CC BY-NC-ND 4.0 · Journal of Academic Ophthalmology 2020; 12(02): e298-e300
DOI: 10.1055/s-0040-1721068
Research Article

Integrating Mental Practice into a COVID-19 Appropriate Virtual Reality Cataract Surgery Course for Ophthalmology Residents

John C. Lin
1   Program in Liberal Medical Education, Brown University, Providence, Rhode Island
2   Section of Ophthalmology, Providence VA Medical Center, Providence, Rhode Island
,
Alfred A. Paul
2   Section of Ophthalmology, Providence VA Medical Center, Providence, Rhode Island
3   Division of Ophthalmology, Alpert Medical School, Brown University, Providence, Rhode Island
,
Ingrid U. Scott
4   Departments of Ophthalmology and Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
,
Paul B. Greenberg
2   Section of Ophthalmology, Providence VA Medical Center, Providence, Rhode Island
3   Division of Ophthalmology, Alpert Medical School, Brown University, Providence, Rhode Island
5   Office of Academic Affiliations, US Department of Veterans Affairs, Washington, District of Columbia
› Author Affiliations
Funding This material is the result of work supported with resources and the use of facilities at the Providence VA Medical Center, Providence, Rhode Island, United States; JCL was supported by a Summer Research Assistantship grant from the Brown University Program in Liberal Medical Education.
 

Abstract

To present a revised, publicly available virtual reality cataract surgery course for ophthalmology residents that integrates a novel mental practice program into the curriculum, fulfills the six core competencies of the Accreditation Council for Graduate Medical Education, and adheres to the Centers for Disease Control and Prevention educational recommendations for the coronavirus disease 2019 pandemic.


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Mental practice (MP) is the cognitive rehearsal of a task and is grounded in symbolic learning theory and neurophysiological research.[1] MP has been shown to improve operating performance and is becoming an important part of surgical residency curricula.[2] We developed an MP cataract surgery training program and integrated it into a publicly available, virtual reality (VR) cataract surgery course for ophthalmology residents.[3] The revised VR cataract surgery course fulfills the six core competencies of the Accreditation Council for Graduate Medical Education (ACGME)[4] and the Centers for Disease Control and Prevention (CDC) educational recommendations for the coronavirus disease 2019 (COVID-19) pandemic.[5]

The VR course curriculum has three sections: MP, didactics, and VR training. A key component of MP is the use of mental imagery to visualize and practice a procedure, and MP scripts can greatly facilitate this goal. To this end, the methodology ([Fig. 1]) described by Saab et al[6] was used to develop an MP script for cataract surgery instruction. Employing modified verbal protocol analysis, a cognitive walkthrough of cataract surgery was developed by interviewing three attending cataract surgeons, all of whom have several decades of experience teaching and mentoring resident surgeons. The surgeons were instructed to mentally perform cataract surgery and recall the visual, audial, kinesthetic, and cognitive sensations they experienced; when necessary, they were prompted for further detail about the mental imagery. The interviews were transcribed and coded by cue type using emergent theme analysis. Cues were then organized according to hierarchical task analysis of the key procedural steps of cataract surgery based on the American Academy of Ophthalmology's “Cataract in the Adult Eye: Preferred Practice Patterns.”[7] The resulting nine-step MP script was then reviewed by the three surgeons, revised based on their feedback, and integrated into the VR course. The MP section can be conducted in-person or virtually in one-on-one video conference or phone call sessions between the resident and attending ophthalmologist.

Zoom Image
Fig. 1 Flow chart for developing the mental practice script.

The didactics section is based on the 2020 to 2021 AAO Basic and Clinical Science Course “lens and cataract” section. There are short pre- and post-tests on the didactics that residents can complete online each year.

The VR section consists of training modules from the EyeSi Simulator (VRmagic, Mannheim, Germany; courseware version 2.5, software version 3.4). The VR training can be supervised remotely by an attending ophthalmologist reviewing videos of the resident's simulator performance. A validated practical test on their VR training[8] is administered at the end of the second year of residency; the test also can be evaluated remotely by a supervising ophthalmologist.

The course provides a table detailing pertinent course sections that meet the six-core ACGME competencies ([Table 1]): patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice.[4] It also includes a section outlining cleaning and handling of the VR simulator that is in alignment with CDC guidelines for the COVID-19 pandemic. Additionally, the MP and didactic training can be conducted remotely for social distancing.

In summary, this revised VR cataract surgery course uses MP to augment a more traditional curriculum composed of didactics and simulation training. It meets the ACGME core competencies, and at a time when the COVID-19 pandemic has reduced opportunities for hands-on surgical training, it promotes social distancing and safe, flexible surgical training in accordance with CDC recommendations.

The VR course is available at no cost in the Brown Digital Repository: https://doi.org/10.26300/ygj1-xc17. We hope other ophthalmology residency programs will find the course useful to integrate MP into their cataract surgery educational curricula.

Table 1

Accreditation Council for Graduate Medical Education competencies

Core competencies

Course content

Course section

Patient care

Perioperative patient care for cataract surgery

Didactics

Medical knowledge

Medical knowledge about cataracts and cataract surgery, including the key steps of cataract surgery

Didactics and mental skills

Professionalism

Care for patients with developmental disabilities, trauma, and psychosocial considerations

Didactics

Communication and interpersonal skills

Communication with patients regarding their surgical care

Didactics

Practice-based learning

Cognitive rehearsal of cataract surgery

Virtual cataract surgery

Mental skills virtual reality

Systems-based practice

Communicating preoperatively with the patient's primary care provider

Didactics


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Conflict of Interest

None declared.

Acknowledgments

The authors thank David R. Rivera, MD; Ezra L. Galler, MD; and Jorge J. Rivera, MD for their contributions to the mental practice script.

Note

The views expressed here are those of the authors and do not necessarily reflect the position or policy of the U.S. Department of Veterans Affairs or the U.S. government.


  • References

  • 1 Zhang H, Xu L, Zhang R. et al. Parallel alterations of functional connectivity during execution and imagination after motor imagery learning. PLoS One 2012; 7 (05) e36052
  • 2 Rao A, Tait I, Alijani A. Systematic review and meta-analysis of the role of mental training in the acquisition of technical skills in surgery. Am J Surg 2015; 210 (03) 545-553
  • 3 Paul SK, Scott IU, Paul AA, Greenberg PB. A virtual reality cataract surgery course for residents. J Acad Ophthalmol 2018; 10 (01) e41-e42
  • 4 Edgar L, McLean S, Hogan SO. et al. The Milestones Guidebook. Accreditation Council for Graduate Medical Education; 2020
  • 5 Centers for Disease Control and Prevention. Considerations for schools. Atlanta, GA: Centers for Disease Control; 2020. . Available at: https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/schools.html. Accessed July 10, 2020
  • 6 Saab SS, Bastek J, Dayaratna S, Hutton E, Salva CR. Development and validation of a mental practice tool for total abdominal hysterectomy. J Surg Educ 2017; 74 (02) 216-221
  • 7 Olson RJ, Braga-Mele R, Chen SH. et al. Cataract in the adult eye preferred practice pattern®. Ophthalmology 2017; 124 (02) 1-P119
  • 8 Jacobsen MF, Konge L, Bach-Holm D. et al. Correlation of virtual reality performance with real-life cataract surgery performance. J Cataract Refract Surg 2019; 45 (09) 1246-1251
  • 9 Centers for Disease Control and Prevention. Non-COVID-19 care framework. Atlanta, GA: Centers for Disease Control; 2020. . Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/framework-non-COVID-care.html. Accessed June 24, 2020

Address for correspondence

Paul B. Greenberg, MD, MPH
Section of Ophthalmology, Providence VA Medical Center
830 Chalkstone Ave, Providence
Rhode Island 02980   

Publication History

Received: 27 July 2020

Accepted: 08 September 2020

Article published online:
18 December 2020

© 2020. 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 Zhang H, Xu L, Zhang R. et al. Parallel alterations of functional connectivity during execution and imagination after motor imagery learning. PLoS One 2012; 7 (05) e36052
  • 2 Rao A, Tait I, Alijani A. Systematic review and meta-analysis of the role of mental training in the acquisition of technical skills in surgery. Am J Surg 2015; 210 (03) 545-553
  • 3 Paul SK, Scott IU, Paul AA, Greenberg PB. A virtual reality cataract surgery course for residents. J Acad Ophthalmol 2018; 10 (01) e41-e42
  • 4 Edgar L, McLean S, Hogan SO. et al. The Milestones Guidebook. Accreditation Council for Graduate Medical Education; 2020
  • 5 Centers for Disease Control and Prevention. Considerations for schools. Atlanta, GA: Centers for Disease Control; 2020. . Available at: https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/schools.html. Accessed July 10, 2020
  • 6 Saab SS, Bastek J, Dayaratna S, Hutton E, Salva CR. Development and validation of a mental practice tool for total abdominal hysterectomy. J Surg Educ 2017; 74 (02) 216-221
  • 7 Olson RJ, Braga-Mele R, Chen SH. et al. Cataract in the adult eye preferred practice pattern®. Ophthalmology 2017; 124 (02) 1-P119
  • 8 Jacobsen MF, Konge L, Bach-Holm D. et al. Correlation of virtual reality performance with real-life cataract surgery performance. J Cataract Refract Surg 2019; 45 (09) 1246-1251
  • 9 Centers for Disease Control and Prevention. Non-COVID-19 care framework. Atlanta, GA: Centers for Disease Control; 2020. . Available at: https://www.cdc.gov/coronavirus/2019-ncov/hcp/framework-non-COVID-care.html. Accessed June 24, 2020

Zoom Image
Fig. 1 Flow chart for developing the mental practice script.