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

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

• References

• 1 Randleman JB, Wolfe JD, Woodward M, Lynn MJ, Cherwek DH, Srivastava SK. The resident surgeon phacoemulsification learning curve. Arch Ophthalmol 2007; 125 (09) 1215-1219
• 2 Taravella MJ, Davidson R, Erlanger M, Guiton G, Gregory D. Characterizing the learning curve in phacoemulsification. J Cataract Refract Surg 2011; 37 (06) 1069-1075
• 3 Borboli-Gerogiannis S, Jeng-Miller KW, Koulisis N. , et al. A comprehensive surgical curriculum reduced intra-operative complication rates of resident-performed cataract surgeries. J Surg Educ 2019; 76 (01) 150-157
• 4 Rogers GM, Oetting TA, Lee AG. , et al. Impact of a structured surgical curriculum on ophthalmic resident cataract surgery complication rates. J Cataract Refract Surg 2009; 35 (11) 1956-1960
• 5 Subramonian K, Muir G. The 'learning curve' in surgery: what is it, how do we measure it and can we influence it?. BJU Int 2004; 93 (09) 1173-1174
• 6 Maruthappu M, Duclos A, Lipsitz SR, Orgill D, Carty MJ. Surgical learning curves and operative efficiency: a cross-specialty observational study. BMJ Open 2015; 5 (03) e006679
• 7 Puri S, Kiely AE, Wang J, Woodfield AS, Ramanathan S, Sikder S. Comparing resident cataract surgery outcomes under novice versus experienced attending supervision. Clin Ophthalmol 2015; 9: 1675-1681
• 8 Mahmoudi E, Lu Y, Chang S-C. , et al. The associations of hospital volume, surgeon volume, and surgeon experience with complications and 30-day rehospitalization after free tissue transfer: a national population study. Plast Reconstr Surg 2017; 140 (02) 403-411
• 9 Corey RP, Olson RJ. Surgical outcomes of cataract extractions performed by residents using phacoemulsification. J Cataract Refract Surg 1998; 24 (01) 66-72
• 10 Campbell RJ, El-Defrawy SR, Gill SS. , et al. New surgeon outcomes and the effectiveness of surgical training: a population-based cohort study. Ophthalmology 2017; 124 (04) 532-538
• 11 Blomquist PH, Morales ME, Tong L, Ahn C. Risk factors for vitreous complications in resident-performed phacoemulsification surgery. J Cataract Refract Surg 2012; 38 (02) 208-214
• 12 Zare M, Javadi M-A, Einollahi B, Baradaran-Rafii A-R, Feizi S, Kiavash V. Risk factors for posterior capsule rupture and vitreous loss during phacoemulsification. J Ophthalmic Vis Res 2009; 4 (04) 208-212
• 13 Tielsch JM, Sommer A, Katz J, Quigley H, Ezrine S. ; Baltimore Eye Survey Research Group. Socioeconomic status and visual impairment among urban Americans. Arch Ophthalmol 1991; 109 (05) 637-641
• 14 Zhang X, Cotch MF, Ryskulova A. , et al. Vision health disparities in the United States by race/ethnicity, education, and economic status: findings from two nationally representative surveys. Am J Ophthalmol 2012; 154 (6, Suppl): S53-62.e1
• 15 Alexander P, Matheson D, Baxter J, Tint NL. United Kingdom national cataract training survey. J Cataract Refract Surg 2012; 38 (03) 533-538