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Benchmarking cataract surgery training in Spain: the perspective of final-year residents

Session Details

Session Title: Ocular pathologies and training and innovation

Session Date/Time: Monday 07/10/2013 | 08:00-10:00

Paper Time: 08:18

Venue: Emerald (First Floor)

First Author: : J.Keller SPAIN

Co Author(s): :    S. Ortiz-Pérez   X. Corretger-Ruhķ           

Abstract Details


To investigate the current standards of cataract surgery training in Spain and to determine the frequency and efficacy of resources available to trainees.


Country-wide survey of final-year Ophthalmology residents in Spain.


An anonymous internet-based questionnaire was administered to final year residents in Spain during December 2012. The main outcome measurements were the rate of posterior capsular rupture (PCR) and the number of complete operations (CO) performed to date. Variables studying the sample demographics, surgical performance, the resources available for training and the resident’s opinion of their training programme were also collected and correlated with the main outcome measurements.


Of 159 trainees there were 55 respondents (36.7%). Mean CO was 131.9 +/-106. Mean PCR rate was 5.46% +/-5.7. A negative correlation is found between CO and PCR rate (r=-0.362, p<0.01). 49 (89.1%) trainees have already completed 50 cases. 10 (18.1%) report RCP rates >10%. 40 (72.7%) keep a logbook. 42 (76.4%) report collecting visual results data and 35 (63.6%) refraction data. Mean surgeries done per hospital/trainee/year were 907.7 +/-563.4. There is positive correlation between hospital’s throughput per trainee and CO (r=0.519; p<0.01) and also between number of trainees per centre and CO (rho=-0.407; p<0.01). Training resources available: optical biometer (85.5%), dedicated cataract trainer (83.6%), wet-lab (43.4%), resident-led theatre lists (34.6%), specific training sessions (33.9%) and training curriculum (27.1%). Mean operating sessions per week were 1.65 +/-0.87. A dedicated trainer translates to mean CO 143.8 with 4.77% PCR rate versus 71.1 y 8.9% (p=0.03; p=0.04). 40 (72.7%) trainees feel confident to operate without supervision with mean CO 152.7 and (p<0.01) and a PCR rate of 4.9% (p=0.06). Trainees that rate programme highly perform 237.6 CO (p<0.01) with a PCR rate of 2.68% (p=0.06). None of the demographic variables interact with surgical performance.


We have obtained proficiency markers that may be used by trainees and trainers to assess the progress of the training process. We believe that they reflect the current state of training in Spain. The results of our analysis suggest that training opportunities are not uniformly distributed and depend on the hospital throughput and the number of peers. This is relevant in a system where trainees do not rotate through various centres during the course of their training. There seem to be a high frequency of recording surgical activity but there is a significant group of trainees that do not collect such records. We recommend that recording of surgical outcomes should also become more extended. The role of a dedicated trainer is very important both in terms of performing a higher number of operations and in attaining a lower rate of complications. Residents seem to gain greater confidence with increased experience in terms of completed surgical cases and to a lesser degree with lower complication rates.

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