Ophthalmology Surgical Competency Assessment Rubric Research Articles

Utility of real-time 3D visualization system in the early stage of phacoemulsification training.

To determine the teaching effects of a real-time three dimensional (3D) visualization system in the operating room for early-stage phacoemulsification training. A total of 10 ophthalmology residents of the first-year postgraduate were included. All the residents were novices to cataract surgery. Real-time cataract surgical observations were performed using a custom-built 3D visualization system. The training lasted 4wk (32h) in all. A modified International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubric (ICO-OSCAR) containing 4 specific steps of cataract surgery was applied. The self-assessment (self) and expert-assessment (expert) were performed through the microsurgical attempts in the wet lab for each participant. Compared with pre-training assessments (self 3.2±0.8, expert 2.5±0.6), the overall mean scores of post-training (self 5.2±0.4, expert 4.7±0.6) were significantly improved after real-time observation training of 3D visualization system (P<0.05). Scores of 4 surgical items were significantly improved both self and expert assessment after training (P<0.05). The 3D observation training provides novice ophthalmic residents with a better understanding of intraocular microsurgical techniques. It is a useful tool to improve teaching efficiency of surgical education.

Comparison of Machine and Human Expert Evaluation of Capsulorrhexis Creation Performance Through Analysis of Surgical Video Recordings.

Achieving competency in cataract surgery is an essential component of ophthalmology residency training. Video-based analysis of surgery can change training through its objective, reliable, and timely assessment of resident performance. Using the Image Labeler application in MATLAB, the capsulorrhexis step of 208 surgical videos, recorded at the University of Michigan, was annotated for subjective and objective analysis. Two expert surgeons graded the creation of the capsulorrhexis based on the International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubric:Phacoemulsification (ICO-OSCAR:phaco) rating scale and a custom rubric (eccentricity, roundness, size, centration) that focuses on the objective aspects of this step. The annotated rhexis frames were run through an automated analysis to obtain objective scores for these components. The subjective scores were compared using both intra and inter-rater analyses to assess the consistency of a human-graded scale. The subjective and objective scores were compared using intraclass correlation methods to determine relative agreement. All rhexes were graded as 4/5 or 5/5 by both raters for both items 4 and 5 of the ICO-OSCAR:phaco rating scale. Only roundness scores were statistically different between the subjective graders (mean difference = -0.149, p-value = 0.0023). Subjective scores were highly correlated for all components (>0.6). Correlations between objective and subjective scores were low (0.09 to 0.39). Video-based analysis of cataract surgery presents significant opportunities, including the ability to asynchronously evaluate performance and provide longitudinal assessment. Subjective scoring between two raters was moderately correlated for each component.

Exploring the Assessment Tool ICO OSCAR. A Comparison of Reliability of Whole of the Operation with Its Parts

Purpose: To compare the reliability of Ophthalmology Surgical Competency Assessment Rubric (ICO-OSCAR: phaco) between assessment of whole of the operation and its parts. Study Design: Mixed method study design. Place and Duration of Study: Mughal Eye Hospital, Lahore from January 2020 to January 2021. Methods: Three raters assessed six anonymized phaco video operations with the help of ICO OSCAR phaco first as whole operations and then as parts of the operation. Inter rater reliability of the assessments of parts of the operation were compared with inter rater reliability of whole of the operation. Intra class coefficient (ICC) was used in SPSS – version 20. Raters also filled a survey form to detect how satisfied they were with the rubric. Raters’ feedback was taken to describe shortcomings/faults found during the use of ICO OSCAR phaco form. Results: In the quantitative part, the ICC for the combined parts of the operation (0.910) was better than the value of ICC for the whole operation (0.904). In the questionnaire part, raters were satisfied with ICO OSCAR phaco rubric as a useful tool for learning and assessment of phacoemulsification surgical skills. In the qualitative part, many deficiencies were observed by the assessors in the rubric during videos analysis with the rubric ICO OSCAR phaco. This rubric is more accurate for assessment of operations in the operation theater. Conclusion: Parts of the operations can be used instead of the whole operations for the assessment of surgical skills of phacoemulsification with the help of ICO OSCAR phaco rubric. For assessment of videos, it requires some modifications as it is more valid for the assessment of surgical skills during live surgery than in operation theater.

Reliability of open globe injury repair surgical videos on the internet for resident education

Introduction This study aimed to assess quality of surgical training videos for management of open globe injury (OGI) on online platforms. Material and Methods Twenty-three websites with surgical training videos were queried using the search keyword “open globe repair.” Video content characteristics and quality assessment scores using Sandvik score, Health on the Net Foundation Code of Conduct (HON code), mDISCERN scoring, and global quality score (GQS) were recorded. To evaluate the relevance of the surgical videos to the surgical procedure, steps were analyzed as per the Ophthalmology Surgical Competency Assessment Rubric (OSCAR) for Open Globe Surgical Management. Results One hundred and twenty-three videos were evaluated, and 63 analyzed. Majority videos were uploaded by solitary ophthalmologists (53/63; 84.13%). Mean video quality score (VQS) and GIS scores were 6.55 ± 1.59 and 7.95 ± 1.39, respectively. Mean mDISCERN, GQS, HON Code and Sandvik scores for all the videos were 2.87 ± 1.07, 3.77 ± 1.08, 5.14 ± 1.67, 12.06 ± 1.84, respectively. Videos with background audio and descriptive subtitles had significantly better quality ( p &lt; 0.05). All Quality assessment scores showed a statistically significant ( p &lt; 0.000) positive correlation with each other. On linear regression analysis, number of video likes, comments and views had a significant ( p &lt; 0.05) positive relation with quality of video, whereas video length showed a negative relation with different scores. Conclusion Nearly two-thirds of surgical videos showing OGI repair had good quality assessment scores. Consensus guidelines should be developed to guide uploaders as regards the essential features required for good quality surgical videos using a standardized rubric.

The Ophthalmology Surgical Competency Assessment Rubric (OSCAR) for Open Globe Surgical Management.

Background/AimsTo produce an internationally developed rubric to assess surgical competency in open globe management.MethodsAn international expert panel of seven ophthalmologist educators developed a standardized competency-based rubric. The steps to perform an open globe repair were outlined. Based on a modified Dreyfus model, the experts agreed on the steps of surgery and certain global indices. They then assigned descriptors for the competency expected of a novice, beginner, advanced beginner, and competent surgeon. The tool was then vetted by another panel of ten ophthalmologists. The main outcome measure was the final version of the tool as agreed upon by the expert review panel.ResultsThe steps of open globe repair and key global indices were established. Descriptive wording for each step and global indices for novice, beginner, advanced beginner, and competent surgery were listed. All the expert comments were integrated to establish face and content validity.ConclusionThis standardized rubric to evaluate resident competency should be used globally in training programs to assess open globe repair surgical skills. Using a modified Dreyfus model, four different levels of training competency were defined allowing a non-biased, objective, numerical and simple assessment.

The Ophthalmology Surgical Competency Assessment Rubric for External Dacryocystorhinostomy Surgery.

The International Council of Ophthalmology (ICO) is currently developing a series of standardized, internationally validated, teaching tool for key ophthalmic surgical procedures called the Ophthalmology Surgical Competency Assessment Rubrics (OSCARs). This study aims to develop an OSCAR for external dacryocystorhinostomy (ExDCR). An international panel of content experts, representing Argentina, India, U.A.E., United Kingdom, and the U.S.A. was established and worked to develop the rubric using a range of online collaboration tools. The team used the standardized OSCAR template as a baseline, developing explicit behavioral descriptors (the behavior and performance expected for each step) that were reviewed and modified with successive models. Learners were scored on a modified 4-point Dreyfus scale of skill acquisition (novice, beginner, advanced beginner, competent) with the removal of the expert domain. The tool was then reviewed by a secondary panel of international content experts, representing Brazil, India, Iran, Singapore, United Kingdom, and the U.S.A. The final OSCAR ExDCR tool was developed in alignment with the ICO-OSCAR standard. Nineteen agreed and weighted stems were produced. Specific comments with regards to the parameters and wording were incorporated to formulate the final rubric, which was internationally agreed and demonstrated face and content validity. The OSCAR ExDCR is skill and behavior based, has ICO agreed standards for assessment, and provides learners with specific targets for improvement. Although the OSCAR tool has face and content validity, further development could better elucidate its precise role.

The impact of distance cataract surgical wet laboratory training on cataract surgical competency of ophthalmology residents

BackgroundThis study assessed the impact of distance cataract surgical wet laboratory training on surgical competency of ophthalmology residents at a tertiary-level ophthalmic training center in Trujillo, Peru.MethodsThree five-week distance wet lab courses were administered through Cybersight, Orbis International’s telemedicine platform. Weekly lectures and demonstrations addressed specific steps in phacoemulsification surgery. Each lecture had two accompanying wet lab assignments, which residents completed and recorded in their institution’s wet lab and uploaded to Cybersight for grading. Competency was assessed through anonymous grading of pre- and post-training surgical simulation videos, masked as to which occurred before and after training, using a standardized competency rubric adapted from the Ophthalmology Surgical Competency Assessment Rubric (OSCAR, scale of 0–32). Day one best-corrected post-operative visual acuity (BVCA) was assessed in the operative eye on the initial consecutive 4–6 surgeries conducted by the residents as per the norms of their residency training. An anonymous post-training satisfaction survey was administered to trainees’.ResultsIn total, 21 ophthalmic residents participated in the courses, submitting a total of 210 surgical videos. Trainees’ average competency score increased 6.95 points (95%CI [4.28, 9.62], SD = 5.01, p < 0.0001, two sample t-test) from 19.3 (95%CI [17.2, 21.5], SD = 4.04) to 26.3 (95%CI [24.2, 28.3], SD = 3.93). Visual acuity for 92% of post-training resident surgeries (n = 100) was ≥20/60, meeting the World Health Organization’s criterion for good quality.ConclusionsStructured distance wet lab courses in phacoemulsification resulted in significantly improved cataract surgical skills. This model could be applicable to locations where there are obstacles to traditional in-person training, such as the current COVID-19 pandemic.

The Ophthalmology Surgical Competency Assessment Rubric for Intravitreal Injections (ICO-OSCAR:IVI).

(1) Background: Intravitreal injections (IVIs) are the most commonly performed intraocular procedure worldwide. Ensuring correct learning is essential to avoid complications. Our purpose was to develop an internationally valid tool to assess skill in performing IVIs. (2) Methods: A panel of six content experts designed a rubric for assessing the IVI procedure by using a modified Dreyfus scale of skill acquisition, dividing it into steps and providing objective behavioral descriptors for each level of skill in each category, following the International Council of Ophthalmology (ICO) guidance. The rubric draft was then critically reviewed by 12 international content experts, and their constructive comments were considered for the final rubric. (3) Results: The Ophthalmology Surgical Competency Assessment Rubric for IVI (ICO-OSCAR:IVI) is the proposed tool for assessing healthcare professionals training to perform IVI. (4) Conclusions: The ICO-OSCAR:IVI is the result of the consensus of an international expert panel. The methodology used for its development provides this rubric with face and content validity. It can be used globally to assess healthcare professionals training to perform IVI, as well as the impact of different teaching methods on performance. Further studies are required to establish intra- and inter-rater reliability, as well as the predictive validity of this tool.

Impact of a structured training program to enhance skills in phacoemulsification surgery.

Purpose:The aim of this study was to determine whether the introduction of a structured short-term phacoemulsification training program improved the ICO-OSCAR (International Council of Ophthalmology’s Ophthalmology Surgical Competency Assessment Rubric) score and the learning curve of the trainees and decreased the complication rates of the cases.Methods:This study was a retrospective, observational study conducted in a tertiary eye care hospital in India. The study was conducted from March 2018 to October 2019 based on a structured phacoemulsification training program introduced in January 2019. The trainees enrolled in the phacoemulsification training program were divided into two groups: Group 1 (n = 33), who underwent training before the introduction of the structured program, and Group 2 (n = 29), who underwent the training after the introduction of the structured training program. Each trainee performed 20 cases. Group 1 training consisted of wet-lab and phacoemulsification surgeries. Group 2 training program comprised three modules over 5 weeks and a preassessment examination. Premodule 1 imparted cognitive skills; Module 1 was on structured wet-lab, Module 2 was about phacoemulsification step surgery, and Module 3 had independent complete surgeries. Group 2 also underwent compulsory Observation of cases being performed in the operation theater, surgical video recording review, and formative feedback. Mean OSCAR score comparison was done for both the groups. The OSCAR score was also calculated case-wise to obtain the learning curve with respect to the entry and exit levels, by classifying the trainees in each group as Novice, Beginner, Advanced Beginner, or Competent. A comparison of the posterior capsular rupture (PCR) rates and vision at discharge of all the cases was done.Results:Group 2 had a significantly better mean OSCAR score than Group 1 (4.03 and 3.43, respectively; P < 0.001). The PCR rate of the cases was significantly lower in Group 2 than in Group 1 (9.14% and 20.30%, respectively; P < 0.001). Group 2 had a significantly better visual acuity outcome of the cases than Group 1. Group 1 started as Novice (OSCAR score: 2), whereas Group 2 started as Beginner (OSCAR score: 3). Group 2 reached the Advanced Beginner level eight to 10 cases prior to Group 1.Conclusion:A structured training curriculum can make a significant difference in the training experience of the trainees and enable better surgical outcomes and a decrease in the complication rates.

Comparison of video-based observation and direct observation for assessing the operative performance of residents undergoing phacoemulsification training.

Purpose:To compare the video observation of procedural skills (VOPS) method with the direct observation of procedural skills (DOPS) method in the assessment of senior residents' performance utilizing the International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubric for phacoemulsification (ICO-OSCAR; phaco).Methods:This is a prospective comparative study conducted at a university-affiliated hospital. Six ophthalmology residents of postgraduate year 4 participated. Their performance in phacoemulsification was rated via DOPS and later in a masked manner through VOPS by a single faculty assessor.Results:Seventy-one surgeries were evaluated. There were no statistically significant differences between the scores of VOPS and DOPS regarding all ICO-OSCAR indices except “instrument insertion into the eye” in which DOPS had higher scores (P = 0.035). A significant correlation was observed in total scores of “task-specific” (r = 0.64, P < 0.001) and “global” (r = 0.38, P = 0.003) indices between VOPS and DOPS while some subscales did not show a correlation between the two methods of assessment. The Bland-Altman analysis demonstrated that nearly all data points of total “task-specific” and “global” scores fell within the 95% limits of agreement ([-5.84, 6.87] and [-4.78, 4.86], respectively).Conclusion:This study demonstrated that VOPS holds promise for a general rating of residents' performance.

Operative Time and Complication Rates of Resident Phacoemulsification Surgeries in a National University Hospital: A Five-Year Review.

PurposeTo determine the operative time and complication rates of resident phacoemulsification surgeries at different time points in training.MethodsRetrospective cross-sectional study at the Department of Ophthalmology of the Philippine General Hospital. All resident-performed elective adult phacoemulsification surgeries from January 1, 2014, to December 31, 2018, were included, while operations with planned anterior or posterior procedures were excluded. Cases were arranged chronologically and divided into time points with 25 cases each. Operative time and complication rates were computed for each time point. As defined by the ICO Ophthalmology Surgical Competency Assessment Rubric (OSCAR), 30 minutes was used to gauge competency based on operative time, while complications were compared to published rates for residents. Results for the first 50 cases, the minimum number required by graduation, were also compared with succeeding cases.ResultsA total of 4635 cases were included. Residents performed an average of 115.9 ± 30.4 cases, with no significant difference among residents (F(4,35)=2.64, p=0.12). Overall complication rate was 6% (n=276), similar to those reported internationally. Both median operative time and complication rates decreased significantly for every time point in training (p<0.001). After 50 cases, only 40% (n=16) of residents reached the operative time of 30 minutes. Median operative time is significantly lower when comparing the first 50 surgeries with the succeeding cases (37 minutes vs 29 minutes, p<0.001). Likewise, complication rate is also significantly lower (9.3% vs 3.5%, Χ2 (1, N=4635) = 68.481, p<0.001), with an odds ratio of 2.85 (p<0.001, 95% CI [2.2, 3.7]).ConclusionThere are significant improvements in both operative time and complication rates as more surgeries are performed. However, the minimum required 50 cases is not enough for resident competency based on operative time and complication rates.

Evaluation of ophthalmology residents' self-assessments and peer assessments in simulated surgery

ObjectiveTo evaluate the accuracy of ophthalmology residents’ self-assessment and peer assessment of surgical skills in a simulation setting. DesignSimulation laboratory assessment. ParticipantsOphthalmology residents novice to cataract surgery. MethodsA modified International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubric: Phacoemulsification structured assessment tool for simulated cataract surgery was established by conventional Delphi method. Residents completed 10 independent simulated surgeries that were video-recorded. Two experts graded the videos using the assessment tool. Participants performed self-assessment of their own 10 videos, and peer assessment of 10 of their peers’ videos. ResultsNine cataract surgery experts provided feedback and modifications for the assessment tool. Agreement for the first round of the Delphi method ranged from 55.56% to 100%. Second round agreement was 80% or greater for all answers. The final assessment tool comprised (i) 4 procedural items scored from 0 (not performed) to 7 (competent), and (ii) a global rating scale (GRS) requiring yes/no answers to 4 performance-related questions. Eight residents participated in the study. There was excellent expert inter-rater reliability intraclass correlation ((ICC) = 0.844, 0.875, 0.809, 0.844) and fair to excellent inter-rater reliability between expert and peer scores (ICC = 0.702, 0.831, 0.521, 0.423), but systematic disagreement (ICC = −0.428, −0.038) or poor inter-rater reliability (ICC = 0.298, 0.362) between expert and self-scores. There was poor agreement for all GRS questions (κ statistic < 0.40) except 2 comparisons. ConclusionsIn the simulation setting, experts were able to reliably assess trainees’ performance using the assessment tool. Participants demonstrated inconsistency in assessing their own skills; however, they were adequate at assessing their peers’ overall performance.

Ophthalmic Simulated Surgical Competency Assessment Rubric for manual small-incision cataract surgery

PurposeTo develop and test the validity of a surgical competency assessment tool for simulated small-incision cataract surgery (SICS).SettingParticipating ophthalmologists contributed from 8 countries.DesignQualitative and quantitative development and evaluation of face and content validity of an assessment rubric, and evaluation of construct validity and reliability.MethodsThe SICS Ophthalmic Simulated Surgical Competency Assessment Rubric (Sim-OSSCAR) was developed and assessed for face and content validity by an international group of experienced ophthalmologists. Groups of novice and competent surgeons from 4 countries were recorded performing surgery, and masked assessments were performed by 4 expert surgeons, to determine construct validity and reliability.ResultsThe Sim-OSSCAR for SICS was assessed by a panel of 12 international experts from 8 countries. In response to the question, “Do you think the OSSCAR represents the surgical techniques and skills upon which trainees should be assessed?,” all respondents either agreed or strongly agreed. Face validity was rated as 4.60 (out of 5.0). The content was iteratively agreed to by the panel of experts; final content validity was rated as 4.5. Interobserver reliability was assessed, and 17 of 20 items in the assessment matrix had a Krippendorff α correlation of more than 0.6. A Wilcoxon rank-sum test showed that competent surgeons perform better than novices (P = .02).ConclusionsThis newly developed and validated assessment tool for simulation SICS, based on the International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubric, has good face and content validity. It can play a role in ophthalmic surgical education.

Objective assessment of intraoperative technical skill in capsulorhexis using videos of cataract surgery.

Objective assessment of intraoperative technical skill is necessary for technology to improve patient care through surgical training. Our objective in this study was to develop and validate deep learning techniques for technical skill assessment using videos of the surgical field. We used a data set of 99 videos of capsulorhexis, a critical step in cataract surgery. One expert surgeon annotated each video for technical skill using a standard structured rating scale, the International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubric:phacoemulsification (ICO-OSCAR:phaco). Using two capsulorhexis indices in this scale (commencement of flap and follow-through, formation and completion), we specified an expert performance when at least one of the indices was 5 and the other index was at least 4, and novice otherwise. In addition, we used scores for capsulorhexis commencement and capsulorhexis formation as separate ground truths (Likert scale of 2 to 5; analyzed as 2/3, 4 and 5). We crowdsourced annotations of instrument tips. We separately modeled instrument trajectories and optical flow using temporal convolutional neural networks to predict a skill class (expert/novice) and score on each item for capsulorhexis in ICO-OSCAR:phaco. We evaluated the algorithms in a five-fold cross-validation and computed accuracy and area under the receiver operating characteristics curve (AUC). The accuracy and AUC were 0.848 and 0.863 for instrument tip velocities, and 0.634 and 0.803 for optical flow fields, respectively. Deep neural networks effectively model surgical technical skill in capsulorhexis given structured representation of intraoperative data such as optical flow fields extracted from video or crowdsourced tool localization information.

Impact of virtual reality simulation on learning barriers of phacoemulsification perceived by residents.

ObjectiveTo identify residents’ perceived barriers to learning phacoemulsification surgical procedures and to evaluate whether virtual reality simulation training changed these perceptions.DesignThe ophthalmology residents undertook a simulation phacoemulsification course and proficiency assessment on the Eyesi system using the previously validated training modules of intracapsular navigation, anti-tremor, capsulorrhexis, and cracking/chopping. A cross-sectional, multicenter survey on the perceived difficulties in performing phacoemulsification tasks on patients, based on the validated International Council of Ophthalmology’s Ophthalmology Surgical Competency Assessment Rubric (ICO-OSCAR), using a 5-point Likert scale (1 = least and 5 = most difficulty), was conducted among residents with or without prior simulation training. Mann–Whitney U tests were carried out to compare the mean scores, and multivariate regression analyses were performed to evaluate the association of lower scores with the following potential predictors: 1) higher level trainee, 2) can complete phacoemulsification most of the time (>90%) without supervisor’s intervention, and 3) prior simulation training.SettingThe study was conducted in ophthalmology residency training programs in five regional hospitals in Hong Kong.ResultsOf the 22 residents, 19 responded (86.3%), of which 13 (68.4%) had completed simulation training. Nucleus cracking/chopping was ranked highest in difficulty by all respondents followed by capsulorrhexis completion and nucleus rotation/manipulation. Respondents with prior simulation training had significantly lower difficulty scores on these three tasks (nucleus cracking/chopping 3.85 vs 4.75, P = 0.03; capsulorrhexis completion 3.31 vs 4.40, P = 0.02; and nucleus rotation/manipulation 3.00 vs 4.75, P = 0.01). In multivariate analyses, simulation training was significantly associated with lower difficulty scores on these three tasks.ConclusionResidents who had completed Eyesi simulation training had higher confidence in performing the most difficult tasks perceived during phacoemulsification.

The Ophthalmology Surgical Competency Assessment Rubric for Panretinal Photocoagulation

To develop an internationally valid skill-based rubric that can be used as a global standardized platform for teaching, training, and evaluation of panretinal photocoagulation (PRP) in training programs. A panel of educators and experts in retinal lasers was assembled to develop a standardized objective skill-based rubric. Sixteen international educators and retina specialists. The steps to performing slit-lamp delivery of PRP was described in detail. A group of 6 authors reviewed and agreed on the steps and assigned descriptors to expectation levels of novice, beginner, advanced beginner, and expert according to a modified Dreyfuss model. The tool then was vetted by an international panel of 10 retina specialists who are involved in training ophthalmologists in other countries. Final version of the tool agreed on by the international review panel. The consecutive steps to performing PRP were outlined and broken down into preparation, procedure, and postoperative care. Descriptive words explaining what to expect from a novice, beginner, advanced beginner, and expert were listed for each step of PRP. Expert comments were incorporated, establishing face and content validity. This group of authors clearly defined expectations of a trainee at 4 levels of training according to the modified Dreyfus model, and an international panel of retina specialists agreed to its accuracy. This tool, the International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubric for Panretinal Photocoagulation, has face and content validity. It can be used globally in training programs bothtoteach and assess this important comprehensive skill in ophthalmic training.

The Ophthalmology Surgical Competency Assessment Rubric for Vitrectomy.

The Ophthalmology Surgical Competency Assessment Rubric for Vitrectomy.

The Ophthalmology Surgical Competency Assessment Rubric for Trabeculectomy.

To produce an internationally valid tool to assess skill in performing trabeculectomy surgery. A panel of 5 experts developed a tool for assessing trabeculectomy surgery by using a modified Dreyfus scale of skill acquisition and providing descriptors for each level of skill for each category. The tool was then reviewed by a panel of 10 international content experts for their constructive comments, which were incorporated into the final rubric tool. A final rubric, incorporating the suggestions of the international panel, published here as the ICO-OSCAR: Trabeculectomy. The tool ICO-OSCAR: Trabeculectomy has content and face validity. It can be used internationally to assess trabeculectomy surgery skill. Predictive and construct validity, and reliability are yet to be determined.

Impact of a Strabismus Surgery Suture Course for First- and Second-Year Ophthalmology Residents.

To investigate the effectiveness of an eye muscle surgery course on first- and second-year postgraduate ophthalmology residents. This prospective cohort pilot study invited first- and second-year ophthalmology residents to participate in a 2-hour strabismus surgery course at Wills Eye Hospital. The course consisted of a didactic session followed by a wet laboratory session. The wet laboratory session simulated strabismus surgery using a model constructed of chicken breast followed by partial-thickness scleral suture passes in pig eyes. A structured self-assessment evaluation form and a questionnaire in the validated Ophthalmology Surgical Competency Assessment Rubric approved by the International Council of Ophthalmology (ICO-OSCAR:strabismus) were used to assess the effectiveness of the course. A total of 12 residents, 8 (67%) first-year and 4 (33%) second-year, were enrolled for this survey. Following the course, most residents felt less anxious (73%). All residents responded that the course was helpful or somewhat helpful in preparation for strabismus surgery. Regarding the distribution of ratings on questions of subjective experience, knowledge of steps, and understanding of potential complications, the residents gave significantly higher ratings after the course (P < .029). The change in the modified ICO-OSCAR:strabismus assessment's mean score was statistically significant before and after training (P = .038). A strabismus course can play an important role in preparing residents for strabismus surgery. [J Pediatr Ophthalmol Strabismus. 2017;54(6):339-345.].

A Cataract Surgery Training Program: 2-Year Outcome After Launching

To investigate whether a short-term training program can produce competent cataract surgeons. This observational pilot study enrolled 12 trainees who could not perform phacoemulsification independently. The training consisted of 2 phases. During the first 3-month phase, trainees were taught phacoemulsification through wet laboratory exposure and deliberate practice in patients at the training center in the Eye Hospital of Wenzhou Medical University in China. The second phase consisted of performing 50 cases at the trainees׳ home institution with supports from instructors of the first phase. Trainees׳ surgical results were followed-up. The surgical skill as measured by the Ophthalmology Surgical Competency Assessment Rubric (OSCAR) and surgical outcomes were analyzed. During the first phase trainees performed 193.3 ± 95.4 wet laboratory cases and 557 eyes in patients. The complication rate was 0.54%. The OSCAR scores improved significantly (p < 0.01) in the first phase. At the second phase, all the trainees could carry out phacoemulsification at their home hospital and the complication rate was 1.87%. During the long-term follow-up, 4936 cases of phacoemulsification were performed and the complication rate was 0.87%. Trainees succeeded in performing phacoemulsification safely and skillfully through a limited short period of training by wet laboratory exposure, deliberate practice in patients, and frequent formative feedback provided by the OSCAR tool.