A Masterclass For Upskilling Ophthalmology Residents In Manual Small Incision Cataract Surgery: A Flipped Classroom Educational Intervention

Manual Small Incision Cataract Surgery (MSICS) is a cost-effective, high-volume cataract technique critical for addressing global cataract blindness, particularly in low- and middle-income settings. Despite its clinical importance, MSICS is underrepresented in modern ophthalmology residency programmes where phacoemulsification predominates. This study aimed to evaluate the impact of a structured simulation-based masterclass on surgical confidence, perceived importance, and willingness to incorporate MSICS into future independent surgical practice among ophthalmology residents.

A single-day MSICS masterclass was conducted at a tertiary ophthalmology training centre (Moorfields Eye Hospital, London, UK). The course comprised of pre-course online educational material (narrated tutorial videos), followed by an in-person simulation session using wet-lab simulation/instructor feedback, followed by post-course educational material for further reading.

The masterclass was delivered using a prospective flipped classroom approach to inspire active adult learning. Pre- and post-course survey design was employed. Participants completed validated questionnaires immediately before (n = 10) and after (n = 7) the simulation session. Outcomes included self-rated surgical confidence across four domains (wound construction, nucleus management, intraocular lens implantation, wound closure), perceived clinical importance of MSICS, intent to incorporate MSICS into future surgical practice, and overall educational benefit. Questionnaire responses were recorded using a five-point Likert scale (agree/disagree). Descriptive statistics were used for analysis.

All participants (n=10) had minimal prior MSICS experience (0–4 cases/year). The most frequently cited barriers to learning MSICS were lack of surgical theatre opportunity (100%), lack of surgical mentors (90%), and insufficient case indications (60%). Pre-course, 70% of participants reported no confidence in MSICS overall. Post-simulation, 100% reported at least some confidence, with 71% achieving 'quite confident' overall. All 7 post-course respondents (100%) agreed/strongly agreed that MSICS is very important for ophthalmic surgeons. All respondents gained educational benefit from the masterclass, with instructor feedback unanimously rated as the most beneficial simulation component (100% strongly agree).

MSICS represents a vital yet underutilised skill in modern ophthalmic surgery, and its integration into residency training programmes warrants greater emphasis. A structured, simulation-based MSICS masterclass demonstrated significant improvements in surgical confidence, perceived clinical relevance, and trainees' intent to incorporate the technique into independent practice. Simulation-based surgical education, augmented by a flipped classroom approach to consolidate foundational knowledge, offers a scalable, evidence-informed pathway for training the next generation of surgeons in this essential technique.