Standardizing Cataract Surgery Rating Skill Between Ophthalmology Residents and Attending Physicians: An Educational Intervention

Introduction

References

Methods Results Conclusion

Group-by-Time Interaction

Cataract surgery is one of the most frequently performed surgical procedures in the world. Ophthalmology residents must become skilled cataract surgeons during the course of their training. The Accreditation Council on Graduate Medical Education has committed to a paradigm shift in resident education from simply meeting a minimum number of cases to ensuring quality by measuring outcomes. Recently there has been an effort to standardize the assessment of resident surgical skills with the goal of a more uniform and accurate process.  There are cataract surgery grading rubrics that show low inter-grader variability among attendings, however, there is no standardized training on how to use these rubrics. We have started a multi-institution project adapting the International Council of Ophthalmology Surgical Competency Assessment Rubric. We have chosen 5 steps out of the 14 steps of the rubric in order to facilitate the initial phase of the study:

1) Capsulorrhexis Commencement

2) Capsulorrhexis Completion

3) Hydrodissection

4) Irrigation and Aspiration

5) Lens Insertion and Placement

Screenshot of Moodle

We employ a group-by-time interaction model to evaluate the cataract surgery grading assessments pre and post-training between residents and attendings. We recruited 2 PGY-3 and 2 PGY-4 residents and 1 experienced attending physician from Loyola University Medical Center, University of Illinois at Chicago, Northwestern University and John Stroger Hospital of Cook County to volunteer for the study for a total of 20 participants. All participants will go through 1 orientation session and 2 training sessions as a group. At orientation we will explain how to use to written rubric to ensure everyone has the same understanding. We will also administer a subjective self-confidence assessment. Following orientation there will be 4 cases administered to participants via Moodle and this will be labeled “Measurement 1.” The cases will be spread out over two weeks; one will be sent out every three days. After completion of measurement 1, all participants will undergo training. After training another 4 cases will be administered over the course of the following two weeks. Following completion of the last case, the subjective self-confidence assessment will be administered again.

The surgery cases are graded on four different well- defined skill levels:

I. Novice

II. Beginner

III. Advanced Beginner

IV. Competent  

This project describes a novel, multi-institutional approach to integrating a surgical grading rubric into the resident surgical training curriculum. We have created a user-friendly computer application to train residents in surgical skill assessment and measure the effect of training.

This study is an important step in standardizing cataract surgery rating for resident and attending cataract surgeons. This will ultimately facilitate their ability to assess their resident surgical skill and expedite their skill development.

1) Accreditation Council for Graduate Medical Education. Educating Physicians for the 21st Century. Systems-Based Practice, 2006. Available at: http://www.acgme.org/outcome/e-learn/introduction/SBP.html. 2) Chung AKK, Gauba V, Saleh GM. Assessing resident competency [letter]. Ophthalmology 2007; 114:1587–1588.3) Henderson BA, Rasha A. Teaching and assessing competence in cataract surgery. Curr Opin Ophthalmol 2007; 18:27–31.4) Cremers SL, Ciolino JB, Ferrufino-Ponce ZK, Henderson BA. Objective Assessment of Skills in

Intraocular Surgery (OASIS). Ophthalmology. 2005;112:1236-41.5) Cremers SL, Lora AN, Ferrufino-Ponce ZK. Global Rating Assessment of Skills in Intraocular Surgery (GRASIS). Ophthalmology 2005; 112:1655–1660.6) Saleh GM, et al. Objective Structured Assessment of Cataract Surgical Skill. Arch Ophthalmol 2007;125:363-366. 7) Golnik KC, Beaver H, Gauba V, Lee AG, Mayorga E, Palis G, Saleh GM. Cataract surgical skill

assessment [letter]. Ophthalmology 2011; 118:427–427.

Above is the Moodle interface we are using to administer the assessments that the resident and attending cataract surgeons will grade pre and post-training.

Screenshot of Cyberlink PowerdirectorTM

We have created a comprehensive video rubric with a corresponding standardized training session. The goal of the study is to measure the effect of our video training on resident and attending surgeons’ ability to grade cataract surgical skill before and after rubric use training.

Screen shots of Cyberlink PowerDirectorTM video editing software being used to create cataract surgery video clips.

Acknowledgements: Grant Support: The Richard A. Perritt Charitable Foundation and the Illinois Society for the Prevention of Blindness.

Andrew Pittner1A, Michael Nolan, MD1B, Aisha Traish, MD2, Asim Farooq, MD2, Robert Feder, MD3 Geoff Hill, MD4,Surrendar Dwarakanathan, MD4,William McGaghie, PhD1C,Charles Bouchard, MD1B,A Stritch School of Medicine, BOphthalmology, CLeischner Institute for Medical Education, 1Loyola University Chicago, Maywood, IL, 2UIC, Chicago, IL,3Northwestern, Evanston, IL, 4John H. Stroger Hospital of Cook County, Chicago, IL