Purchase this article with an account.
Mira Shiloach, Marian Macsai, Paras Shah; Capturing Resident Cataract Surgical Skills through an Electronic Medical Record. Invest. Ophthalmol. Vis. Sci. 2017;58(8):768.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Residents commonly perform cataract surgery as a part of their ophthalmological training, but it can be difficult to objectively track their surgical competence. We created a new operative note to facilitate data collection for a retrospective observational study of ophthalmology resident skills.
A new operative note was created with discrete fields and integrated into the existing Epic electronic medical record (EMR). Cataract surgeons used the note to document the specified procedures, including a section for resident-performed data points, without the need for a text narrative. The structured note included a section for documenting the resident name, class, and which parts of the surgery required attending assistance. In addition, factors that may demonstrate resident skill improvement including total phacoemulsification time, cumulative dissipate energy (CDE), average phacoemulsification power and intraoperative complications were built into data collection fields. A report was set up for automatic extraction of the data from the EMR on a monthly basis.
Data were collected from 6 residents performing 135 cataract procedures (regular or complex) with three attending surgeons. Average procedure time varied from 22.5 to 34.5 minutes, resulting in significant difference among residents (p <0.0001). Procedures requiring attending assistance ranged from 19% to 84 % per resident. CDE, Phacoemulsification time, and average phacoemulsification power were shown to trend downwards over time in four out of five residents with available data. Overall intraoperative complication rate was 8%; Posterior capsule rupture with vitreous loss was found to be the most frequent occurrence. The lowest complication rate per resident was 3% and the highest was 12.5%.
Intraoperative data was efficiently collected using the existing EMR, and allowed for useful analysis of resident progress in cataract procedures. Rate of vitreous loss in the hands of residents was 4.4%, which is comparable with previously published data. A trend toward reducing phacoemulsification use over the course of the rotation time served to emphasize the residents’ progress. Future effort will provide individual reports that specify the areas needing attending assistance during procedures.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
This PDF is available to Subscribers Only