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 Table of Contents  
CLINICAL PRACTICE GUIDELINES
Year : 2019  |  Volume : 57  |  Issue : 1  |  Page : 87

Expert comments on wet-laboratory training for residents


Department of Cataract and IOL Services, Aravind Eye Hospital, Chennai, Tamil Nadu, India

Date of Web Publication10-Jun-2019

Correspondence Address:
Dr. Haripriya Aravind
Aravind Eye Hospital, 10, Poonamallee High Road, Numbal, Chennai - 600 077, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/tjosr.tjosr_35_19

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How to cite this article:
Aravind H. Expert comments on wet-laboratory training for residents. TNOA J Ophthalmic Sci Res 2019;57:87

How to cite this URL:
Aravind H. Expert comments on wet-laboratory training for residents. TNOA J Ophthalmic Sci Res [serial online] 2019 [cited 2019 Nov 11];57:87. Available from: http://www.tnoajosr.com/text.asp?2019/57/1/87/259885



Residency training is crucial for the future of ophthalmology, as well as delivery of quality eye care. Therefore, the approach an institution takes to educate residents is important. Microsurgical training curriculum is designed keeping in mind the knowledge, skill, and attitude required to become a competent surgeon. Skill development of the surgical steps is learnt, first at the wet laboratory, then through simulator practice, and later through surgery on patients.

Wet-laboratory training plays an integral part of the trainee surgeon gaining the correct skill and confidence. Right from orientation to the operating microscope to gain hand-eye coordination, practicing suturing techniques, and performing the various steps of cataract surgery, role of wet-laboratory practice is significant. Either animal eyes (commonly goat or pig) or artificial model eyes may be used in the wet laboratory based on availability and need. Most of the resident learning curve studies have focused on phacoemulsification, the preferred surgical technique in developed countries. By contrast, the manual small incision cataract surgery (MSICS) technique is commonly practiced and taught at the various residency programs within India, and wet-laboratory models for MSICS with well-structured training programs have shown to reduce surgical complication rates and smoothen the learning curve.[1],[2] Timely evaluation and feedback for each surgery to assess the competence of the trainee surgeon by the trainer is also critical.

A number of studies have shown evidence of a resident learning curve, namely, an inverse relationship between the number of surgeries performed by a resident and adverse surgical outcomes.[2],[3],[4] The average number of cataract surgeries performed by our residents over 3 years ranges from 600–800, most of which are MSICS. Their complication rates are around 4% over the first 50 cases, decreasing gradually over the next 300 cases until it hits a level below 2% over the final 300–400. However, not all residency programs are able to provide adequate hands-on opportunities for residents. Hands-on practice in the wet laboratory or simulator helps to maximize the learning from each procedure while keeping the complication rates low.

In conclusion, a structured training curriculum with adequate wet-laboratory opportunities and timely feedback helps to develop residents who are confident and competent to perform quality cataract surgery.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
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. 1
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2.
Gupta S, Haripriya A, Vardhan SA, Ravilla T, Ravindran RD. Residents' learning curve for manual small-incision cataract surgery at Aravind eye hospital, India. Ophthalmology 2018;125:1692-9.  Back to cited text no. 2
    
3.
Randleman JB, Wolfe JD, Woodward M, Lynn MJ, Cherwek DH, Srivastava SK, et al. The resident surgeon phacoemulsification learning curve. Arch Ophthalmol 2007;125:1215-9.  Back to cited text no. 3
    
4.
Corey RP, Olson RJ. Surgical outcomes of cataract extractions performed by residents using phacoemulsification. J Cataract Refract Surg 1998;24:66-72.  Back to cited text no. 4
    




 

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