67 Novel, validated simulations to bridge an identified training gap in the management of complex cataract surgery cases

Abstract

Background/context While ophthalmology trainees are required to meet a minimum quantitative standard of competence in cataract surgery to complete ophthalmic specialty training (OST), their proficiency in managing complex cases is assumed but not formally measured. As modern surgical techniques become safer, trainees encounter fewer complex cases than their predecessors and risk completing OST without adequate experience or confidence in managing these. In keeping with stipulations from the Royal College of Ophthalmologists, most regions offer simulation facilities to supplement operating theatre training. However, these are limited to simulations of fundamental surgical steps. There are currently no validated simulations for training in managing complex or complicated cases. Methodology We carried out an online survey of 21 trainees (ST3-7) in our region, which revealed inadequate self-reported exposure and experience in four advanced techniques, namely managing: (1) vitreous loss; (2) capsular instability; (3) alternative intraocular lens placement and (4) small pupils. Eighteen (86%) were eager to access simulation-based training for these techniques. We have therefore designed novel simulations of all four techniques by augmenting commercially available basic cataract surgery training equipment with readily sourced, inexpensive materials to produce reliable, reusable simulations of complex scenarios. Experienced consultant ophthalmic surgeons have tested our designs. All four simulations have been shown to have robust face and content validity and have been deemed useful for training. Potential impact In August 2016 we will deliver these simulations as a practical course for trainees who have completed at least 50 simple cataract cases. Delegates will learn and practise all four techniques under supervision, with a trainee to trainer ratio of 2:1. At this pilot session we will assess the construct validity of our simulations. If this is adequate, and trainees’ learning objectives are met, we will have compelling evidence to include such training in the regional and national delivery of