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Randomised, controlled, double masked trial to investigate the effect of an online training tool on the surgical proficiency of novice cataract surgeons

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Session Details

Session Title: Training and Innovation

Session Date/Time: Tuesday 10/10/2017 | 16:30-18:00

Paper Time: 16:30

Venue: Room 4.4

First Author: : C. Yvon UK

Co Author(s): :    J. Wawrzynski   H. Naveed   G. Saleh   N. Nair           

Abstract Details


Recent technological advances have facilitated the development of many electronic educational tools to assist surgeons in training. Such tools have potential to accelerate the learning curve of novice surgeons by stimulating active learning and also to reduce the complication rate of novice surgeons by allowing them to learn from their mistakes in a simulated rather than real patient setting. However it is important that such tools are supported by robust evidence of efficacy before formal integration into surgical training programmes. In this study we investigate the efficacy of one such tool (Touch Surgery) as applied to novice cataract surgeons.


Location: Moorfields Eye Hospital surgical simulation centre, London, UK. Tool studied: Touch surgery cataract module – interactive/ animated surgical training application downloadable on smart phone. Participants: Senior medical students and junior doctors with an interest in pursuing ophthalmic specialty training. All were naïve to cataract surgery.


A randomised, controlled, double masked trial was performed to evaluate the surgical proficiency of participants after either standard reading (control group) or standard reading in addition to completion of the cataract modules on the Touch Surgery smart phone app (intervention group). All participants completed multiple choice questions (MCQ) on cataract surgery before and after exposure to the learning materials. Candidates were then assessed on performing capsulorhexis, phacoemulsification and IOL insertion in a virtual reality setting (EYESI simulator). Performances were marked by a masked observer according to the validated ICO-OSCAR surgical assessment tool.


Nine participants have completed the study. The intervention and control groups were well matched initially with a mean multiple choice question (MCQ) score of 48.8% in the intervention group and 42.0% in the control group, p=0.50. The percentage increase (value added) in MCQ score after studying the relevant learning materials was 11.3% in the intervention group and 7.0% in the control group, p=0.76. The scores obtained for simulated surgical tasks were as follows: Capsulorhexis (intervention: 18.5, control: 13.8, p=0.20), phacoemulsification (intervention: 26.5, control: 20.2, p=0.13), IOL insertion (intervention: 14.5, control: 11.0, p=0.51).


Participants exposed to the touch surgery interactive smartphone app obtained better scores for both the MCQ test (cognitive task) and for each step of simulated cataract surgery (cognitive and technical task). It is possible that the interactive learning style of the studied surgical training tool together with its graphical illustrations of surgery helped novices to better comprehend how to perform each step of the operation in more precise detail than those who read a text book only. The lack of statistical significance is likely to be related to the relatively small sample size and high variability within the groups.

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