Abstract
Purpose :
Residency administrators rely on case logs as a proxy for trainees’ surgical experience. Since MIGS are replacing traditional glaucoma surgeries, graduating ophthalmology residents should have some exposure to MIGS. However, there is no minimum MIGS requirement for residents, and little is known about the extent of resident MIGS exposure. Misleading data from inaccurate or inadequate case logs imposes a barrier to conducting education research, improving residency curricula, and determining minimum surgical volume requirements. Since MIGS is a relatively new class of procedures, we performed an analysis to explore the accuracy of resident case logging with regard to procedure volume and type.
Methods :
Electronic medical record and billing data were utilized to identify all MIGS procedures performed before June 30, 2018 by the glaucoma division at a single institution. The operative notes were examined to determine if a trainee was involved. Case logs were downloaded from the Accreditation Council for Graduate Medical Education website and compared against operative reports.
Results :
A total of 503 MIGS procedures were identified: 177 iStent, 5 XEN Gel Stent, 0 Cypass Micro-Stent, 194 goniotomy, 124 ab interno trabeculotomy, and 2 ab interno canaloplasty. Of the 503 cases, 137 did not involve a trainee, 125 involved 1 of 5 fellows, 230 involved 1 of 19 residents, and 11 involved both a resident and a fellow. Among cases involving a resident, 67/241 (27.8%) were logged. Among logged cases, 58/67 (86.6%) were logged correctly (9 primary surgeon, 49 assistant), and 9/67 (13.4%) were logged incorrectly (4 primary surgeon, 5 assistant). Regarding inaccurate logging, there was 1 goniotomy logged as iStent, 1 goniotomy logged as XEN, 1 goniotomy logged as trabeculotomy, 1 trabeculotomy logged as iStent, 3 trabeculotomies logged as goniotomies, and 2 iStents logged as tube shunts.
Conclusions :
This analysis revealed significant quantitative and qualitative deficits in resident case logging of MIGS. Due to widespread underreporting of assistant cases, case logs likely underrepresent the true extent of residents’ MIGS exposure. Due to the unfamiliarity with the array of specific MIGS procedures, residents may be logging many MIGS procedures inaccurately.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.