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Danielle Lo, Michael Main, Priya Patel, Habeeb Ahmad; Impact of Video Coaching on Ophthalmology Resident Capsulorhexis Performance in Cataract Surgery. Invest. Ophthalmol. Vis. Sci. 2019;60(9):489.
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© ARVO (1962-2015); The Authors (2016-present)
Simulation-based practice has become prevalent in residency training, however much of this learning is self-directed. This study seeks to evaluate the effect of active surgical coaching on residents using virtual reality (VR) simulation, and to determine whether video coaching improves capsulorhexis performance in comparison to passive viewing of instructional videos in a surgical curriculum.
A prospective randomized trial of 12 ophthalmology residents was conducted utilizing the capsulorhexis module on the Eyesi VR surgical training simulator where baseline scores were obtained. Residents were randomized to a control group or video-based coaching intervention group with an attending surgeon. The control group watched a nonverbal instructional video demonstrating the steps of a capsulorhexis and the video was repeated for a total of 2.5 minutes. The video-based coaching group received 2.5 minutes of personalized feedback during which an attending surgeon reviewed video replay of the resident’s baseline attempt and provided coaching to improve surgical technique. Both groups then completed the same capsulorhexis module again and the objective VR simulator scores were compared.
Baseline capsulorhexis scores were notable for an average of 61 in PGY3 level residents and 73.3 in PGY4 residents. Scores improved from baseline after coaching with a mean score of 69 in the control group and 88 in the video coaching group. There was a statistically significant mean improvement of 64% in the coaching group scores compared with a 9% improvement in control scores (p=0.04). PGY3s and PGY4s in the video-based coaching cohort exhibited more robust improvement in nearly all objective measures in the capsulorhexis module post intervention as compared to controls, with the junior PGY3s showing the highest statistically significant improvement (p=0.05). Categories that yielded the largest score increases within the video coaching group were target achievement and instrument handling.
Our study is the first known video-based coaching study in ophthalmology. Coaching from an expert surgeon for as little as 2.5 minutes results in statistically significant improvements in simulated capsulorhexis performance. With low cost and improved outcomes, we recommend adoption early into surgical curriculum as junior residents showed the largest increase in skills acquisition for cataract surgery.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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