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M. H. Grodin, B. Glaser; Ophalmic Surgical Simulation: Developments to Enhance Surgical Training. Invest. Ophthalmol. Vis. Sci. 2007;48(13):2387.
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Ophthalmic surgery training requires significant investment and involves risk; in these respects it is similar to aviation training. The aviation model, a Systems Approach to Training, was used to analyse ophthalmic surgical prodcedures. A curriculum was developed to profile performance metrics in simulated intraocular surgery.
Medical students, ophthalmology residents, retinal fellows, and attending staff from 4 major training programs in the United States were enrolled in a one day training seminar. This seminar incorporated an introduction and overview of VRMagic's EYESI simulator as well as two intensive epiretinal membrane training modules coupled with instruction based upon standard surgical textbooks or systemic task breakdown and analysis. Multiple performance metrics were recorded including % of ERM removed and incidence of retina damage.
Of the 48 participants, there were 3 medical students (6%), 29 ophthalmology residents (60%), ten retinal fellows (21%), and 6 attending staff (13%). 9 (19%) of the 48 participants reported limited experience with surgical simulation; the remaining 38 (81%) reported no experience. During the simulator-based training the % of ERM removed increased from 89.97% to 94.56%. Out of 96 total attempts by 48 participants only 1 atempt by an attending resulted in 100% removal. 90% of the retinal fellows removed between 86% ans 95% on both attempts, and residents showed the most gain from 29% removing more than 90% on the first attempt to 44% on the second. The incidence of retina damage decreased from 12 to 9 and the area of retinal damage decreased from 3.7% to 0.8% for all participants. The participants' subjective assesement of the courseware via a 5 point Likert scale survey strongly indicates that task analysis is superior to current methods of instruction in two ways. First, it results in a superior mental model for the surgical procedure (statement 1), and second it results in a better understanding of risks associated (statement 4).
The emergence of a virtual reality simulator for intraocular surgery, the EYESI allows repetition of procedures in a virtual environment with objective performance metrics. Acurriculum based on systemic task breakdown and analysis leverages this capability to enable surgical skill performance gains. Further studies to validate the use of surgical simulation in ophthalmic training are warrented and underway.
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