From the Department of Ophthalmology, Massachusetts Eye and Ear (Liebman, McKay, Moustafa, Kloek), Boston, Department of Medicine, Cambridge Health Alliance (Liebman), Cambridge, Massachusetts, Department of Ophthalmology, University of Washington (McKay), Seattle, Washington, Department of Epidemiology, Boston University (Haviland), Boston, Massachusetts, Department of Ophthalmology, Duke University Eye Center (Borkar), Durham, North Carolina, Dean McGee Eye Institute, University of Oklahoma (Kloek), Oklahoma City, Oklahoma, USA.
J Cataract Refract Surg. 2020 Nov;46(11):1495-1500. doi: 10.1097/j.jcrs.0000000000000298.
To quantify the resident learning curve for cataract surgery using operative time as an indicator of surgical competency, to identify the case threshold at which marginal additional educational benefit became equivocal, and to characterize heterogeneity in residents' pathways to surgical competency.
Academic medical center.
Large-scale retrospective consecutive case series.
All cataract surgery cases performed by resident physicians as primary surgeon at Massachusetts Eye and Ear from July 1, 2010, through June 30, 2015, were reviewed. Data were abstracted from Accreditation Council for Graduate Medical Education case logs and operative time measurements. A linear mixed-methods analysis was conducted to model changes in residents' cataract surgery operative times as a function of sequential case number, with resident identity included as a random effect in the model to normalize between-resident variability.
A total of 2096 cases were analyzed. A marked progressive decrease in operative time was noted for resident cases 1 to 39 (mean change -0.17 minutes per additional case, 95% CI, -0.21 to -0.12; P < .001). A modest, steady reduction in operative time was subsequently noted for case numbers 40 to 149 (mean change -0.05 minutes per additional case, 95% CI, -0.07 to -0.04; P < .001). No statistically significant improvement was found in operative times beyond the 150th case.
Residents derived educational benefit from performing a greater number of cataract procedures than current minimum requirements. However, cases far in excess of this threshold might have diminishing educational return in residency. Educational resources currently used for these cases might be more appropriately devoted to other training priorities.
使用手术时间作为手术能力的指标，量化白内障手术住院医师的学习曲线，确定边际额外教育收益变得不确定的病例阈值，并描述住院医师达到手术能力的途径的异质性。
学术医疗中心。
大规模回顾性连续病例系列。
回顾了 2010 年 7 月 1 日至 2015 年 6 月 30 日期间，在马萨诸塞眼耳由住院医师作为主刀医师进行的所有白内障手术病例。从研究生医学教育认证委员会病例日志和手术时间测量中提取数据。采用线性混合方法分析模型，以手术时间为因变量，作为连续病例数量的函数，将住院医师身份作为模型中的随机效应，以标准化住院医师之间的变异性。
共分析了 2096 例。在第 1 至 39 例住院医师病例中，手术时间明显逐渐下降（平均每增加 1 例手术时间减少 0.17 分钟，95%CI，0.21 至 0.12；P <.001）。随后，在第 40 至 149 例病例中，手术时间出现适度、稳定的下降（平均每增加 1 例手术时间减少 0.05 分钟，95%CI，0.07 至 0.04；P <.001）。在第 150 例病例之后，手术时间没有明显的改善。
与当前的最低要求相比，住院医师通过完成更多的白内障手术获得了教育收益。然而，远远超过这一阈值的病例可能会使住院医师的教育回报减少。目前用于这些病例的教育资源可能更适合用于其他培训重点。
