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 Table of Contents  
POST GRADUATE’S KORNER
Year : 2019  |  Volume : 57  |  Issue : 1  |  Page : 84-86

Contemporary appraisal on wet-laboratory training for ophthalmology residents


Dr. Agarwal's Eye Hospital, Tirunelveli, Tamil Nadu, India

Date of Web Publication10-Jun-2019

Correspondence Address:
Dr. D Lional Raj
Dr. Agarwal's Eye Hospital, Tirunelveli, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjosr.tjosr_29_19

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  Abstract 


Ophthalmic surgery is different from other surgical fields as it requires additional skills of hand-eye coordination. Wet lab training helps the residents to master the initial steps of stereoscopic vision, hand-eye coordination and microsurgical skill in a non stressful laboratory setting. This tool is useful to develop self -awareness among trainess, to identify gaps and to eventually improve their surgical skills with a reduced rate of complications. The need to mandate the wet lab in ophthalmology training as a part of the curriculum in post graduate training in India requires serious consideration to improve the cataract surgical outcome.

Keywords: ICO -OSCAR, ophthalmology residents training, wet-laboratory training


How to cite this article:
Raj D L, Anandan H. Contemporary appraisal on wet-laboratory training for ophthalmology residents. TNOA J Ophthalmic Sci Res 2019;57:84-6

How to cite this URL:
Raj D L, Anandan H. Contemporary appraisal on wet-laboratory training for ophthalmology residents. TNOA J Ophthalmic Sci Res [serial online] 2019 [cited 2019 Aug 24];57:84-6. Available from: http://www.tnoajosr.com/text.asp?2019/57/1/84/259884




  Introduction Top


India is home to a quarter of the blind population of the world, but unfortunately, the number of trained ophthalmologists is lagging behind the current need.[1],[2] Our country needs 25,000–30,000 ophthalmologists till 2020, which means adding 300 training slots per year.

Ophthalmic surgery is different from other surgical fields as it requires additional skills of hand–eye coordination. Microsurgery allows only one person to operate at a time; hence, it does not give ample time for a supervisor to intervene before a complication occurs. The residents operate under a highly demanding and stressful environment that may hamper their development as good surgeons.

Rogers et al.[3] showed that the implementation of a structured curriculum for the ophthalmic residents significantly reduced the rate of complications, especially posterior capsule (PC) rupture and vitreous loss.[4] In their study, the 1st- and 2nd-year residents went through intensive wet-laboratory training and supervised surgical training, thus emphasizing the need for training of microskills at a skills laboratory before residents are allowed to operate on patients. Khanna et al.[5] also concluded in their study that having a uniform standard of training can result in improvement of outcomes, irrespective of the surgery performed.

This needs a major revamp of our residency system as the existing system is found to be inadequate in its current form.[6]

Most of the residency programs are not focusing much on the surgical training of the residents. The International Council of Ophthalmology designed its Ophthalmology Surgical Competency Assessment Rubrics (ICO-OSCAR) to facilitate assessment and teaching of surgical skill.[7]

The interest of the students in ophthalmology was increased by the block week and additionally by the wet laboratory. The wet laboratory enriched the block week and was rated as very good by the participants. The overall rating of the block week was significantly better among participants in the wet laboratory than in the group without wet-laboratory participation. The wet laboratory gave the students great pleasure, enabled them to apply the acquired knowledge and gain valuable insights into ophthalmology, and was easily implemented.[8]


  Modified Ophthalmology Surgical Competency Assessment Rubrics Tool Top


ICO-OSCAR tools proposed by Farooqui et al. could be used for wet-laboratory training and be made part of the teaching curriculum. The training exercise was held over 5 days. The residents were trained on the 1st day on wound construction, 2nd day on capsulorhexis and hydroprocedures, 3rd and 4th day on phacoemulsification technique, and 5th day on intraocular lens insertion and wound closure. The training also had 11 didactic lectures. Wet-laboratory training should be made mandatory for all residents before surgical training on actual eyes.[4]

Modified OSCAR offers a reliable way to objectively assess the surgical skills acquired during wet-laboratory training. Trainees tend to overestimate their skills. The tool is useful to develop self-awareness among trainees and to identify gaps, lead active continuous professional development plan, and eventually improve their surgical skills. Such modified OSCAR tools can be developed for other surgical wet laboratories also, and we should find a way to integrate this in our residency curriculum.


  Oculoplastics Top


Methods to optimize surgical education are important given limited operating room time in oculoplastics, a subspecialty in which the number of surgeries performed during residency is relatively low. Mishra et al. developed a curriculum based on learning theory and sought to formally test one important aspect, surgical video for wet laboratories. This study, despite its limitations, showed that wet-laboratory surgical videos can be effective tools in improving motor skill acquisition for oculoplastic surgery.[9]

Wet-laboratory and surgical simulation can reduce the learning curve of difficult surgical techniques, accelerate the rate for trainees to achieve surgical competency, and improve patient safety.

The format is multileveled surgical training, with a beginner level targeting undergraduate medical students, an intermediate level for ophthalmology residents, and an advanced level for trained ophthalmologist. In addition, the level of industry participation allows the development of true partnership and offers a method to introduce awareness and innovation in a cost-effective manner.[10]


  Capsulorhexis Simulator Top


Daly[11] compared the operating room performance of ophthalmology residents trained by traditional wet-laboratory versus surgical simulation on the continuous curvilinear capsulorhexis portion of cataract surgery.

Preoperative simulator training prepared residents for the operating room as effectively as the wet laboratory. The time to pass the simulator curriculum was predictive of the time and overall performance in the operating room.


  Glaucoma Surgeries Top


A teaching model for trabeculectomy is described using pig eyes prepared in formalin. Wet laboratories will become an increasingly important aspect of a comprehensive ophthalmology training program.[12]


  Manual Small-Incision Cataract Surgery Top


Ramani et al. studied the effect of wet-laboratory training on the surgical outcome of resident performed manual small-incision cataract surgery.[13]

A wet-laboratory training facility plays a major role in enhancing the confidence and surgical skills in the resident which is ultimately manifested in the reduced rate of complications and a better visual outcome in resident-performed cataract surgery. The need to mandate the wet-laboratory or simulation facility in ophthalmology training as a part of the curriculum in postgraduate training in India requires serious consideration to improve the cataract surgical outcomes.


  Accreditation Council for Graduate Medical Education Top


The Accreditation Council for Graduate Medical Education has recognized the importance of wet-laboratory and simulator training in ophthalmology residency and mandated the wet-laboratory or simulation training in the USA for ophthalmology training.[14]


  Pitfall Top


The pitfall of this is the cost involved in setting up and maintaining the wet laboratory. However, in the long run, it definitely has the benefit of improving trainee confidence and the quality of surgeries.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Murthy G, John N, Gupta SK, Vashist P, Rao GV. Status of pediatric eye care in India. Indian J Ophthalmol 2008;56:481-8.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Dhaliwal S, Ayyala RS. Post graduate training program in ophthalmology in India: Idealistic vs. realistic. J Clin Ophthalmol Res 2015;3:39-43. Available from: http://www.jcor.in/article.asp?issn=2320-3897;year=2015;volume=3;issue=1;spage=39; epage=43;aulast=Dhaliwal. [Last accessed on 2019 Mar 05].  Back to cited text no. 2
    
3.
Rogers GM, Oetting TA, Lee AG, Grignon C, Greenlee E, Johnson AT, et al. Impact of a structured surgical curriculum on ophthalmic resident cataract surgery complication rates. J Cataract Refract Surg 2009;35:1956-60.  Back to cited text no. 3
    
4.
Farooqui JH, Jaramillo A, Sharma M, Gomaa A. Use of modified international council of ophthalmology-ophthalmology surgical competency assessment rubric (ICO-OSCAR) for phacoemulsification-wet lab training in residency program. Indian J Ophthalmol 2017;65:898-9.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Khanna RC, Kaza S, Palamaner Subash Shantha G, Sangwan VS. Comparative outcomes of manual small incision cataract surgery and phacoemulsification performed by ophthalmology trainees in a tertiary eye care hospital in India: A retrospective cohort design. BMJ Open 2012;2. pii: e001035.  Back to cited text no. 5
    
6.
Thomas R, Dogra M. An evaluation of medical college departments of ophthalmology in India and change following provision of modern instrumentation and training. Indian J Ophthalmol 2008;56:9-16.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
Golnik KC, Beaver H, Gauba V, Lee AG, Mayorga E, Palis G, et al. Cataract surgical skill assessment. Ophthalmology 2011;118:427.e1-5.  Back to cited text no. 7
    
8.
Enders C, Schneider A, Keis O, Grab-Kroll C, Loidl M, Kampmeier J, et al. Innovative teaching methods: Wet lab-based ophthalmosurgical education for medical students. Klin Monbl Augenheilkd 2018. doi: 10.1055/a-0624-2599. [Epub ahead of print].  Back to cited text no. 8
    
9.
Mishra K, Mathai M, Della Rocca RC, Reddy HS. Improving resident performance in oculoplastic surgery: A new curriculum using surgical wet laboratory videos. J Surg Educ 2017;74:837-42.  Back to cited text no. 9
    
10.
Liu EY, Li B, Hutnik CM. Canadian ophthalmic microsurgery course: An innovative spin on wet lab-based surgical education. Can J Ophthalmol 2016;51:315-20.  Back to cited text no. 10
    
11.
Daly MK, Gonzalez E, Siracuse-Lee D, Legutko PA. Efficacy of surgical simulator training versus traditional wet-lab training on operating room performance of ophthalmology residents during the capsulorhexis in cataract surgery. J Cataract Refract Surg 2013;39:1734-41.  Back to cited text no. 11
    
12.
Lee GA, Chiang MY, Shah P. Pig eye trabeculectomy-a wet-lab teaching model. Eye (Lond) 2006;20:32-7.  Back to cited text no. 12
    
13.
Ramani S, Pradeep TG, Sundaresh DD. Effect of wet-laboratory training on resident performed manual small-incision cataract surgery. Indian J Ophthalmol 2018;66:793-7.  Back to cited text no. 13
[PUBMED]  [Full text]  
14.
Haripriya A, Chang DF, Reena M, Shekhar M. Complication rates of phacoemulsification and manual small-incision cataract surgery at Aravind Eye Hospital. J Cataract Refract Surg 2012;38:1360-9.  Back to cited text no. 14
    




 

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Abstract
Introduction
Modified Ophthal...
Oculoplastics
Capsulorhexis Si...
Glaucoma Surgeries
Manual Small-Inc...
Accreditation Co...
Pitfall
References

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