Phacoemulsification to MSICS: A transfer of skills study in a simulated environment.: Transfer of phacoemulsification surgical skills to MSICS.

Abstract

To investigate if phacoemulsification experience impacts and transfers to the skill acquisition of novices in manual small incision cataract surgery (MSICS) within a simulation environment. Copenhagen Academy for Medical Education and Simulation, Denmark. Prospective controlled experimental study. The study included 29 residents or specialist in ophthalmology with no prior MSICS experience. Participants were required to either have 1) proficiency on the EyeSi surgical simulator (PG; phaco group) or 2) no prior extensive exposure to the EyeSi simulator or any phacoemulsification surgery experience as a primary surgeon (CG; control group). Possible skill transfer was assessed using a test on the HelpMeSee virtual-reality simulator, including nine modules and 30 steps (points). A pass/fail score was determined at 20 points (out of 30 points). Performance scores were analyzed using independent samples t-tests, pass rates using Fisher's exact test, and individual modules using Fisher-Freeman-Halton analysis. The PG performed significantly better in terms of overall performance score (mean SD, PG; 21.8 points 2.3 versus CG; 18.9 points 2.2, p = 0.002, t-value = -3.39) and pass rates (PG; 72 % versus CG; 22%, p = 0.018). The sub-analysis for individual modules demonstrated significant differences exclusively in the capsulorhexis and cortex removal modules. The results suggest a positive inter-procedural transfer of skills between phacoemulsification and MSICS. Pretraining and experience in phacoemulsification demonstrated a significant effect on the performance of MSICS within a simulation environment. These findings suggest that phacoemulsification experience provides an advantage before MSICS training in surgical residency programs.