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Randomized Controlled Trial
. 2023 Jan 1;32(1):57-64.
doi: 10.1097/IJG.0000000000002114. Epub 2022 Aug 22.

The Impact of Simulation-Based Trabeculectomy Training on Resident Core Surgical Skill Competency

Roxanne Annoh  1 , John Buchan  1 , Stephen Gichuhi  2 , Heiko Philippin  1   3 , Simon Arunga  1   4 , Agrippa Mukome  5 , Fisseha Admassu  6 , Karinya Lewis  7   8 , William Makupa  9 , Juliet Otiti-Sengeri  10 , Min Kim  11 , David MacLeod  11 , Matthew J Burton  1   12 , William H Dean  1   13
Affiliations
Randomized Controlled Trial

The Impact of Simulation-Based Trabeculectomy Training on Resident Core Surgical Skill Competency

Roxanne Annoh et al. J Glaucoma. .

Abstract

Prcis: Simulation-based surgical education shows a positive, immediate, and sustained impact on core surgical skill competency in trabeculectomy among resident ophthalmologists in training.

Purpose: To measure the impact of trabeculectomy, surgical simulation training on core surgical skill competency in resident ophthalmologists.

Materials and methods: This is a post hoc analysis of the GLAucoma Simulated Surgery trial, which is a multicenter, multinational randomized controlled trial. Resident ophthalmologists from 6 training centers in sub-Saharan Africa (in Kenya, Uganda, Tanzania, Zimbabwe, and South Africa) were recruited according to the inclusion criteria of having performed zero surgical trabeculectomies and assisted in <5. Participants were randomly assigned to intervention and control arms using allocation concealment. The intervention was a 1-week intensive trabeculectomy surgical simulation course. Outcome measures were mean surgical competency scores in 8 key trabeculectomy surgical skills (scleral incision, scleral flap, releasable suturing, conjunctival suturing, sclerostomy, tissue handling, fluidity, and speed), using a validated scoring tool.

Results: Forty-nine residents were included in the intention-to-treat analysis. Baseline characteristics were balanced between arms. Median baseline surgical competency scores were 2.88/16 [interquartile range (IQR): 1.75-4.17] and 3.25/16 (IQR: 1.83-4.75) in the intervention and control arms, respectively. At primary intervention, median scores increased to 11.67/16 (IQR: 9.58-12.63) and this effect was maintained at 3 months and 1 year ( P =0.0001). Maximum competency scores at primary intervention were achieved in the core trabeculectomy skills of releasable suturing (n=17, 74%), scleral flap formation (n=16, 70%), and scleral incision (n=15, 65%) compared with scores at baseline.

Conclusions: This study demonstrates the positive impact of intensive simulation-based surgical education on core trabeculectomy skill development. The rapid and sustained effect of resident skill acquisition pose strong arguments for its formal integration into ophthalmic surgical education.

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Conflict of interest statement

Disclosure: The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Timeline of interventions (simulation-based surgical education trabeculectomy (SBSE TE) course) and assessments of the primary intervention (X) and intervention in the control (x) groups using the Sim-OSSCAR tool. Sim:OSSCAR =Ophthalmic Simulated Surgical Competency Assessment Rubric
Figure 2
Figure 2
Sim:OSSCAR tool for simulated trabeculectomy. Performance of each individual core surgical skill is ranked from 0 (novice), 1 (advanced beginner) and 2 (competent). Sim:OSSCAR =Ophthalmic Simulated Surgical Competency Assessment Rubric
Figure 3
Figure 3
The GLASS trial core skills in trabeculectomy and assessment scores. GLASS= GLAucoma Simulated Surgery, Sim:OSSCAR= Ophthalmic Simulated Surgical Competency Assessment Rubric
Figure 4
Figure 4
Mean resident competency scores by core surgical skill between arms, over time. Primary intervention denotes simulation training in the intervention arm, given shortly after baseline assessment. Intervention in the control arm occurred shortly after one year. Sim:OSSCAR= Ophthalmic Simulated Surgical Competency Assessment Rubric
Figure 5
Figure 5. Number of participants achieving maximum scores in competency in surgical skills over time
See this image and copyright information in PMC

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