandan Mekap
- Cataract Department, Ruby Eye Hospital, Berhampur, Ganjam, Odisha, India
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Geary A, Wen Q, Adrianzén R, Congdon N, Janani R, Haddad D, Timbo CS, Khalifa YM. The impact of distance cataract surgical wet laboratory training on cataract surgical competency of ophthalmology residents. BMC MEDICAL EDUCATION 2021; 21:219. [PMID: 33874941 PMCID: PMC8054504 DOI: 10.1186/s12909-021-02659-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 04/05/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND This study assessed the impact of distance cataract surgical wet laboratory training on surgical competency of ophthalmology residents at a tertiary-level ophthalmic training center in Trujillo, Peru. METHODS Three five-week distance wet lab courses were administered through Cybersight, Orbis International's telemedicine platform. Weekly lectures and demonstrations addressed specific steps in phacoemulsification surgery. Each lecture had two accompanying wet lab assignments, which residents completed and recorded in their institution's wet lab and uploaded to Cybersight for grading. Competency was assessed through anonymous grading of pre- and post-training surgical simulation videos, masked as to which occurred before and after training, using a standardized competency rubric adapted from the Ophthalmology Surgical Competency Assessment Rubric (OSCAR, scale of 0-32). Day one best-corrected post-operative visual acuity (BVCA) was assessed in the operative eye on the initial consecutive 4-6 surgeries conducted by the residents as per the norms of their residency training. An anonymous post-training satisfaction survey was administered to trainees'. RESULTS In total, 21 ophthalmic residents participated in the courses, submitting a total of 210 surgical videos. Trainees' average competency score increased 6.95 points (95%CI [4.28, 9.62], SD = 5.01, p < 0.0001, two sample t-test) from 19.3 (95%CI [17.2, 21.5], SD = 4.04) to 26.3 (95%CI [24.2, 28.3], SD = 3.93). Visual acuity for 92% of post-training resident surgeries (n = 100) was ≥20/60, meeting the World Health Organization's criterion for good quality. CONCLUSIONS Structured distance wet lab courses in phacoemulsification resulted in significantly improved cataract surgical skills. This model could be applicable to locations where there are obstacles to traditional in-person training, such as the current COVID-19 pandemic.
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Affiliation(s)
- Amelia Geary
- Orbis International, 520 8th Avenue, Floor 12, New York, NY, 10018, USA.
| | - Qing Wen
- Centre for Public Health, Queen's University Belfast, Belfast, BT12 6BJ, Northern Ireland
| | - Rosa Adrianzén
- Instituto Regional de Oftalmología Javier Servat Univazo, Trujillo, La Libertad, Peru
- Universidad Nacional de Trujillo, Trujillo, La Libertad, Peru
| | - Nathan Congdon
- Orbis International, 520 8th Avenue, Floor 12, New York, NY, 10018, USA
| | - R Janani
- Aravind eye hospital, Madurai, Tamil Nadu, 625020, India
| | - Danny Haddad
- Orbis International, 520 8th Avenue, Floor 12, New York, NY, 10018, USA
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