A Broadly Applicable Surgical Teaching Method: Evaluation of a Stepwise Introduction to Cataract Surgery

• Published in: Journal of surgical education 2014-03, Vol.71 (2), p.169-175
• Main Authors: Kloek, Carolyn E., MD, Borboli-Gerogiannis, Sheila, MD, Chang, Kenneth, MD, Kuperwaser, Mark, MD, Newman, Lori R., MEd, Marie Lane, Anne, MPH, Loewenstein, John I., MD
• Format: Article
• Language: English
• Subjects: Adult; cataract; Cataract Extraction - education; cataract surgery; deliberate practice; General Surgery - education; Humans; Internship and Residency; medical education; Medical Knowledge; Ophthalmology - education; Patient Care; Practice-Based Learning and Improvement; procedural training; Retrospective Studies; Surgery; surgical curriculum; Teaching - methods
• ISSN: 1931-7204; 1878-7452
• DOI: 10.1016/j.jsurg.2013.07.007

Objective Although cataract surgery is one of the most commonly performed surgeries in the country, it is a microsurgical procedure that is difficult to learn and to teach. This study aims to assess the effectiveness of a new method for introducing postgraduate year (PGY)-3 ophthalmology residents to cataract surgery. Setting Hospital-based ophthalmology residency program. Design Retrospective cohort study. Participants PGY-3 and PGY-4 residents of the Harvard Medical School Ophthalmology Residency from graduating years 2010 to 2012. Results In July 2009, a new method of teaching PGY-3 ophthalmology residents cataract surgery was introduced, which was termed “the stepwise introduction to cataract surgery.” This curriculum aimed to train residents to perform steps of cataract surgery by deliberately practicing each of the steps of surgery under a structured curriculum with faculty feedback. Assessment methods included surveys administered to the PGY-4 residents who graduated before the implementation of these measures ( n = 7), the residents who participated in the first and second years of the new curriculum ( n = 16), faculty who teach PGY-4 residents cataract surgery ( n = 8), and review of resident Accreditation Council for Graduate Medical Education surgical logs. Resident survey response rate was 100%. Residents who participated in the new curriculum performed more of each step of cataract surgery in the operating room, spent more time practicing each step of cataract surgery on a cataract surgery simulator during the PGY-3 year, and performed more primary cataract surgeries during the PGY-3 year than those who did not. Faculty survey response rate was 63%. Faculty noted an increase in resident preparedness following implementation of the new curriculum. There was no statistical difference between the precurriculum and postcurriculum groups in the percentage turnover of cataracts for the first 2 cataract surgery rotations of the PGY-4 year of training. Conclusions The introduction of cataract surgery to PGY-3 residents in an organized, stepwise manner improved resident preparedness for the PGY-4 year of residency. This surgical teaching method can be easily applied to other surgical specialties.