PHACO TRAINING

A new ‘dry lab’ training methodology for phacoemulsification surgery may prove to be a useful adjunct to traditional training methods, suggests research presented during the 2013 Irish College of Ophthalmologists Annual Meeting.

Princeton Lee MD, an ophthalmic surgery specialist registrar in the Royal Victoria Eye and Ear Hospital, Dublin, Ireland, has developed a new programme for teaching phacoemulsification surgery. He presented the pilot study results at the conference.

While learning phacoemulsification is an exciting process for trainees, the learning process can be slow and risky for patients due to the high skill-set required to perform the surgery, he noted.

Dr Lee said he thus set out to design a proficiency- based training methodology that would increase trainees’ confidence, reduce training costs and improve patient safety. The programme consists of both didactic and practical skill components and takes place in a real operating theatre using real surgical instruments utilising a plastic model eye to build up trainees’ surgical skills. The skill training focuses on imitating the instrument manoeuvring inside the plastic eye, therefore, no consumable components such as artificial capsules and lens materials are required.

Traditionally, trainees learn by repeating the same step on patients a few times before moving on to the next step. This training programme requires the trainees to master the knowledge and skills required in all steps before starting to operate on patients. After each step was learned, the trainees rehearsed the entire operation repeatedly until thorough familiarity with the procedure was achieved. Once competency was reached, the trainees then commenced cataract surgery on a real patient, Dr Lee said.

The success of the study was determined by the number of patients required by the trainee to complete a full case under the supervision of their hospital trainer without any intervention.

Two trainees without prior ophthalmic surgical experience took part in Dr Lee’s pilot study of this new training programme. The trainees spent an average of 50 hours on lectures, reading and practising their manual skills. They learned proper microscope operation, effective instrument handling and manoeuvring, and then learned how to precisely control the phaco machine with their foot.

When operating on real patients they reached their first fully completed, unaided case after an average of six patients (range of 4-8 patients), compared to a random survey of Irish trainees who were trained in the traditional way who reached their first unaided completed case following an average of 36 patients, Dr Lee told the conference.

“At the end of the training programme, trainees developed a thorough understanding of the procedure and good eye- hand co-ordination. Therefore when it came to their very first case, they were more confident as nothing was unfamiliar, except for the handling of biological tissues,” he stated.

Dr Lee said the effectiveness of the new training programme is evident by the small number of patients the trainees needed to complete their first full case. Furthermore, as training takes place primarily away from actual patients, it is safer. It is also cheaper because there are no consumable components or replaceable technology required. “It incurs minimal cost yet achieves the most direct transfer of skill from a dry lab to the operating room,” he commented.

Concluding, Dr Lee said his dry lab training model addressed the key concerns of effectiveness, safety and cost and offers a real alternative to traditional phaco surgery training methods.