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Abstract

Purpose To assess the impact of individualized one-on-one wet lab training on the learning curve of phacoemulsification cataract surgery among ophthalmology residents. Methods This prospective study involved 15 ophthalmology residents at a single institution between 2016 and 2019. Each resident participated in tailored training sessions focusing on phacoemulsification surgical steps, guided by an experienced cataract surgeon. Proficiency across 11 procedural steps was evaluated using a 5-level ordinal scale, and data on complications, case times, and proficiency scores were collected and analyzed using multiple regression models. Competency was defined as resident trainee performance of a surgical case without complication and level 3 proficiency for all steps, all within 1 standard deviation (SD) of the average attending surgical time. Univariate logistic regression modeling was used to model outcomes of complication and competency with difficulty as the independent variables, each performed separately. All models utilized general estimating equations with an exchangeable correlation to account for multiple records from residents. A p-value

disassembly and removal. A marked decrease in complications in later cases (beyond 100 surgeries) was noted. Complication rates were much higher when case was scored as difficult (2.3% among cases that were not difficult, 14.6% among difficulty score of 1, and 21.0% among difficulty score of 2). Full proficiency in all 11 surgical steps rose from 5.0% in the first quintile to 90.7% in the final quintile of surgical cases. Conclusions Personalized wet lab training allowed for expedient and efficient resident mastery of phacoemulsification cataract surgery. This training method was associated with a short time to achieve proficiency in some of the most challenging steps reported by residents, such as cortex removal, wound integrity, and capsulorrhexis. The number of prior cases and the degree of difficulty remained the most significant predictors of surgical competency. Offering more tailored training sessions with progressively challenging models, particularly in the later years of ophthalmology residency, could further improve educational outcomes and patient safety.

Received Date

Jun 5, 2024

Accepted Date

Sep 18, 2024

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