Cataract Surgery Learning Curve: Data From A Series Of 69 Videos Within The First 150 Full Cataract Surgeries Of A Single Resident.

To analyze the learning curve of a single resident in every step of cataract surgery training during routine cases, using operative time as a proxy for surgical proficiency, tracking complication rates and the need for assistance from supervisors.

Cataract surgery is one of the core aspects of ophthalmological training in our environment. It is often wondered by both trainers and trainees at what point a resident is ready to perform cases autonomously, what the learning curve looks like, and what surgical steps are more difficult to learn. Through this study we aim to objectively quantify the learning curve of a single resident, tracking operative times of every maneuver during routine, non-complex cases.

We filmed cataract surgeries performed by a single resident during 6 months of training. The first video started in case number 35 when the resident could complete a full cataract surgery without a supervisor having to step in. For homogeneity, only routine, non-complex cases were included in the analysis. We quantified the operative time of every step (13 distinct phases of the surgery), as well as the time spent without instruments inside the eye or doing additional maneuvers. We also tracked complication rates and assistance from supervisors to obtain a full picture of the learning curve.

We included 69 videos, between case number 35 and 115 of a single resident. The mean total time of surgery was 20.05 minutes, and the median was 19.68 minutes (IQR 16.14 – 22.48). The minimum was 12.73 and the maximum was 48.93 minutes. The total time of surgery had a significative downward trend (p<0.01), as well as 9 other operative phases. Both the total time and phacoemulsification phase had a significant stabilization of the learning curve around case number 50, and the rest of the maneuvers that had a significant change stabilized between cases 65 and 85. Only one complication was recorded, in case number 69, during the capsulorhexis. In five cases a supervisor had to step in to complete a step of the surgery.

This analysis quantifies the learning curve in cataract surgery of a single resident, considering the complication rate and the need for supervisor assistance. Its results, consistent with what other studies have previously shown, indicate that it is between cataracts 65 and 85 that the learning curve of most maneuvers starts to stabilize, allowing the trainee to start doing routine cases independently.