CHU Nantes, Ophthalmology Department, Nantes University, Nantes, France.
CHU Nantes, Inserm, CIC 1413, Nantes University, Nantes, France.
BMC Med Educ. 2024 Sep 30;24(1):1078. doi: 10.1186/s12909-024-06064-z.
Training novice ophthalmology residents on the EyeSi simulator increases cataract surgery safety. However, there is no consensus regarding how much training residents should perform before their first time on patients. We evaluated the French national training program through the analysis of the learning curves of novice residents.
This prospective multicentric pedagogic study was conducted with French novice residents. Each resident completed the recommended four two-hour training sessions and performed a standardized assessment simulating standard cataract surgery before the first session (A0), at the end of the first (A1), second (A2), third (A3) and fourth (A4) sessions. For each surgical step of each attempt, the following data were collected: score, odometer, completion time, posterior capsular rupture and cumulative energy delivered (ultrasounds) during phacoemulsification. A performance threshold was set at a score of 80/100 for each surgical step, 400/500 for the overall procedure. Only descriptive statistics were employed.
Sixteen newly nominated ophthalmology residents were included. Median score progressively increased from 95 [IQR 53; 147]) at A0 to 425 [IQR 411; 451] at A4. Despite a significant progression, the "emulsification" step had the lowest A4 scores 86 [IQR 60; 94] without reduction in completion time, odometer or ultrasounds delivered. The rate of posterior capsular rupture decreased linearly from 75% at A0 to 13% at A4 during "emulsification" and from 69 to 0% during "irrigation and aspiration". At A4, only 25% [8; 53] of residents had > 80 at each step and only 75% [47; 92] had > 400/500 overall.
A training program consisting of four two-hour sessions on the EyeSi simulator over four consecutive days effectively enhances the surgical skills of novice ophthalmology residents. Undergoing more training sessions may improve scores and decrease the incidence of surgical complications, particularly at the emulsification step of cataract surgery. The learning curves presented here can reassure residents who are progressing normally and help identify those who need a further personalized training program. TRIAL REGISTRATION: ClinicalTrials registration number: NCT05722080 (first submitted 22/12/2022, first posted 10/02/2023).
在 EyeSi 模拟器上培训新手眼科住院医师可以提高白内障手术的安全性。然而，对于新手住院医师在首次接触患者之前应该进行多少培训，目前尚无共识。我们通过分析新手住院医师的学习曲线，对法国国家培训计划进行了评估。
这是一项前瞻性多中心教学研究，纳入了法国的新手住院医师。每位住院医师都完成了推荐的四个两小时培训课程，并在第一次培训课程之前（A0）、第一次培训课程结束时（A1）、第二次培训课程结束时（A2）、第三次培训课程结束时（A3）和第四次培训课程结束时（A4）进行了一项标准白内障手术模拟标准化评估。对于每个尝试的手术步骤，收集以下数据：得分、里程表、完成时间、后囊破裂和超声乳化过程中累积的能量（超声）。每个手术步骤的绩效阈值设定为 80/100，整个手术过程的绩效阈值设定为 400/500。仅采用描述性统计。
共纳入 16 名新任命的眼科住院医师。中位数评分从 A0 时的 95[IQR 53；147]逐渐增加到 A4 时的 425[IQR 411；451]。尽管取得了显著进展，但“乳化”步骤在 A4 时的得分仍最低，为 86[IQR 60；94]，完成时间、里程表或超声输出无减少。在后囊破裂方面，从 A0 时的 75%线性下降到 A4 时的 13%，在乳化阶段，从 69%下降到 0%，在冲洗和抽吸阶段。在 A4 时，只有 25%[8；53]的住院医师在每个步骤的得分均>80，只有 75%[47；92]的住院医师总得分均>400/500。
在 EyeSi 模拟器上进行为期四天、共四个两小时培训课程的培训计划可有效提高新手眼科住院医师的手术技能。进行更多的培训课程可能会提高得分并降低手术并发症的发生率，特别是在白内障手术的乳化阶段。这里呈现的学习曲线可以使正常进展的住院医师感到安心，并帮助确定需要进一步个性化培训计划的住院医师。
临床试验注册号：NCT05722080（首次提交日期：2022 年 12 月 22 日，首次公布日期：2023 年 2 月 10 日）。
