Abstract
Purpose:
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.
Methods:
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.
Results:
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%).
Conclusions:
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.