Abstract
Purpose: :
To determine the evolution of phaocemulsification cataract surgery skill in naive trainees training surgery in a VR simulator.
Methods: :
Altogether 10 medical students during their ophthalmology training at the undergraduate program of medicine at Karolinska Institutet and Uppsala university, Sweden, were the trainees. The PhacoVision (Melerit Medical, Sweden) phacoemulsification cataract surgery VR-simulator was used for the training. All surgeries were performed on one standard patient setting considered to be an average difficulty case. The training was performed in one day. Each trainee first passed a tutorial including a theoretical introduction to the simulator, a demonstration operation performed by the teacher with comments, initial practice by the trainee followed by one complete surgery. Then, the trainee performed 5 consecutive cycles, each cycle including one complete surgery commented by the teacher, one demonstration surgery by the teacher, commenting on how the trainee can improve the surgical technique and 3 independent trainee surgeries. During each independent surgery, the sculpting phase and the evacuation phase of the surgery were recorded separately and during each surgical phase altogether 22 surgical skill variables were recorded by downloading performance data directly from the VR-simulator. All measurements from all variables were summarized for each trainee in a performance index (PI). The average of the three consecutive measurements in one cycle was used as the cycle measurement. The evolution of surgical skill was finally estimated for each student with linear regression.
Results: :
An initial analysis of the data indicated that a first order polynomial is a good approximation for the observation interval selected. It was found that there is a significant increase of performance index, both for the sculpting and the evacuation phase, respectively. After the last cycle of training, the trainee had reached slightly above half the performance index typical for an experienced phacoemulsification surgery with experience of using the simulator.
Conclusions: :
A trainee, with good theoretical knowledge about the anatomy of the eye and on how to perform phacoemulsification surgery but no previous surgical training, improves the surgical skill linearly with the number of training sessions within one day while training with the simulator. The trainee needs more than 5x3 surgeries before the maximum potential of learning with the simulator has been achieved.
Keywords: training/teaching cataract surgery • clinical (human) or epidemiologic studies: systems/equipment/techniques • cataract