Assessment of perceived difficulties by residents in performing routine steps in phacoemulsification surgery and in managing complications

• Published in: Canadian journal of ophthalmology Vol. 44; no. 3; pp. 284 - 287
• Main Authors: Prakash, Gaurav, MD, Jhanji, Vishal, MD, Sharma, Namrata, MD, Gupta, Kamlesh, MBBS, Titiyal, Jeewan S., MD, Vajpayee, Rasik B., MS, FRCSEd, FRANZCO
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01.06.2009
• Subjects: Clinical Competence - standards; Cross-Sectional Studies; difficult situations; Education, Medical, Graduate - standards; Hospitals, Teaching; Humans; Internal Medicine; Internship and Residency; Intraoperative Complications; learning curve; Lens Implantation, Intraocular; management; Ophthalmology; phacoemulsification; Phacoemulsification - education; resident training; Risk Assessment; Surveys and Questionnaires; Time Factors; resident training; management; difficult situations; phacoemulsification; learning curve
• ISSN: 0008-4182; 1715-3360
• DOI: 10.3129/i09-051

Abstract Objective: To analyze the perceived difficulties of residents in performing the routine steps of phacoemulsification surgery and in managing complications. Design: Cross-sectional questionnaire-based study. Participants: Thirty-six residents performing phacoemulsification during their learning curve. Methods: On an 8-point Likert scale, residents noted comfort levels with various steps of cataract surgery and with managing complications. Results: The respondents were grouped into Group 1 (second-year residents, n = 19) and Group 2 (third-year residents, n = 17). Residents in Group 2 had greater surgical experience than residents in Group 1 ( p = 0.001). The most difficult step in cases of phacoemulsification for Group 1 was loading a foldable intraocular lens (IOL) (mean score 6.05, SD 1.57), and for Group 2 it was nuclear emulsification (mean score 3.59, SD 1.42). Both second- and third-year residents found capsular bag dialysis the most difficult complication (mean scores 6.0 [SD 1.9] and 5.75 [SD 2.14], respectively). The second-year residents had significantly more difficulty with errant capsulorrhexis, anterior chamber IOL placement, and repeated iris prolapse as compared with third-year residents. Group 2 residents reported that mature, senile cataracts were the most difficult cases for them to manage (mean score 6.23, SD 1.56). Conclusions: This study identifies perceived difficulties that residents experience in routine cases of cataract surgery, highlighting specific areas in which they may benefit from additional training and practice.