Abstract
Objectives
To develop and implement a simulation-based training model for the management of posterior capsule rupture (PCR) from a non-technical skills (NTS) perspective, and analyse changes in participant’s NTS and technical skills (TS).
Methods
The simulation-based training model consisted of two identical PCR simulations with NTS stressors applied, separated by a predominantly NTS focussed training intervention. Participants’ TS and NTS were evaluated by two blinded assessors using the Objective Structured Assessment of Technical Skill (OSATS) global rating scale and the HUman Factors in intraoperative Ophthalmic Emergencies Scoring System (HUFOES) respectively. Paired t-tests were used to establish the difference in mean HUFOES and OSATS scores between initial and repeat simulations; p < 0.05 indicated statistical significance. McGaghie’s model of translational outcomes for simulation-based learning was used to establish the simulation model’s educational status.
Results
Seventeen cataract surgeons of varying training grades participated in the simulation-based training model. NTS improved with statistical significance; mean HUFOES scores increased from 48.7 ± 16.6 to 59.2 ± 14.8 (p < 0.001). Mean OSATS scores increased without statistical significance from 16.0 ± 7.3 to 17.9 ± 8.3 (p = 0.07). This simulation model achieved Level 1 (internal acceptability) and Level 2 (contained effects) according to McGaghie’s model.
Conclusions
This novel simulation-based training model was designed to improve the NTS required for managing intraoperative PCR, through the provision of an interactive training session. Statistically significant improvements in participants’ NTS in combination with statistically insignificant improvements in TS demonstrate that the simulation-based training model has specificity within the NTS domain.
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Acknowledgements
The authors would like to thank the Simulation department at the University Hospitals Sussex (UHSussex) NHS Trust for helping with the semantics of the simulation. The authors are also grateful to: Theatre staff: Jenny Brookes, Vasiliki Xenaki, Chris Tully, Letizia Buccoliero, Tina McMilan, Regis Chaco, Myrna McHarg and Philip Harris. Consultants: Edward Hughes, Dominic Heath. Trainees: Hasan Naveed, Simerdeep Kaur, Hanbin Lee, Christopher Holmes, Ahmed Roble, Vidushi Golash, Patrick Idam, Jamal Sawan, Radhika Dashputra, Huw Oliphant, Tristian Mann, Gabriela Ortiz, Krystian Kyza. Management: Emma Goudman, Alex Shaw, Jane McNevin, and Neil Vine.
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TCW contributed to the study’s concept and design, data acquisition and statistical analysis, drafting and revision of the manuscript, administrative and technical support throughout the study, and final approval of the manuscript. SM contributed to the study’s concept and design, data acquisition and statistical analysis, drafting and revision of the manuscript, administrative and technical support throughout the study, provided regular supervision, and approved the final manuscript. AS contributed to the study’s concept and design, data acquisition, revision of the manuscript, administrative and technical support throughout the study, provided regular supervision, and approved the final manuscript. WS contributed to the study’s concept and design, revision of the manuscript, administrative and technical support throughout the study, provided regular supervision, and approved the final manuscript. MAN contributed to the study’s concept and design, data analysis, drafting and revision of the manuscript, administrative and technical support throughout the study, provided regular supervision, and approved the final manuscript. MW contributed to data acquisition, drafting and revision of the manuscript, technical support throughout the study, provided supervision, and approved the final manuscript. SR contributed to the study’s concept and design, data acquisition and statistical analysis, drafting and revision of the manuscript, administrative and technical support throughout the study, provided regular supervision, and approved the final manuscript.
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None of the authors have any financial interest in any product or procedures mentioned in this manuscript. Other disclosures are as follows: TCW, SM, AS, WS, MW and SR: none. MAN: research grants from Alcon Laboratories, USA; European Society of Cataract and Refractive Surgery; Johnson & Johnson, USA; Rayner Intraocular lenses, UK. Lecture fees from Alcon Laboratories, USA. Consultant to Hoya. Travel grant from Alcon Laboratories, USA & Bausch & Lomb, USA.
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Wood, T.C., Maqsood, S., Saunders, A. et al. Non-technical skills simulation-based training model for managing intraoperative posterior capsule rupture during cataract surgery. Eye 37, 474–479 (2023). https://doi.org/10.1038/s41433-022-01962-2
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DOI: https://doi.org/10.1038/s41433-022-01962-2
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