Surgical competency in residents

Current Opinion in Ophthalmology

Volumn 20, Issue 1, 2009, Pages 56-60

  Oetting, Thomas A ^a,b  

^a UNIVERSITY OF IOWA   (United States)

^b VETERANS AFFAIRS MEDICAL CENTER   (United States)

Author keywords

Ophthalmology curriculum; Ophthalmology wet laboratory; Simulation of eye surgery; Surgical competency; Training ophthalmology residents

Indexed keywords

ACCREDITATION; CATARACT EXTRACTION; CURRICULUM DEVELOPMENT; DISEASE SIMULATION; EDUCATION PROGRAM; GRADUATE STUDENT; HUMAN; HUMAN COMPUTER INTERACTION; JOB PERFORMANCE; MEDICAL EDUCATION; POSTOPERATIVE COMPLICATION; PRIORITY JOURNAL; PROFESSIONAL COMPETENCE; RESIDENCY EDUCATION; REVIEW; SURGEON; SURGICAL RISK;

CATARACT EXTRACTION; CLINICAL COMPETENCE; COMPUTER SIMULATION; CURRICULUM; EDUCATIONAL MEASUREMENT; HUMANS; INTERNSHIP AND RESIDENCY; LABORATORIES; LEARNING; OPHTHALMOLOGY;

EID: 58149213901     PISSN: 10408738     EISSN: None     Source Type: Journal    
DOI: 10.1097/ICU.0b013e328319914f     Document Type: Review

References (35)

1. ACGME Project, http://www.acgme.org/outcome/e-learn/introduction/SBP. html, accessed on October 10, 2007.
2. • Chang DF. Mastering Refractive IOLs, The Art and Science, Chapter 26 Refractive IOLs in a residency Setting - Can it work, 78-81, Slack Inc, Thorofare NJ 2008. Chapter in Dr Chang's excellent recent text that outlines an approach to using new technology IOLs in residency programs to emphasize the difficult to teach competencies such as professionalism and systems based care.
3. Lee AG, Carter KD. Managing the new mandate in residency education: a blueprint for translating a national mandate into local compliance. Ophthalmology 2004; 111:1807-1812.
4. Henderson BA, Ali R. Teaching and assessing competence in cataract surgery. Curr Opin Ophthalmol 2007; 18:27-31.
5. Binenbaum G, Voípe NJ. Ophthalmology resident surgical competency: a national survey. Ophthalmology 2006; 113:1237-1244; Epub 2006 May 24.
6. •• McDonnell PJ, Kirwan TJ, Brinton GS, et al. Perceptions of recent ophthalmology residency graduates regarding preparation for practice. Ophthalmology 2007; 114:387-391. Very important look at recent resident graduates' perception of their own competence in a variety of areas.
7. •• Randleman JB, Wolfe JD, Woodward M, et al. The resident surgeon phacoemulsification learning curve. Arch Ophthalmol 2007; 125:1215-1219. Demonstrates a clear resident learning curve in a large United States program. These data compel us to search for ways to better simulate the OR learning experience to hasten the learning curve prior to having residents start operating on live patients.
8. Randleman JB, Srivastava SK, Aaron MM. Phacoemulsification with topical anesthesia performed by resident surgeons. J Cataract Refract Surg 2004; 30:149-154.
9. •• Teus MA, de Benito-Llopis L, Sánchez-Pina JM. Learning curve of laser-assisted subepithelial keratectomy: influence on visual and refractive results. J Cataract Refract Surg 2007; 33:1381-1385. Demonstrates a learning curve with experienced surgeons trying a new procedure.
10. Bell CM, Hatch WV, Cernat G, Urbach DR. Surgeon volumes and selected patient outcomes in cataract surgery: a population-based analysis. Ophthalmology 2007; 114:405-410; Epub 2006 Dec 14.
11. •• Zaidi FH, Corbett MC, Burton BJ, Bloom PA. Raising the benchmark for the 21st century: the 1000 cataract operations audit and survey: outcomes, consultant-supervised training and sourcing NHS choice. Br J Ophthalmol 2007; 91:731-736; Epub 2006 Oct 18. Demonstrates a learning curve for cataract surgery among residents.
12. Hollander DA, Vagefi MR, Seiff SR, Stewart JM. Bacterial endophthalmitis after resident-performed cataract surgery. Am J Ophthalmol 2006; 141:949-951.
13. • Khatibi A, Naseri A, Stewart JM. Rate of rhegmatogenous retinal detachment after resident-performed cataract surgery is similar to that of experienced surgeons. Br J Ophthalmol 2008; 92:438. Despite an increased rate of vitreous loss relative to experienced surgeons the rate of RDs in this group of resident cases was comparable to experienced surgeons.
14. Bhagat N, Nissirios N, Potdevin L, et al. Complications in resident-performed phacoemulsification cataract surgery at New Jersey Medical School. Br J Ophthalmol 2007; 91:1315-1317; Epub 2007 Apr 12.
15. • Unal M, Yücel I, Altin M. Pain induced by phacoemulsification performed by residents using topical anesthesia. Ophthalmic Surg Lasers Imaging 2007; 38:386-391. Resident cases using topical anesthesia had little difference in perceived pain than experienced surgeons despite increased operative time.
16. Unal M, Yücel I, Sarici A, et al. Phacoemulsification with topical anesthesia: resident experience. J Cataract Refract Surg 2006; 32:1361-1365.
17. Dooley U, O'Brien PD. Subjective difficulty of each stage of phacoemulsification cataract surgery performed by basic surgical trainees. J Cataract Refract Surg 2006; 32:604-608.
18. •• Olali CA, Ahmed S, Gupta M. Surgical outcome following breach rhexis. Eur J Ophthalmol 2007; 17:565-570. Very interesting look at where residents fail in producing and maintaining the anterior capsule integrity.
19. Oetting TA, Lee AG, Beaver HA, et al. Teaching and assessing surgical competency in ophthalmology training programs. Ophthalmic Surg Lasers Imaging 2006; 37:384-393.
20. • Oetting TA. Preparing residents for Surgery, Cataract & Refractive Surgery Today. October 2008. Outlines the curriculum for competency based surgical training at the University of Iowa.
21. Oetting TA. Teaching the capsulorhexis technique. Cataract & Refractive Surgery Today October 2007; 7:10:46-48. Outlines the curriculum for teaching capsulorhexis at the University of Iowa.
22. Ericsson KA. Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Acad Med 2004; 79 (10 Suppl):S70-S81.
23. Nguyen TN, Silver D, Arthurs B. Consent to cataract surgery performed by residents. Can J Ophthalmol 2005; 40:34-37.
24. • Moodie JJ, Masood I, Tint N, Rubinstein M, Vemon SA. Patients' attitudes towards trainee surgeons performing cataract surgery at a teaching hospital. Eye 2007; 22:1183-1186. Brings up important professionalism and ethical issues with consent on resident cases.
25. O'Day DM. Assessing surgical competence in ophthalmology training programs. Arch Ophthalmol 2007; 125:395-396.
26. Reznik R, Regehr G, MacRae H, et al. Testing technical skill via an innovative 'Bench Station' examination. Am J Surg 1997; 180:226-230.
27. Fisher JB, Binenbaum G, Tapino P, et al. Development and face and content validity of an eye surgical skills assessment test for ophthalmology residents. Ophthalmology 2006; 113:2364-2370.
28. Cremers SL, Ciolino JB, Ferrufino-Ponce ZK, Henderson BA. Objective assessment of skills in intraocular surgery (OASIS). Ophthalmology 2005; 112:1236-1312.
29. Cremers SL, Lora AN, Ferrufino-Ponce ZK. Global Rating Assessment of Skills in Intraocular Surgery (GRASIS). Ophthalmology 2005; 112:1655-1660.
30. •• Gauba V, Tsangaris P, Tossounis C, et al. Human reliability analysis of cataract surgery. Arch Ophthalmol 2008; 126:173-177. A different approach to assessing competency using error analysis rather than subjective grading to assess resident surgeons.
31. • Saleh GM, Gauba V, Mitra A, et al. Objective structured assessment of cataract surgical skill. Arch Ophthalmol 2007; 125:363-366. An objective approach to assessing cataract surgery validated by videotape analysis.
32. McGreevy JM. The aviation paradigm and surgical education. J Am Coll Surg 2005; 201:110-117.
33. •• Lee AG, Greenlee E, Oetting TA, et al. The Iowa ophthalmology wet laboratory curriculum for teaching and assessing cataract surgical competency. Ophthalmology 2007; 114:21-26. Competency based curriculum for the wet lab including pre and post testing. Emphasizes just in time learning with regular wet laboratory sessions.
34. •• Mahr MA, Hodge DO. Construct validity of anterior segment antitrernor and forceps surgical simulator training modules: attending versus resident surgeon performance. J Cataract Refract Surg 2008; 34:980-985. Nice first step toward validating the first commercially available cataract surgical simulator.
35. Feldman BH, Ake JM, Geist CE. Virtual reality simulation. Ophthalmology 2007; 114:828.e1-828.e4.