Effectiveness of stepwise surgical training program in Ocular surgery

Background: Training programs are putting increasing emphasis on teaching and assessment of surgical skills. Ocular surgery having a learning curve, is better taught in parts in a stepwise manner as per the training level of the resident. Methods: A pre-post study was conducted at Mayo Hospital, including a total of 15 post- graduate residents. Step 2, 5, 12 and 13 from ICO-OSCAR:Phaco were evaluated. Pre-training scores were given by resident and supervisor for each step. Training comprised of 3 theater lists with repetition of one step in 5 cases and giving of post-training scores. Mean pre and post-training scores were calculated and paired t-test applied. (p-value <0.01 significant). Correlation was calculated between post- training scores by resident and supervisor. Results: Out of 15 resident 9 (60%) were in second year of residency and 6 (40%) were in third year. Mean pre-training scores by resident were 2.6, 2.3, 2.7, 2.1 which increased to 4.7, 3.8, 4.4 and 4.3 post-training (p-value 0.00) and mean pre-training scores by the supervisor were 2.7, 2.0, 2.4, 2.7 which increased to mean post-training scores of 4.6, 3.7, 4.3 and 3.6 (p-value 0.00) for incision, capsulorhexis, irrigation/aspiration, and lens insertion respectively. Post training scores of resident and supervisor showed positive correlation for 3 out of 4 steps; 0.289, 0.510, 0.577, -0.99, respectively for incision, capsulorhexis, irrigation/aspiration, and negative for lens insertion. Conclusion: Pre-post training score differences of both residents and supervisors were statistically significant. The step-wise surgical training program was more acceptable by residents. More ideas need to be generated and step-wise training method pruned with input from supervisors. Keywords : Ocular surgery; Ophthalmological surgical procedure; Phacoemulsification; Training techniques