Orbis International, 520 8th Avenue, Floor 12, New York, NY, 10018, USA.
Centre for Public Health, Queen's University Belfast, Belfast, BT12 6BJ, Northern Ireland.
BMC Med Educ. 2021 Apr 19;21(1):219. doi: 10.1186/s12909-021-02659-y.
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.
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'.
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.
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.
本研究评估了远程白内障手术湿实验室培训对秘鲁特鲁希略三级眼科培训中心眼科住院医师手术能力的影响。
通过 Orbis International 的远程医疗平台 Cybersight 实施三个为期五周的远程湿实验室课程。每周的讲座和演示都针对白内障超声乳化手术的具体步骤进行。每次讲座都有两个配套的湿实验室作业，住院医师在其所在机构的湿实验室完成并记录，并上传到 Cybersight 进行评分。通过对手术模拟视频进行匿名评分来评估能力，这些视频在培训前后进行了伪装，使用了改编自眼科手术能力评估量表（OSCAR）的标准化能力量表（范围为 0-32）。根据住院医师培训的规范，在居民进行的前 4-6 例连续手术中评估手术眼的第一天最佳矫正术后视力（BVCA）。对学员进行了匿名的培训后满意度调查。
共有 21 名眼科住院医师参加了该课程，共提交了 210 个手术视频。住院医师的平均能力评分从 19.3（95%CI [17.2, 21.5]，SD=4.04）增加到 26.3（95%CI [24.2, 28.3]，SD=3.93），增加了 6.95 分（95%CI [4.28, 9.62]，SD=5.01，p<0.0001，双样本 t 检验）。在接受培训的居民手术后，有 92%（n=100）的视力≥20/60，符合世界卫生组织良好质量的标准。
白内障超声乳化术的结构化远程湿实验室课程显著提高了白内障手术技能。这种模式可能适用于存在传统现场培训障碍的地区，例如当前的 COVID-19 大流行。
