Identifying Key Parameters Affecting The Surgical Confidence Of Early-Career Ophthalmologists

To identify and quantify the clinical, educational, and psychological factors that influence the self-confidence of young surgeons during their learning curve in cataract surgery, and to evaluate the prevalence of the "Second Victim Syndrome."

Multi-center prospective study across 15 Moroccan and French teaching hospitals

This study followed 180 young surgeons (residents and fellows, <200 independent phacoemulsification cases) over a 12-month period. Surgical confidence was assessed monthly using the Surgical Self-Efficacy (SSE) scale and a Visual Analogue Scale (VAS). Key parameters tracked included: weekly surgical volume, cumulative case count, frequency of intraoperative complications (e.g., PCR, vitreous loss), and the quality of senior supervision (measured by the Surgical Mentorship Tool). The impact of complications was specifically analyzed through the Second Victim Experience and Support (SVEST) survey.

Analysis of the 180 participants revealed that surgical confidence does not grow linearly  but follows a "U-shaped" trajectory, with a significant "confidence crash" occurring after the first major complication. The three most critical predictors of low surgical confidence were:

Supervision Quality (p < 0.001): Non-constructive verbal feedback from seniors was the primary driver of persistent anxiety.Surgical Frequency: Surgeons performing fewer than 4 cases per week exhibited 45% higher stress levels.Second Victim Prevalence: 28% of the 180 surgeons met the criteria for "Second Victim Syndrome" following a complication.Prior high-fidelity simulation (Eyesi) was associated with a significantly faster recovery op = 0.02).

Surgical confidence in early-career ophthalmologists is highly volatile and deeply influenced by the intraoperative educational environment. With nearly one-third of trainees experiencing "Second Victim" symptoms, it is imperative for surgical programs to transition from a "blame culture" to a "safety culture." Implementing structured peer-support and "Emotional First Aid" protocols is essential to preserve the mental well-being of the next generation of surgeons and ensure long-term patient safety.