Impact of a structured training program to enhance skills in phacoemulsification surgery.

PURPOSE: The aim of this study was to determine whether the introduction of a structured short-term phacoemulsification training program improved the ICO-OSCAR (International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubric) score and the learning curve of the trainees and decreased the complication rates of the cases. METHODS: This study was a retrospective, observational study conducted in a tertiary eye care hospital in India. The study was conducted from March 2018 to October 2019 based on a structured phacoemulsification training program introduced in January 2019. The trainees enrolled in the phacoemulsification training program were divided into two groups: Group 1 (n = 33), who underwent training before the introduction of the structured program, and Group 2 (n = 29), who underwent the training after the introduction of the structured training program. Each trainee performed 20 cases. Group 1 training consisted of wet-lab and phacoemulsification surgeries. Group 2 training program comprised three modules over 5 weeks and a preassessment examination. Premodule 1 imparted cognitive skills; Module 1 was on structured wet-lab, Module 2 was about phacoemulsification step surgery, and Module 3 had independent complete surgeries. Group 2 also underwent compulsory Observation of cases being performed in the operation theater, surgical video recording review, and formative feedback. Mean OSCAR score comparison was done for both the groups. The OSCAR score was also calculated case-wise to obtain the learning curve with respect to the entry and exit levels, by classifying the trainees in each group as Novice, Beginner, Advanced Beginner, or Competent. A comparison of the posterior capsular rupture (PCR) rates and vision at discharge of all the cases was done. RESULTS: Group 2 had a significantly better mean OSCAR score than Group 1 (4.03 and 3.43, respectively; P < 0.001). The PCR rate of the cases was significantly lower in Group 2 than in Group 1 (9.14% and 20.30%, respectively; P < 0.001). Group 2 had a significantly better visual acuity outcome of the cases than Group 1. Group 1 started as Novice (OSCAR score: 2), whereas Group 2 started as Beginner (OSCAR score: 3). Group 2 reached the Advanced Beginner level eight to 10 cases prior to Group 1. CONCLUSION: A structured training curriculum can make a significant difference in the training experience of the trainees and enable better surgical outcomes and a decrease in the complication rates.

Comparative evaluation of qualitative performance of technical human resource in school eye health program.

PURPOSE: To measure sensitivity and specificity of vision screeners in identifying children with visual impairment and positive signs and symptoms and assess association of effectiveness with individual characteristics of screeners and type of schools screened. METHODS: A total of 1096 children from age 5 to 15 years of age were screened. A total of 396 children were screened from a municipal school, 200 children from a government-aided school, and 500 children from a private school were screened. Four persons with basic 12th standard science qualification willing to be a part of school eye health program were selected who carried out screening in school children after receiving appropriate training. RESULTS: The two vision screeners who had a background of conducting community eye health programs and worked in eye hospital had 100% sensitivity and specificity for presenting visual acuity, squint detection, and blurring. The screening by these screeners was done in private and semi-private schools, respectively. The other two screeners with no such background conducting screening in government schools had 60% and 75% sensitivity in detecting presenting visual acuity, respectively. CONCLUSION: People with a background of organizing community eye health programs and those working in eye hospitals are the best candidates for being trained as new cadre of vision screeners with best results being obtained in private and government-aided schools.