Assessing Surgical Competency among Fellows in Vitreoretinal Surgery: A Survey of Fellowship Program Directors and Fellows

Abstract

Purpose: We surveyed vitreoretinal (VR) fellowship program directors (PDs) to elucidate how they assess surgical competency among VR fellows. In addition, we also surveyed fellowship program graduates for the years 2022 and 2023 regarding assessment metrics and tools used during VR fellowship training.

Design: Web-based, cross-sectional descriptive study.

Subjects: Fellowship PDs and recent fellowship graduates in the United States and Canada METHODS: The survey, distributed via email, queried participants about several aspects of assessing surgical competency in VR training including surgical numbers, teaching/assessment methods used to assess fellow surgical competency, comfort of fellows for various surgical procedures, appropriate degree of supervision, and criteria for a hypothetical national competence standard. A Likert scale was utilized for questions capturing participants' opinion. Mean response scores were reported.

Main outcome measures: Comparison of responses between PDs and fellows.

Results: Forty-two PDs (42.1%) (33 university-based and 9 private institutions) and 40 fellows (16.8%) (28 academic and 12 private institutions) responded to the survey. Fellows expect a higher minimum number of vitrectomies (≥300) by graduation than PDs (≥200). Both PDs and fellows ranked direct observation of fellow (4.95/4.75), discussion with other faculty on fellow surgical performance (3.93/3.60), and outcomes of fellow surgical cases (3.88/3.53) (P > 0.05) respectively, as top 3 teaching tools. Both PDs and fellows expressed high comfort levels with various complex surgeries, such as primary scleral buckle (4.45/4.60), proliferative vitreoretinopathy detachments (4.57/4.45), advanced diabetic retinal detachments (4.57/4.38), and giant retinal tears (4.64/4.50), by the time of graduation. Autonomy was also considered an important indicator of surgical competence by both groups. However, apart from direct surgical experience, fellows rated other educational tools lower than PDs. There was overall agreement between the groups on several aspects of a hypothetical national competence standard.

Conclusions: This survey identified that the key tools utilized to assess surgical proficiency were direct observation of surgery by attending physician, discussions about fellow performance among faculty, and outcomes of fellow surgical cases. Both groups emphasized that by graduation, fellows should be proficient in several complex VR surgeries. These findings suggest a need for a more systematic approach to assess surgical competency of VR fellows.

Financial disclosure(s): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

Keywords: Fellows; Program directors; Surgical competency; Survey; Vitreoretinal surgery.