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Virginia M. Utz, M. Julieta Zutel, B.S., Mark Gelula, Ph.D., Faruk H. Orge, M.D.; Improved Resident Self-efficacy In Performing Strabismus Surgery After Multi-media Curriculum Implementation. Invest. Ophthalmol. Vis. Sci. 2011;52(14):6351.
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For many residency training programs, the first operating experience as primary surgeon is performing strabismus muscle surgery. Many of the steps of this operation can be systematically practiced and objectively assessed via wet lab experience prior to operating on human subjects. The use of post-mortem animal and human eyes poses challenges in expense, availability, and ability to recapitulate tissue mobility and anatomy. Thus, we developed and implemented a multi-media curriculum using a synthetic eye model to improve resident self-efficacy prior to the operating room experience.
An eye model that could be facilely and inexpensively constructed by the resident prior to use in wet-lab surgery to teach relevant surgical anatomy was developed using durafoam balls, adhesive, latex material, and other common household materials. An accompanying self-directed course syllabus and DVD to teach the surgical instrumentation and steps in a rectus muscle recession was produced followed by a hands-on wet lab session. Resident self-efficacy was evaluated by questionnaire using a seven item, Likert-type scale before and after curriculum implementation.
Three PGY-2 and four PGY-3 residents participated in this pilot study, 50% of the PGY-3 residents had prior strabismus surgery experience. All participants reported increased knowledge of relevant surgical anatomy, instrumentation, and potential complications, as well as increased competence and confidence in muscle exposure, isolation, suturing, and passage of a partial thickness scleral bite (p <. 001 on each item).
The implemented curriculum consisting of an eye model construction and surgical practice increases resident self-efficacy and confidence prior to the operating room experience. Current studies are ongoing using the validated Eye Surgical Skills Assessment Test (ESSAT)  to objectively evaluate resident performance before and after intervention with this eye model and curriculum. A larger multi-site study is planned.1. Fisher, J.B., et al., Ophthalmology, 2006. 113(12): p. 2364-70.
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