Department of Ophthalmology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
Eye (Lond). 2009 Mar;23(3):683-7. doi: 10.1038/sj.eye.6703103. Epub 2008 Feb 1.
To assess phacoemulsification learning curve by analysing residents' surgical completion and complication rates.
This prospective study included 226 cases of phacoemulsification performed by 11 senior residents under a single supervisor during a 27-month period. Both completion and complication rates were collected to assess their surgical results. 'Short-term completion rate (STCR)', the frequency of the surgeries completed exclusively by the residents during every five consecutive cases, was used in the evaluation of the learning curve parameter.
These residents could complete phacoemulsification independently in 101 surgeries (44.7%). Intraoperative complications occurred in 62 cases (27.4%), of which 11 cases were complicated with vitreous loss (4.9%). By tracing different residents' individual STCRs, we found that the learning curve for phacoemulsification surgery to be of an exponential pattern, and the first STCR of 60% to be a good representation of the exponential point. Before the residents' first STCR of 60%, their average completion rate was only 16.7% and complication rate was as high as 39.2%. While after that point, the average completion rate accelerated to 76.4% and complication rate decreased to 14.2%.
The learning curve of phacoemulsification is of an exponential pattern and the trainees' STCR can be a useful parameter to evaluate their surgical performance.
通过分析住院医师手术完成率和并发症发生率来评估白内障超声乳化学习曲线。
本前瞻性研究纳入了在 27 个月内由 11 名高年住院医师在一位导师指导下完成的 226 例白内障超声乳化手术。收集手术完成率和并发症发生率以评估手术结果。“短期完成率（short-term completion rate，STCR）”是指每连续 5 例手术中由住院医师单独完成的手术频率，用于评估学习曲线参数。
这些住院医师可以独立完成 101 例手术（44.7%）。术中并发症发生在 62 例（27.4%），其中 11 例并发玻璃体损失（4.9%）。通过追踪不同住院医师的个体 STCR，我们发现白内障超声乳化手术的学习曲线呈指数模式，60%的首次 STCR 是指数点的一个很好的代表。在住院医师首次 STCR 达到 60%之前，其平均完成率仅为 16.7%，并发症发生率高达 39.2%。而在这一点之后，平均完成率加速至 76.4%，并发症发生率降至 14.2%。
白内障超声乳化学习曲线呈指数模式，住院医师的 STCR 可以作为评估其手术表现的有用参数。
