High, low and mixed fidelity simulation for continuous curvilinear capsulorhexis in cataract surgery

Abstract

Simulation models for the continuous curvilinear capsulorhexis (CCC) can be thought of to differ in their fidelity, or the degree to which they accurately reflect in vivo surgery. Low and high fidelity simulations can differ in terms of efficacy and cost. The present investigation aims to determine if these two modalities can be combined to enhance overall learning. In this randomized controlled interventional trial, first year ophthalmology residents with no previous CCC experience (n=25) were randomized into one of three simulation groups: low, high, or mixed fidelity. Low fidelity simulation involved capsulorhexis practice on the skin of a grape in a self-directed manner. High fidelity simulation was on a 3D virtual reality (VR) unit in a scheduled manner. Mixed fidelity utilized both. Participants were tested on a cadaver model that was graded by a masked evaluator. Overall CCC performance was poor, as was self reported confidence. There was some improvement in process indices of performance by the high fidelity group. There was no difference between mixed and high fidelity groups on any outcome measure. Low fidelity simulation appeared less efficacious in the acquisition of skill, and did not enhance overall performance when done in conjunction with high fidelity simulation.