Abstract
Abstract: :
Purpose: To identify the factors associated with a supervising physician’s assuming formal control of an ophthalmology resident cataract extraction case and performing one or more intra–operative steps. Methods: 204 patients underwent a total of 246 cataract extraction procedures from June 2003 through July 2004 at the Massachusetts Eye and Ear Infirmary’s Comprehensive Ophthalmology Service. 9 PGY4 surgeons operated with 2 attending physicians. An Objective Assessment of Skills in Intraocular Surgery (OASIS) evaluation form was completed for each procedure. Univariate analysis was performed to examine the relationship between study factors and attending physician assistance. All explanatory variables significant with a P value ≤ 0.1 were then included in a multiple logistic regression model to determine the independence of effects. Results: Residents were more likely to receive assistance with irrigation/aspiration (19.9%, 95% CI = 14.9% – 24.9%), intraocular lens placement (17.5%, 95% CI = 12.7% – 22.3%), or phacoemulsification (14.6%, 95% confidence interval [CI] = 10.2% – 19.1%), than capsulorrhexis (6.9%, 95% CI = 3.7% – 10.1%), and if they had help, it was typically with more than one step (on average, 2.1 steps, 95% confidence interval 1.8 – 2.3). The rate of vitreous loss was 5.7% (95% CI = 2.8% – 8.6%), and the rate of posterior capsular tear was 6.5% (95% CI = 3.1% – 9.6%). The factors shown by multiple logistic regression analysis to be independently associated with the main outcome include: resident history of receiving assistance (odds ratio [OR] = 8.633, 95% CI = 1.573 – 47.38, P = 0.013), attending physician identity (OR = 0.336, 95% CI = 0.164 – 0.688, P = 0.003), posterior capsule tear (OR = 8.987, 95% CI = 1.225 – 65.94, P = 0.031), zonular dialysis (OR = 21.95, 95% CI = 1.957 – 246.1, P = 0.012), suture placement (OR = 4.165, 95% CI = 1.329 – 13.05, P = 0.014). Conclusions: A supervising physician’s decision to intervene in a resident cataract extraction case is related to the resident’s history of receiving assistance, the physician herself, and whether an intra–operative complication occurs. Understanding the factors associated with attending physician intervention may aid in preventing intra–operative errors by residents.
Keywords: training/teaching cataract surgery • cataract • clinical (human) or epidemiologic studies: outcomes/complications