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CC BY-NC-ND 4.0 · Journal of Academic Ophthalmology 2020; 12(01): e15-e19
DOI: 10.1055/s-0039-3402771
Research Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Learning Curve of a Surgical Educator: Resident Cataract Surgery Outcomes under the Supervision of One Attending Surgeon over 5 Years

Sidra Zafar
1   Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland
,
Ariel Chen
1   Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland
,
Seung Yeon Seo
1   Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland
,
Xinyi Chen
1   Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland
,
Jing Tian
2   Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
,
Divya Srikumaran
1   Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland
,
Shameema Sikder
1   Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland
,
Fasika A. Woreta
1   Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins Hospital, Baltimore, Maryland
› Institutsangaben
Funding None.
Weitere Informationen

Publikationsverlauf

27. August 2019

01. Dezember 2019

Publikationsdatum:
20. Januar 2020 (online)

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Abstract

Background The main purpose of this article is to determine the trend of intraoperative complications of resident-performed cataract surgery under the supervision of one attending surgeon during the initial 5 years of surgical teaching.

Methods A retrospective chart review was conducted at the Wilmer Eye Institute for all postgraduate year 4 resident-performed cataract surgeries between July 2013 and June 2018 that were supervised by one attending surgeon who was directly out of fellowship training. Recorded data included patient demographics, presence of preoperative risk factors (small pupil, dense cataract, history of ocular trauma, pseudoexfoliation syndrome, postvitrectomy, pre-existing zonular weakness, and high myopia), and intraoperative complications (posterior capsule tear resulting in vitreous loss and zonular dehiscence resulting in vitreous loss and/or loss of sulcus support). A generalized estimating equation model was constructed to determine factors associated with intraoperative complications.

Results A total of 1,253 resident cataract surgeries involving 988 patients were included. The overall complication rate was 3.6% (n = 45/1253), with a decreasing trend observed in the rate of intraoperative complications across the study years. Multivariate analysis found that complications during cataract surgery were more likely to occur in earlier years of the supervising surgeon's career (p = 0.01), at the beginning of the academic year (p = 0.03), in eyes with preoperative risk factors (p < 0.001), black patients (p = 0.02), and left eyes (p = 0.02).

Conclusion A learning curve exists for novice attending surgeons during their initial years of resident cataract surgery supervision. Residency programs should consider resources to educate novice surgical educators, especially on how to effectively supervise resident-performed complex cases.

Keywords

learning curve - novice surgeon - surgical educator - complications