Proficiency based training for phacoemulsification
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Proficiency-Based Training for Phacoemulsification. Princeton Lee Research Fellow RCSI & ICO Alcon Education Night 27/02/2009. Peyton’s Learning Circle. Unconsciously Incompetent. Change. Awareness. Unconsciously Competent. Consciously Incompetent. Consciously Competent. Experience.

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Proficiency-Based Training for Phacoemulsification

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Proficiency based training for phacoemulsification

Proficiency-Based Training for Phacoemulsification

Princeton Lee

Research Fellow

RCSI & ICO

Alcon Education Night 27/02/2009


Peyton s learning circle

Peyton’s Learning Circle

Unconsciously

Incompetent

Change

Awareness

Unconsciously

Competent

Consciously

Incompetent

Consciously

Competent

Experience

Learning


Maslows hierarchy

Physiological

Security

Belonging

Esteem

Cognitive

Self acutalisation

Comfortable

Confident can express themselves

Feel a part of the group

Self confident

Have the ability to master the skills

Supported in achieving potential

Maslows Hierarchy


Proficiency based training

Proficiency-Based Training

  • Training program consists of objectively assessment of technical skills improvement proximate to the learning experience.

  • Performance metrics should be relevant to the surgical task being trained

  • Trainees to reach an objectively determined proficiency criterion


Education and training curriculum

Education and Training Curriculum

  • Education – acquisition of knowledge

  • Training – acquisition of skill


Template for a curriculum acquisition of knowledge

Template For A CurriculumAcquisition of Knowledge

1. Didactic teaching of relevant knowledge

2. Instruction of the steps of the procedure

3. Defining and illustrate common errors

4. Test of all previous didactic information


Template for a curriculum acquisition of skills

Template For A CurriculumAcquisition of Skills

5. Technical skills training on the simulator

6. Provide immediate feedback when an error occurs

7. Provide summative feedback at the completion of a trial

8. Iterate the skills training while providing evidence at the end of each trial of progress with reference to a proficiency performance goal that the trainee is expected to attain.


How does pbp training work

How does PBP training work?

  • Improves attention capacity for learning new and complex skills in theatre


Hypothetical model of attention

Hypothetical Model of Attention

Gaining additional

Knowledge

Attentional Capacity Threshold

Comprehending

Instruction

Operative Judgment

And Decision making

Attentional

resources

Depth & Spatial

judgment

Psychomotor

performance

Master

Surgeon

Novice

Surgeon

Gallagher et al. Annals of Surgery 2005;241(2):364-72


Hypothetical attentional resource benefits of pbp training

Hypothetical Attentional Resource Benefits of PBP Training

Gaining additional

Knowledge

Attentional Capacity Threshold

Comprehending

Instruction

Operative Judgment

And Decision making

Attentional

resources

Depth & Spatial

judgment

Psychomotor

performance

Pre-trained

Novice Surgeon

Master

Surgeon

Novice

Surgeon

Gallagher et al. Annals of Surgery 2005;241(2):364-72


Individual variability in automation process

Individual Variability in Automation Process

Gifted Surgeon

Attentional Resources

Average Surgeon

Below Average

Surgeon

Experience

Gallagher et al. Annals of Surgery 2005;241(2):364-72


Assessment

Assessment

  • Based on target achievements rather than number of cases


Eyesi simulator in ico

EYESi Simulator in ICO


Proficiency based training for phacoemulsification

Virtual Reality Training Improves Wet-lab Performance of Capsulorhexis: Results of a Randomized, Controlled Study

Graefes Arch Clin Exp Ophthalmol

Published online: 27 Jan. 2009

Szurman et al, Germany


Experimental design

Experimental Design

  • Subjects: 30 medical students and 32 ophthalmology residents.

  • Assessment Day 1 – perform capsulorhexis on pig’s eye (3 trials)

  • Randomization for simulator training and control

  • Simulator training group to reach a pre-set proficiency level

  • Assessment Day 2 – perform capsulorhexis on pig’s eye (3 trials)


Data analysis

Data Analysis

  • All (372) procedures were recorded

  • Scored by a single person who is blinded to the training status

  • Scoring Criteria – Total 10 marks

    • Circularity2 points

    • Size2 points

    • Centering2 points

    • Time2 points

    • Tissue Protection2 points


Forceps training level 1 and 4

Forceps Training Level 1 and 4


Anti tremor training level 1 3 and 4

Anti-tremor Training Level 1, 3 and 4


Capsulorhexis simulation level 1 2 5 and 6

Capsulorhexis Simulation Level 1, 2, 5, and 6


Results

Results


Vr to or clinical trial for phacoemulsification training

VR to OR Clinical Trial for Phacoemulsification Training

  • Objective:

    To demonstrate the transfer of skills acquired from training with simulator to operating room performance

  • A multi-centre clinical trial in Ireland supported by RCSI and ICO


Experimental design1

Experimental Design

  • Prospective, Controlled, Randomized, Blinded Study

  • Subjects: Ophthalmic surgical trainees who has done less than 100 cases of phacoemulsification


Method of vr to or trial

Method of VR to OR Trial

Objective assessment

Of perceptual, visual-spatial,

And psychomotor abilities

Didactic Training

Randomization

Videotaped

Phacoemulsification

procedure

VR Training until

Performance criterion

reached

Normal Training

Videotaped

Phacoemulsification

procedure

Videotaped

Phacoemulsification

procedure

Videotaped performance

objectively assessed

Videotaped performance

objectively assessed


Every subject will have

Every Subject Will Have

  • 1st month

    • Aptitude test

    • Baseline simulator assessment + Didactic training

    • Submit 3 video recordings of surgery

  • 2nd month

    • Randomization to simulator training or control group

  • 3rd month

    • Repeat simulator assessment

    • Submit 3 video recordings of surgery


Data collection and analysis

Data Collection and Analysis

  • Video recordings (either modular or complete case) will be assessed by two scorers who are blinded to the surgeons’ training status

  • 3 videos pre and post training each. But only 1 will be randomly selected for scoring

  • The score of pre and post training video will be analyzed for difference in the experimental and control group

  • The result is strictly confidential and will not be used to evaluation by the ICO or hospital


Conclusion

Conclusion

  • Proficiency-based progression training aim to improve:

    • Patient safety

    • Training environment for trainee and trainer

    • Knowledge and skill acquisition

    • Objective feedback and appraisal of surgical skills


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