Chen Yunzi, Crothers Oonagh, Ting Darren Shu Jeng, Severn Philip, Mansoor Qasim
Ophthalmology, James Cook University Hospital, Middlesbrough, UK.
Department of Inflammation and Ageing, College of Medicine and Health, University of Birmingham, Birmingham, UK.
BMJ Open Ophthalmol. 2025 Feb 4;10(1):e001716. doi: 10.1136/bmjophth-2024-001716.
The surge in National Health Service (NHS) cataract procedures in the independent sector (IS) has reduced opportunities for cataract surgical training among ophthalmology trainees. This study aims to analyse IS cataract surgery training outcomes and explore its potential as a supplement to NHS-based training by comparing IS outcomes with NHS and National Ophthalmology Database (NOD) standards.
Two trainees (ST5 and ST3) trained in IS high volume and standard NHS lists. A comprehensive IS training programme included modular cataract training, structured feedback framework and non-technical skills development. Prospective data concerning case numbers, complexity, take-over, outcomes and complication rates were collected and compared.
In total, 161 IS and 62 NHS cases were analysed. On average, trainees did 6 cases/12 patient lists in IS versus 3 cases/6 patient lists in NHS. IS cases had similar complexity to NHS cases (43% IS vs 35% in NHS, p=0.32, adjusted p=1). Intraoperative complications (3% IS vs 5% NHS, p=0.53, adjusted p=1) and posterior capsule ruptures (1% IS vs 0% NHS, p=0.38, adjusted p=1) were similar, aligning with NOD standards. Based on cases without any ocular comorbidity, the proportion of eyes achieving a good visual outcome (≥6/12 Snellen vision) was similar between IS (100%) and NHS (96%) (p=0.12, adjusted p=1). Surgical efficiency was maintained with all lists completed within 4 hours.
A structured training programme on high-volume lists within IS setting provided two trainees with valuable exposure to diverse cataract cases while ensuring safety and efficiency, producing training outcomes comparable to the NHS and NOD standards. This is a pilot study, and a much larger multicentre study will be required before the widespread introduction of training in cataract surgery in the IS can be recommended.
国民保健服务体系（NHS）白内障手术在独立部门（IS）的激增减少了眼科住院医师白内障手术培训的机会。本研究旨在分析独立部门白内障手术培训结果，并通过将独立部门的结果与国民保健服务体系及国家眼科数据库（NOD）标准进行比较，探索其作为国民保健服务体系培训补充的潜力。
两名住院医师（ST5和ST3）在独立部门的高手术量和标准国民保健服务体系手术安排中接受培训。一个全面的独立部门培训计划包括模块化白内障培训、结构化反馈框架和非技术技能培养。收集并比较有关病例数量、复杂性、交接、结果和并发症发生率的前瞻性数据。
共分析了161例独立部门病例和62例国民保健服务体系病例。平均而言，住院医师在独立部门每12个患者手术安排中做6例手术，而在国民保健服务体系中每6个患者手术安排中做3例手术。独立部门病例的复杂性与国民保健服务体系病例相似（独立部门为43%，国民保健服务体系为35%，p = 0.32，校正p = 1）。术中并发症（独立部门为3%，国民保健服务体系为5%，p = 0.53，校正p = 1）和后囊破裂（独立部门为1%，国民保健服务体系为0%，p = 0.38，校正p = 1）相似，符合国家眼科数据库标准。基于无任何眼部合并症的病例，独立部门（100%）和国民保健服务体系（96%）中实现良好视力结果（≥6/12 Snellen视力）的眼睛比例相似（p = 0.12，校正p = 1）。所有手术安排均在4小时内完成，维持了手术效率。
在独立部门环境下针对高手术量手术安排的结构化培训计划，为两名住院医师提供了接触各种白内障病例的宝贵机会，同时确保了安全性和效率，产生的培训结果与国民保健服务体系及国家眼科数据库标准相当。这是一项试点研究，在建议广泛开展独立部门白内障手术培训之前，还需要进行更大规模的多中心研究。
