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CC BY-NC-ND 4.0 · Journal of Academic Ophthalmology 2021; 13(02): e304-e310
DOI: 10.1055/s-0041-1740065
Research Article

Resident Skills Assessment in Corneal Suturing: A Comprehensive Review of Currently Proposed Educational Programs and Evaluation Tools

Lea Dormegny 
1   Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, Strasbourg, France
2   GEPROVAS (Groupe Européen de Recherche sur les Prothèses Appliquées à la Chirurgie Vasculaire), Department of Anesthesiology, Civil Hospital, Strasbourg, France
,
Nicole Neumann
2   GEPROVAS (Groupe Européen de Recherche sur les Prothèses Appliquées à la Chirurgie Vasculaire), Department of Anesthesiology, Civil Hospital, Strasbourg, France
,
Anne Lejay
2   GEPROVAS (Groupe Européen de Recherche sur les Prothèses Appliquées à la Chirurgie Vasculaire), Department of Anesthesiology, Civil Hospital, Strasbourg, France
3   Department of Vascular Surgery and Kidney Transplantation, Strasbourg University Hospital, France
,
Arnaud Sauer
1   Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, Strasbourg, France
2   GEPROVAS (Groupe Européen de Recherche sur les Prothèses Appliquées à la Chirurgie Vasculaire), Department of Anesthesiology, Civil Hospital, Strasbourg, France
,
David Gaucher
1   Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, Strasbourg, France
2   GEPROVAS (Groupe Européen de Recherche sur les Prothèses Appliquées à la Chirurgie Vasculaire), Department of Anesthesiology, Civil Hospital, Strasbourg, France
,
Nabil Chakfe
2   GEPROVAS (Groupe Européen de Recherche sur les Prothèses Appliquées à la Chirurgie Vasculaire), Department of Anesthesiology, Civil Hospital, Strasbourg, France
3   Department of Vascular Surgery and Kidney Transplantation, Strasbourg University Hospital, France
,
Tristan Bourcier
1   Department of Ophthalmology, New Civil Hospital, Strasbourg University Hospital, Strasbourg, France
2   GEPROVAS (Groupe Européen de Recherche sur les Prothèses Appliquées à la Chirurgie Vasculaire), Department of Anesthesiology, Civil Hospital, Strasbourg, France
› Author Affiliations Funding No funding source was used for this study.
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Abstract

Purpose This study aimed to perform a comprehensive review of publications proposing educational programs for resident skills assessment in corneal suturing.

Methods An extensive online article search in PubMed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PISMA) reporting guidelines was performed to identify prospective comparative studies or prospective before/after studies published up to March 2021 and reporting the assessment of ophthalmology residents' skills in corneal suturing during dedicated training sessions.

Results Three studies were identified for review. The first reported the efficiency of an electromagnetic tracking system placed on the surgeon's fingers coupled with a computer analysis of movements and time to identify surgeons with different backgrounds in corneal suturing. The second reported the efficiency of the reference system in assessing the improvement of corneal suturing conducted by residents after a training session, with video-based assessment for economy and confidence of movement, limiting tissue damage and precision of operative technique, reviewed by blind assessors. The third proposed an innovative remote corneal suturing training method using Zoom for direct feedback to the residents. The stitch quality was assessed for length, depth, radiality, and tension. The results were similar when compared with a group of residents without feedback.

Conclusion This review underlines the rarity and disparity of available tools for corneal suturing assessment, justifying the need for more complete models to be designed. These should consider body ergonomics and stitch quality and time. Comparative studies involving novices and attendings may provide reliable evaluation of existing gaps and specific metrics to target, helping residents to approach their superiors' experience.

Keywords

corneal suture - training - education - assessment - residents


Publication History

Received: 02 June 2021

Accepted: 19 August 2021

Article published online:
31 December 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Le K, Bursztyn L, Rootman D, Harissi-Dagher M. National survey of Canadian ophthalmology residency education. Can J Ophthalmol 2016; 51 (03) 219-225
    CrossrefPubMedGoogle Scholar
  • 2 ACGME. Accreditation Council for Graduate Medical Education. Accreditation Council for Graduate Medical Education Web site. Accessed November 2020 at: http://www.acgme.org
    PubMedGoogle Scholar
  • 3 Barnes RW. Surgical handicraft: teaching and learning surgical skills. Am J Surg 1987; 153 (05) 422-427
    CrossrefPubMedGoogle Scholar
  • 4 Aggarwal R, Boza C, Hance J, Leong J, Lacy A, Darzi A. Skills acquisition for laparoscopic gastric bypass in the training laboratory: an innovative approach. Obes Surg 2007; 17 (01) 19-27
    CrossrefPubMedGoogle Scholar
  • 5 Randleman JB, Song CD, Palay DA. Indications for and outcomes of penetrating keratoplasty performed by resident surgeons. Am J Ophthalmol 2003; 136 (01) 68-75
    CrossrefPubMedGoogle Scholar
  • 6 Wiggins RE, Cobo M, Foulks GN. Results of penetrating keratoplasty by residents. Arch Ophthalmol 1990; 108 (06) 851-853
    CrossrefPubMedGoogle Scholar
  • 7 Kutzscher EM, Sorenson AL, Goodman DF. Penetrating keratoplasty performed by residents. Arch Ophthalmol 2004; 122 (09) 1333-1336
    CrossrefPubMedGoogle Scholar
  • 8 Shimmura-Tomita M, Shimmura S, Tsubota K, Shimazaki J. Penetrating keratoplasty performed by residents compared with an experienced cornea transplant surgeon. J Surg Educ 2017; 74 (02) 258-263
    CrossrefPubMedGoogle Scholar
  • 9 Mascaro VL, Scarpi MJ, Hofling-Lima AL, de Sousa LB. Corneal transplantation in keratoconus: evaluation of results and complications obtained by skillful and surgeons in training [in Portuguese]. Arq Bras Oftalmol 2007; 70 (03) 395-405
    CrossrefPubMedGoogle Scholar
  • 10 Gross RH, Poulsen EJ, Davitt S, Schwab IR, Mannis MJ. Comparison of astigmatism after penetrating keratoplasty by experienced cornea surgeons and cornea fellows. Am J Ophthalmol 1997; 123 (05) 636-643
    CrossrefPubMedGoogle Scholar
  • 11 Hammoudi DS, Segev F, Abdolell M, Rootman DS. Outcome of penetrating keratoplasty performed by cornea fellows compared with that of an experienced staff surgeon. Cornea 2005; 24 (04) 410-416
    CrossrefPubMedGoogle Scholar
  • 12 Baldwin PJ, Paisley AM, Brown SP. Consultant surgeons' opinion of the skills required of basic surgical trainees. Br J Surg 1999; 86 (08) 1078-1082
    CrossrefPubMedGoogle Scholar
  • 13 Hamstra SJ, Dubrowski A, Backstein D. Teaching technical skills to surgical residents: a survey of empirical research. Clin Orthop Relat Res 2006; 449 (449) 108-115
    CrossrefPubMedGoogle Scholar
  • 14 Thomsen AS, Subhi Y, Kiilgaard JF, la Cour M, Konge L. Update on simulation-based surgical training and assessment in ophthalmology: a systematic review. Ophthalmology 2015; 122 (06) 1111-1130.e1
    CrossrefPubMedGoogle Scholar
  • 15 Ezra DG, Aggarwal R, Michaelides M. et al. Skills acquisition and assessment after a microsurgical skills course for ophthalmology residents. Ophthalmology 2009; 116 (02) 257-262
    CrossrefPubMedGoogle Scholar
  • 16 Saleh GM, Voyatzis G, Hance J, Ratnasothy J, Darzi A. Evaluating surgical dexterity during corneal suturing. Arch Ophthalmol 2006; 124 (09) 1263-1266
    CrossrefPubMedGoogle Scholar
  • 17 Koukkoulli A, Chandra A, Sheth H. et al. Bridging the gap: theory-based design of a microsurgical skills course for ophthalmology residents. J Surg Educ 2015; 72 (04) 585-591
    CrossrefPubMedGoogle Scholar
  • 18 Pasricha ND, Haq Z, Ahmad TR. et al. Remote corneal suturing wet lab: microsurgical education during the COVID-19 pandemic. J Cataract Refract Surg 2020; 46 (12) 1667-1673
    CrossrefPubMedGoogle Scholar
  • 19 Binenbaum G, Volpe NJ. Ophthalmology resident surgical competency: a national survey. Ophthalmology 2006; 113 (07) 1237-1244
    CrossrefPubMedGoogle Scholar
  • 20 Ellis H. Famous Operations. New York, NY: Media, Pa: Harwal Pub. Co.; 1984
    Google Scholar
  • 21 Handelman A, Keshet Y, Livny E, Barkan R, Nahum Y, Tepper R. Evaluation of suturing performance in general surgery and ocular microsurgery by combining computer vision-based software and distributed fiber optic strain sensors: a proof-of-concept. Int J CARS 2020; 15 (08) 1359-1367
    CrossrefPubMedGoogle Scholar
  • 22 Todorich B, Shieh C, DeSouza PJ. et al. Impact of microscope-integrated OCT on ophthalmology resident performance of anterior segment surgical maneuvers in model eyes. Invest Ophthalmol Vis Sci 2016; 57 (09) OCT146-OCT153
    CrossrefPubMedGoogle Scholar
  • 23 Lee AG, Oetting T, Beaver HA, Carter K. Task Force on the ACGME Competencies at the University of Iowa Department of Ophthalmology. The ACGME Outcome Project in ophthalmology: practical recommendations for overcoming the barriers to local implementation of the national mandate. Surv Ophthalmol 2009; 54 (04) 507-517
    CrossrefPubMedGoogle Scholar
  • 24 Zhang Z, Zhou M, Liu K. et al. Development of a new valid and reliable microsurgical skill assessment scale for ophthalmology residents. BMC Ophthalmol 2018; 18 (01) 68
    CrossrefPubMedGoogle Scholar
  • 25 Golnik KC, Motley WW, Atilla H. et al. The ophthalmology surgical competency assessment rubric for strabismus surgery. J AAPOS 2012; 16 (04) 318-321
    CrossrefPubMedGoogle Scholar
  • 26 Pujari A, Sharma N, Chaniyara MH. et al. Optimal refinement of residents' surgical skills by training on induced goat's eye corneoscleral perforation. Indian J Ophthalmol 2019; 67 (04) 547-548
    CrossrefPubMedGoogle Scholar
  • 27 Gurbaxani A, DeCock R. Anyone for leftovers? A simple method for teaching corneal graft suturing. Cornea 2010; 29 (09) 1072
    CrossrefPubMedGoogle Scholar