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CC BY-NC-ND 4.0 · Journal of Academic Ophthalmology 2021; 13(02): e216-e227
DOI: 10.1055/s-0041-1740066
Research Article

Evaluating the Efficacy of Microsurgical Training Methods in Ophthalmology Education: A Systematic Review and Meta-analysis

Geoffrey Nguyen 
1   University of Maryland School of Medicine, Baltimore, Maryland
,
Jamie Palmer
1   University of Maryland School of Medicine, Baltimore, Maryland
,
Emilie Ludeman
2   Health Sciences and Human Services Library, University of Maryland, Baltimore, Maryland
,
Moran R. Levin
3   Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland
,
Ramya Swamy
3   Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland
,
Janet Alexander
3   Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland
› Author Affiliations Funding This research was supported in part by the Program for Research Initiated by Students and Mentors (PRISM), University of Maryland School of Medicine Office of Student Research. J.A. is currently funded by the National Institutes of Health (NIH) the University of Maryland Baltimore (UMB), Institute for Clinical and Translational Research (ICTR)/Clinical Science and Translational KL2 award (award number: 1KL2TR003099-01).
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Abstract

Objective The objective of our paper is to review all of the relevant literature in ophthalmology microsurgical education and identify which teaching methodologies were most effective.

Methods A systematic review and meta-analysis of the literature was conducted. Electronic databases, including Ovid MEDLINE, Cochrane CENTRAL, and EMBASE, were searched with preset terms. The search was through December 11, 2019. Eligibility criteria included studies with sufficient data for analyzing associations between surgical teaching techniques and success rates in surgical skills and the organization of the intervention as a microsurgical skills course, curriculum, or program. The articles were independently reviewed by two authors. Each included study was evaluated for quality using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach and risk of bias using the Cochrane Collaboration's tool for assessing bias.

Data Extraction and Synthesis Data extraction was performed by two reviewers and disagreements were checked by a third reviewer. A random-effects analysis was used to pool the outcomes of studies.

Main Outcomes and Measures Outcomes included time for completion of surgical task, level of preparedness, competency score, and number of surgeries with complications.

Results A total of 439 studies were reviewed and 13 studies (n = 8,790 surgical cases; n = 115 trainees) were included in the meta-analysis. Excluded articles studied cataract simulation training as the primary intervention or were not related to ophthalmology. All pooled results demonstrated a positive association with surgical outcomes; however, video-based education (standardized mean difference [SMD] = 2.49 [95% confidence interval (CI): 0.36–4.63]; four effects [four studies]; n = 69; I 2 = 90%) and stepwise teaching method (odds ratio [OR = 3.84 [95% CI: 2.66–5.55]; six effects [six studies]; n = 6,968; I 2 = 39%) interventions were the most favorable.

Conclusion and Relevance The following five interventions evaluated in this paper were found to be effective methods of improving performance outcomes in ophthalmic microsurgery: (1) didactic lectures, (2) video-based education, (3) surgical wet-laboratory, (4) stepwise method, and (5) direct supervision and feedback. Our meta-analysis concludes that video-based education and stepwise teaching interventions are the most effective methods for a microsurgical ophthalmology training curriculum. Combining the strengths of the interventions analyzed in this study should be considered when implementing and adjusting ophthalmic surgical skills curriculums.

Keywords

microsurgery - surgical skills - ophthalmology training - residency education - surgical curriculum - training program - surgical education - surgical teaching

Supplementary Material



Publication History

Received: 27 November 2020

Accepted: 19 August 2021

Article published online:
05 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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