Department of Ophthalmology, Strasbourg University Hospitals, Strasbourg, France.
GEPROMED, Education department, Strasbourg, France.
BMC Med Educ. 2024 Oct 31;24(1):1245. doi: 10.1186/s12909-024-06245-w.
Cataract surgery requires a high level of dexterity and experience to avoid serious intra- and post-operative complications. Proper surgical training and evaluation during the learning phase are crucial to promote safety in the operating room (OR). This scoping review aims to report cataract surgery training efficacy for patient safety and trainee satisfaction in the OR when using virtual reality simulators (EyeSi [Haag-Streit, Heidelberg, Germany] or HelpMeSee [HelpMeSee foundation, Jersey city, New Jersey, United States]) or supervised surgical training on actual patients programs in residents.
An online article search in the PubMed database was performed to identify studies proposing OR performance assessment after virtual-reality simulation (EyeSi or HelpMeSee) or supervised surgical training on actual patients programs. Outcome assessment was primarily based on patient safety (i.e., intra- and post- operative complications, OR performance, operating time) and secondarily based on trainee satisfaction (i.e., subjective assessment).
We reviewed 18 articles, involving 1515 participants. There were 13 using the EyeSi simulator, with 10 studies conducted in high-income countries (59%). One study used the HelpMeSee simulator and was conducted in India. The four remaining studies reported supervised surgical training on actual patients, mostly conducted in low- middle- income countries. Training programs greatly differed between studies and the level of certainty was considered low. Only four studies were randomized clinical trials. There were 17 studies (94%) proposing patient safety assessments, mainly through intraoperative complication reports (67%). Significant safety improvements were found in 80% of comparative virtual reality simulation studies. All three supervised surgery studies were observational and reported a high amount of cataract surgeries performed by trainees. However, intraoperative complication rates appeared to be higher than in virtual reality simulation studies. Trainee satisfaction was rarely assessed (17%) and did not correlate with training outcomes.
Patient safety assessment in the OR remains a major concern when evaluating the efficacy of a training program. Virtual reality simulation appears to lead to safer outcomes compared to that of supervised surgical training on actual patients alone, which encourages its use prior to performing real cases. However, actual training programs need to be more consistent, while maintaining a balance between financial, cultural, geographical, and accessibility factors.
白内障手术需要高度的灵巧性和经验，以避免严重的术中及术后并发症。在学习阶段进行适当的手术培训和评估对于促进手术室（OR）的安全性至关重要。本范围综述旨在报告使用虚拟现实模拟器（EyeSi [Haag-Streit，海德堡，德国]或 HelpMeSee [HelpMeSee 基金会，泽西城，新泽西，美国]）或在实际患者身上进行监督手术训练的白内障手术培训对患者安全和学员满意度的效果。
在 PubMed 数据库中进行在线文章检索，以确定提出在虚拟现实模拟（EyeSi 或 HelpMeSee）或在实际患者身上进行监督手术训练后进行 OR 绩效评估的研究。主要基于患者安全性（即术中及术后并发症、OR 表现、手术时间），次要基于学员满意度（即主观评估）进行结果评估。
我们回顾了 18 篇文章，涉及 1515 名参与者。其中 13 项使用 EyeSi 模拟器，其中 10 项研究在高收入国家进行（59%）。一项研究使用 HelpMeSee 模拟器，在印度进行。其余四项研究报告了在实际患者身上进行监督手术训练，这些研究主要在中低收入国家进行。研究之间的培训计划差异很大，确定性水平较低。只有四项研究是随机临床试验。有 17 项研究（94%）提出了患者安全性评估，主要通过术中并发症报告（67%）。80%的虚拟现实模拟比较研究发现安全性显著提高。所有三项监督手术研究均为观察性研究，报告了学员完成的大量白内障手术。然而，术中并发症发生率似乎高于虚拟现实模拟研究。学员满意度很少被评估（17%），且与培训结果无关。
在评估培训计划的效果时，OR 中的患者安全评估仍然是一个主要关注点。与单独在实际患者身上进行监督手术训练相比，虚拟现实模拟似乎导致更安全的结果，这鼓励在进行实际病例之前使用它。然而，实际的培训计划需要更加一致，同时在财务、文化、地理和可及性因素之间保持平衡。
