Standardizing cataract surgery rating between resident and attending ophthalmologists: An educational intervention

Abstract

Purpose: Proficiency in cataract surgery is an important goal for ophthalmology residents. We performed a collaborative multi-institution study adapting the assessment rubric from the International Committee on Ophthalmology Surgical Competency. We selected 5 of the 14 steps of the rubric to focus the grading process in this initial phase of the study: 1) commencement of the capsulorrhexis flap; 2) formation of the capsulorrhexis and circular completion; 3) hydrodissection; 4) irrigation and aspiration; and 5) lens insertion. The goal of this study was to create a standardized database of short video clips demonstrating varying surgical skill levels and use them to train resident and attending ophthalmologists to become expert graders of surgical skill.

Methods: The authors collected video clips from Loyola University Medical Center, University of Illinois at Chicago, Northwestern University, and John H. Stroger, Jr. Hospital of Cook County. Through consensus among the authors, clips were chosen for a reference database clearly demonstrating 4 different skill levels ranging from novice, beginner, advanced beginner, to competent. Nine PGY-3 and eight PGY-4 ophthalmology residents, as well as five attending ophthalmologists from the 4 participating residency programs volunteered to take part in the study. The volunteers attended training sessions where the standardized video clips were viewed and discussed. The volunteers then took a rater competency test to assess their ability to rate the surgical skill level in different surgical video clips using the rubric. All volunteers completed four pre-training and four post-training online video assessments.

Results: Study volunteers from 4 Chicago ophthalmology residency programs completed training to become “expert raters” by applying the grading rubric to surgical video clips and reaching the same consensus as the authors. The volunteers' responses in rating cataract surgery video clips were highly dispersed before the training session and became more homogeneous after the educational intervention.

Conclusions: This study suggests that learning to assess cataract surgery skill level through a structured program improves residents' ability to recognize safe and effective surgical technique. This educational intervention serves a foundation for improving resident surgical training.

Keywords: 445 cataract