ASSESSMENT OF THE LEARNING CURVE OF OPHTHALMOLOGY RESIDENTS BY USING ICO-OSCAR

To evaluate phocoemulsification surgery rubric results of 3 trainees for their first 20 cases.

University of Health Sciences, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey

The study was conducted on 3 second-year ophthalmology trainees of who had prior phacoemulsification simulation education and 3 months of active assistance of phaco surgery of the seniors. First 20 cases of each trainee was supervised and intervened when necessary by the senior surgeon. All the steps of the surgery was evaluated regarding the ICO-OSCAR.

The mean age of patients was 69.2+/-8.1 (51-90) years, male/female ratio was 24/36.  The patient groups who underwent by 3 trainees were similar regarding age, side, axial length, cataract roughness grade. None of them had ocular risk for cataract surgery. The overall ICO-OSCAR evaluation was similar for 3 trainees (p= 0.478; p= 0.398; p= 0.583 Mann Whitney U). However, for 2 of trainees, the second 10-cases evaluation was better (group 1,2 : p < 0.001; p < 0.001) and need for intervention was lower then the first 10-cases (group 1,2; p = 0.007; p = 0.004). The third trainee had statistically insignificant  improvement for these parameters (p = 0.063; p = 0.143). As we reviewed overall steps of the surgery, most frequent need for intervention by senior surgeon was for hydrodissection (34/60 surgeries), nucleus cracking (33/60) and IOL implantation (27/60). There were 4 posterior capsule rupture (%6) and their lenses were implanted in sulcus, and 12 (%20) corneal edema seeking hypertonic treatment addition which cleared without shekel. 

Although, personal surgeon factors may have an impact on our findings, it was apparent that meticulous supervision is mandatory at critical steps of the phacoemulsification surgery; especially for hydrodissection, nucleus cracking and IOL implantation those approximately in half of the operations, intervention by the senior surgeon was necessary. Rubric for surgery is a helpful tool to detect the facts and planning of the future trainee programmes.