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Richard Sidney Dykstra, Shannath L Merbs, Beatriz E Munoz, Emily W Gower; Evaluating the Utility of Postoperative Photos as Educational Tools in Trichiasis Surgery Training. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):137.
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© ARVO (1962-2015); The Authors (2016-present)
In trachomatous trichiasis (TT) surgery, poor surgical quality contributes significantly to high postoperative TT rates. We examined 1) the accuracy of experts in evaluating a standard set of immediate post-op photos and 2) the expert trainers’ perceived benefits of such photos for improving training.
We compiled a series of post-op photos with an equal distribution of each outcome of interest: good quality, over-rotation, under-rotation, and eyelid contour abnormality (ECA). We assigned each photo a gold-standard grade, based on our team consensus. We asked a group of TT surgery experts, including ophthalmologists and ophthalmic nurses to participate. First, we showed a series of immediate post-op photos to discuss common surgical mistakes and long-term consequences. Next, the participants evaluated 122 immediate post-op photos and recorded the most apparent surgical mistake (none, over-rotation, under-rotation, or ECA). We compared participant responses to our gold standard answers. Participants completed a questionnaire regarding their opinions on the feasibility and potential benefit of these photos as educational tools.
19 participants evaluated the photos and completed the questionnaire. Overall, participant responses agreed with the gold standard 84% of the time. Individual participant scores ranged from 67%-98%; 15 agreed with the gold standard response on at least 80% of the photos. Participants had the least difficulty identifying eyelids with under- or over-correction (84 and 89% accuracy, respectively). However, the gold standard photos for ECA were difficult to identify; only 74% of the time did participants correctly record ECA. For these, many participants recommended having the option to mark multiple mistakes. Participants agreed that post-op photos would be beneficial for improving the classroom (94%), live-surgery (100%), and examination (94%) portions of training. They indicated that the photos would be useful for demonstrating common mistakes (100%), good surgical outcomes (89%), and long-term complications (79%).
This study showed significant promise for developing a set of training materials that can be used both in teaching and examining trichiasis surgery trainees. From these findings, we can begin to develop meaningful, internationally-standardized educational tools based on documented consensus and discussion.
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