J Med Assoc Thai 2021; 104 (10):1658-66

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The Learning Curve of the Deliberate Practice of Phacoemulsification in the Ophthalmic Training System
Pongsachareonnont P Mail, Uthaithammarat L , Saonanon P , Somkijrungroj T , Reinprayoon U , Ittipanichpong R , Kasetsuwan N

Objective: To determine the number of surgeries needed for trainees to achieve competence in performing phacoemulsification with deliberate practice (DP).

Materials and Methods: The present study was a prospective observational study, the residents were observed as they progressed through their third year of residency. Resident and patient demographic data were recorded. Complexities of the cases and surgical steps and rate of surgical complications were recorded. Self and staff assessments as to the DP learning zone attained by the trainees were collected. Risk adjusted-cumulative summation (RA-CUSUM) was used to evaluate the competency of the trainees to achieve the acceptable posterior capsule rupture (PCR) rate of 5%. Kaplan-Meier analysis was used to determine the median number of surgeries required to attain competency.

Results: Eight of the 10 trainees achieved competence in performing phacoemulsification. A median of 28 cases and 278 days was required before competence was attained. There were no statistically significant associations between the achievement of competence and the gender of the trainees, perceived complexity of the cases, or the grade-point average of the residents during their tenure in medical school. A median of four cases were required for a shift in the trainees’ DP confidence levels from “panic” to “learning” from self-assessment, while the median of ten case were required from staff assessment. The PCR was 8.53% and dropped to 6% at two years after the trainees finished residency training.

Conclusion: Trainees require at least 28 cases of non-complicated phacoemulsification surgery to achieve a minimum level of competency. The perceived skill in performing phacoemulsification differs between novice and experienced surgeons. Phacoemulsification skills can be further developed after graduating from the training program. Assisting staff should be attentive when trainees perform lens nucleus division and lens nucleus removal to avoid complications.

Keywords: Residency training; Phacoemulsification; CUSUM; Deliberate practice; Cataract

DOI: doi.org/10.35755/jmedassocthai.2021.10.13026

Received 24 May 2021 | Revised 14 September 2021 | Accepted 14 September 2021


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