Balas Michael, Kwok Jason M, Miguel Ana, Rai Amrit, Rai Amandeep, Ahmed Iqbal Ike K, Schlenker Matthew B
From the Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada (M.B.).
Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada (J.M.K., A.R., A.R., I.I.K.A., M.B.S.); Kensington Eye Institute, Toronto, Ontario, Canada (J.M.K., A.R., A.R., I.I.K.A., M.B.S.).
Am J Ophthalmol. 2023 May;249:82-89. doi: 10.1016/j.ajo.2022.12.006. Epub 2022 Dec 26.
To track operative phases of cataract surgery over a resident's training to measure action times and frequencies as a surrogate for competency and skill progression.
An n = 1 panel study.
Cataract surgery video recordings performed by a single resident between 2021-2022 were collected. Only full-length videos of adequate quality without supervisor intervention were included. The start and end times of 19 distinct operative phases of cataract surgery were manually labeled by a trained annotator. Timeseries analysis was employed to measure the direction and magnitude of trends in the resident's surgical timing for each action across their first year of training.
The dataset comprised 100 videos spread across the resident's sixth to 760 cases. The median total time was 11.6 minutes (IQR 10.1-14.4 minutes), with overall speed increasing at a rate of 43.4 seconds for every 10 videos (95% CI 35.1, 52.7 seconds). Nine operative phases significantly decreased in time throughout training. The main incision, phacoemulsification, and hydrodissection had the greatest improvements in speed relative to their average procedural time. There was an average of 26.9 distinct operative actions (excluding idle periods) in each video (range 20-50).
This is the first study to quantitatively track operative times and frequencies across all relevant actions in cataract surgery and derive learning curves for each. Consistent with previous works, it was found that a basic level of surgical competency was achieved after performing 80 cases. In addition, results from this study indicated that the next level in skill advancement towards surgical finesse occurs after 300 cases.
在住院医师培训期间跟踪白内障手术的操作阶段，以测量动作时间和频率，作为能力和技能进展的替代指标。
一项n = 1的单组研究。
收集了一名住院医师在2021年至2022年期间进行的白内障手术视频记录。仅纳入没有上级监督干预且质量足够的完整视频。一名经过培训的注释员手动标记了白内障手术19个不同操作阶段的开始和结束时间。采用时间序列分析来测量住院医师在其第一年培训期间每项操作的手术时间趋势的方向和幅度。
数据集包括100个视频，涵盖该住院医师的第6至760例病例。总时间中位数为11.6分钟（四分位间距为10.1 - 14.4分钟），总体速度每增加10个视频加快43.4秒（95%置信区间为35.1，52.7秒）。在整个培训过程中，九个操作阶段的时间显著减少。相对于平均手术时间，主切口、超声乳化和水分离的速度提高最为显著。每个视频平均有26.9个不同的操作动作（不包括空闲时间）（范围为20 - 50）。
这是第一项定量跟踪白内障手术所有相关操作的时间和频率并得出每项操作学习曲线的研究。与先前的研究一致，发现进行80例手术后达到了基本的手术能力水平。此外，本研究结果表明，在进行300例手术后，技能提升到手术精湛水平的下一个阶段出现。
