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A. Ratanasit, R. E. Coffee, A. K. Reddy, E. F. Baze, S. Orengo-Nania, E. R. Holz; The Effect of Wet Lab Surgical Curriculum Implementation on Resident Performance During Cataract Surgery. Invest. Ophthalmol. Vis. Sci. 2007;48(13):1045. doi: https://doi.org/.
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To investigate the benefit of including wet lab training as part of the core curriculum in ophthalmologic surgical training programs as a means of preparation for cataract surgery. In June 2004, the Department of Ophthalmology at the Baylor College of Medicine in Houston, Texas, implemented a mandatory surgical curriculum with wet lab participation as part of their program for residents to better prepare themselves for intraocular surgery designed to increase the comfort and confidence level of a beginning resident and to improve patient care outcomes during the critical surgical evolution period for a trainee. The curriculum consists of an oral examination, a video review, and wet lab training sessions.
A retrospective chart review was performed for 3477 resident phacoemulsifications between July 2002 and June 2006 at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, Texas, with surgical curriculum implemented in July 2004. The incidence of posterior capsular rupture, zonular dehiscence with vitreous loss, and retained nuclear fragments were compared between groups before and after implementation of the curriculum.
Posterior capsular tears were less frequent after the implementation of the surgical curriculum and this difference was statistically significant (p = 0.01). The rate of a dropped nucleus or lens fragment was also less after the surgical curriculum (0.73% versus 0.30%), but this difference was not statistically significant. Cases with zonular dehiscence were actually more common after the surgical curriculum (0.17% versus 0.53%), but this difference was not statistically significant either (p = 0.07). When these types of problems were analyzed together, the rate of any type of complication was lower after the surgical curriculum (3.7% versus 2.37%) and this difference was statistically significant (p = 0.02).
Our study demonstrates a significant decrease in the incidence of certain complications in cataract surgery performed by ophthalmology residents after implementing a mandatory wet lab-based surgical curriculum as part of the training program. The incidence of posterior capsular tears decreased markedly (2.8% to 1.5%), as did the number of cases with retained lens fragments (0.7% to 0.3%). Wet lab training, as part of intraocular surgery training, is a valuable tool for trainees to gain confidence and familiarity of basic surgical skills to reduce complication rates in our series.
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