Virtual reality simulator-based assessment of non-technical skills in eye surgery

BACKGROUND: Non-technical skills (NTS) are cognitive, social, and personal abilities that, when combined with technical skills (TS), contribute to surgical competence through safe and efficient task performance. The objective of this study was to develop and implement a simulation-based training model that integrates both NTS and TS in complex cataract surgery. METHODS: A comparative study was performed. Ophthalmology residents with experience in cataract surgery ranging from novice to beginner level were enrolled. During the first step, the participants were engaged in a “training simulation” on the Eyesi® Surgical simulator (CAT-D module: Advanced courses: white cataract). During the second step, an “evaluative simulation” was conducted using the Eyesi® simulator on the same complex case. After each simulation, participants were rated using HUFOES score (HUman Factors in intraoperative Ophthalmic Emergencies Scoring System) for NTS and Eyesi® performance score for TS. The primary outcome was the comparison of NTS (HUFOES score) between training and evaluative simulations. A p-value under 0.05 was considered significant. RESULTS: A total of 14 ophthalmology residents were included with a median age of 27 (interquartile range [IQR] 25–28). They had undergone a median of 30 cataract surgeries prior to the study (IQR 10–60). The mean global HUFOES score significantly improved between the simulations (from 42.0 ± 6.7 after the training simulation to 75.2 ± 6.3 after the evaluative simulation; p < 0.001). A positive correlation was identified between the different items of the HUFOES score following each simulation (p < 0.001). In multivariate analysis, the HUFOES score after the evaluative simulation was significantly associated with the HUFOES score after the training simulation (β = 0.49; p = 0.019) and with participant age (β = +1.89 per year; p = 0.008). CONCLUSIONS: A surgical simulation-based training program with debriefing led to a significant improvement in NTS for residents with a mean experience in cataract surgery ranging from novice to beginner level. NTS training could be implemented in a simulated environment and incorporated into the ophthalmology residents’ training curriculum for cataract surgery learning.

Augmented reality · Cataract surgery · Eye tracking · MEDLINE · Virtual patient · Virtual reality · Intraocular Surgery and Lenses · Ophthalmology and Visual Health Research · Surgical Simulation and Training

• Simulation in healthcare education

  Ivette Motola, Luke Devine et al.•Medical Teacher•2013

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