A Novel Simulation Model Significantly Improves Confidence in Canthotomy and Cantholysis Among Ophthalmology and Emergency Medicine Trainees

• Published in: The Journal of emergency medicine 2023-11, Vol.65 (5), p.e460-e466
• Main Authors: Wilde, Caroline, Memon, Sara, Ah-Kye, Laura, Milligan, Alice, Pederson, Marcus, Timlin, Hannah
• Format: Article
• Language: English
• Subjects: Cantholysis; Canthotomy; Low-fidelity; Orbital compartment syndrome; Simulation model
• ISSN: 0736-4679; 2352-5029
• DOI: 10.1016/j.jemermed.2023.05.009

Orbital compartment syndrome is a potentially blinding eye condition. Timely diagnosis and treatment are paramount to optimize visual outcomes. Lateral canthotomy and cantholysis is the definitive management and a required competency for emergency physicians and ophthalmologists. Lack of confidence in the procedure can result in delayed treatment and poor outcomes. Our aim was to create a low-cost, realistic, simulation model to ensure trainees were confident in performing lateral canthotomy and cantholysis. A model was created using equipment found in the emergency department. This model's efficacy was assessed using pre- and post-teaching questionnaires measuring learner's self-perceived confidence. Forty-seven emergency medicine and 18 ophthalmology registrars rated their confidence in the procedure using a 5-point Likert scale (1 = not very confident, 5 = extremely confident); 42% (n = 27) of participants felt ‘quite confident’ (4 on Likert scale) in carrying out the procedure unsupervised out of hours after the teaching session, compared with 9.23% (n = 6) before (p < 0.01). Our model resulted in significant increases in all three measures of confidence (diagnosing orbital compartment syndrome, locating the necessary equipment and performing canthotomy and cantholysis) and was rated as 4.35 (1 = not at all helpful, 5 = extremely helpful) in understanding the anatomy of the region. Sixty-six percent (n = 43) of participants stated they would like further simulation teaching. Our model is low cost, easy to assemble, and anatomically correct. The user can ‘strum’ the inferior canthal tendon without cutting the lower lid, appreciating the difference between canthotomy and cantholysis. Use of this model significantly increased the number of learners who felt “quite confident” with performing the procedure. Use of this model should be considered for trainees in ophthalmology and emergency medicine.