How Many Surgeries Equal Surgical Proficiency?

There is no real, absolute, and universally accepted number of surgeries to perform that grants surgical proficiency while in ophthalmology training—but practice with wet labs, dry labs, and even new technologies such as simulators or having structured curricula is really useful, according to Bonnie An Henderson MD.

Some countries, like the US or the UK, require a minimum number of performed cataract surgeries during residency training. In any training programme, two things are paramount: skills and safety.

“The steps of proficiency are learning about cataract surgery and observing both experienced surgeons and people who are learning, practising, and finally performing,” she explained.

Learning surgery has become easier because of the internet, where online resources are easily accessible to trainees, no matter the location. Observation and assisting during surgery are also fundamental to the learning process. While residents in many European countries do not perform so many surgeries, they extensively observe other surgeons in the OR.

“I could always tell who is going to be a good surgeon by how they assist, how they anticipate the next step or complication, or which instrument to get ready to hand over. I know that person is already thinking two steps ahead,” Professor Henderson commented.

Practice is where innovative technologies really come into play. Wet labs, dry labs, and artificial eyes help the resident become familiar with the microscope and instruments, work both feet and both hands simultaneously, and repeat the process to train muscle memory. Simulators allow trainees to repeat the steps of the surgery as many times as they want or learn how to manage complications they may not encounter when operating on real patients during residency training.

Prof Henderson suggested having the residents start with the last stages of the surgery, such as removing the OVD, and gradually having them do the other steps backwards—because if the learner makes mistakes at the very beginning, the whole case will be complicated. She also stressed the importance of making trainees do several surgeries on the same day so they do not forget the steps and what they previously learned.

With this reasoning, it is impossible to determine an exact, standard number of cataract surgeries required for each trainee to become fully proficient and competent, but implementing other strategies could help standardisation.

“I think there could be a minimum number we can really agree on, and it is important to have a structured curriculum,” she concluded. “Also, you really need particularly good supervision and intentional practice, and surgery needs to be performed again and again.”

Prof Henderson spoke at the 2024 ESCRS Congress in Barcelona.

Bonnie An Henderson MD is a Clinical Professor at Tufts University School of Medicine in Boston, US. She is past president of the ASCRS.