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Transcript of Proficiency-Based Training for Phacoemulsification Princeton Lee Research Fellow RCSI & ICO Alcon...
Proficiency-Based Training for Phacoemulsification
Princeton Lee
Research Fellow
RCSI & ICOAlcon Education Night 27/02/2009
Peyton’s Learning Circle
Unconsciously
Incompetent
Consciously
Competent
Consciously
Incompetent
Unconsciously
Competent
Awareness
LearningExperience
Change
Maslows Hierarchy
Physiological Security
Belonging
Esteem Cognitive Self acutalisation
Comfortable Confident can
express themselves Feel a part of the
group Self confident Have the ability to
master the skills Supported in
achieving potential
Proficiency-Based Training
Training program consists of objectively assessment of technical skills improvement proximate to the learning experience.
Performance metrics should be relevant to the surgical task being trained
Trainees to reach an objectively determined proficiency criterion
Education and Training Curriculum
Education – acquisition of knowledge Training – acquisition of skill
Template For A CurriculumAcquisition of Knowledge
1. Didactic teaching of relevant knowledge
2. Instruction of the steps of the procedure
3. Defining and illustrate common errors
4. Test of all previous didactic information
Template For A CurriculumAcquisition of Skills
5. Technical skills training on the simulator
6. Provide immediate feedback when an error occurs
7. Provide summative feedback at the completion of a trial
8. Iterate the skills training while providing evidence at the end of each trial of progress with reference to a proficiency performance goal that the trainee is expected to attain.
How does PBP training work?
Improves attention capacity for learning new and complex skills in theatre
Hypothetical Model of Attention
Attentional Capacity Threshold
Attentionalresources
NoviceSurgeon
MasterSurgeon
Psychomotorperformance
Depth & Spatialjudgment
Operative JudgmentAnd Decision making
ComprehendingInstruction
Gaining additionalKnowledge
Gallagher et al. Annals of Surgery 2005;241(2):364-72
Hypothetical Attentional Resource Benefits of PBP Training
Attentional Capacity Threshold
Attentionalresources
NoviceSurgeon
MasterSurgeon
Psychomotorperformance
Depth & Spatialjudgment
Operative JudgmentAnd Decision making
ComprehendingInstruction
Gaining additionalKnowledge
Gallagher et al. Annals of Surgery 2005;241(2):364-72
Pre-trainedNovice Surgeon
Individual Variability in Automation Process
Gallagher et al. Annals of Surgery 2005;241(2):364-72
Gifted Surgeon
Average Surgeon
Below AverageSurgeon
Experience
Att
enti
on
al R
eso
urc
es
Assessment
Based on target achievements rather than number of cases
EYESi Simulator in ICO
Virtual Reality Training Improves Wet-lab Performance of Capsulorhexis: Results of a Randomized, Controlled Study
Graefes Arch Clin Exp Ophthalmol
Published online: 27 Jan. 2009
Szurman et al, Germany
Experimental Design
Subjects: 30 medical students and 32 ophthalmology residents.
Assessment Day 1 – perform capsulorhexis on pig’s eye (3 trials)
Randomization for simulator training and control Simulator training group to reach a pre-set profi
ciency level Assessment Day 2 – perform capsulorhexis on
pig’s eye (3 trials)
Data Analysis
All (372) procedures were recorded Scored by a single person who is blinded
to the training status Scoring Criteria – Total 10 marks
Circularity 2 points Size 2 points Centering 2 points Time 2 points Tissue Protection 2 points
Forceps Training Level 1 and 4
Anti-tremor Training Level 1, 3 and 4
Capsulorhexis Simulation Level 1, 2, 5, and 6
Results
Level of Improvement
Simulator Training
Control
Student +3.67
(0 to +7.33)
+0.33
(-2.33 to +4.00)
Resident +3.33
(+1.33 to +6.67)
+0.00
(-3.67 to +3.33)
VR to OR Clinical Trial for Phacoemulsification Training
Objective:
To demonstrate the transfer of skills acquired from training with simulator to operating room performance
A multi-centre clinical trial in Ireland supported by RCSI and ICO
Experimental Design
Prospective, Controlled, Randomized, Blinded Study
Subjects: Ophthalmic surgical trainees who has done less than 100 cases of phacoemulsification
Method of VR to OR TrialObjective assessment
Of perceptual, visual-spatial,And psychomotor abilities
Didactic Training
Randomization
VR Training untilPerformance criterion
reached
VideotapedPhacoemulsification
procedure
VideotapedPhacoemulsification
procedure
Normal Training
Videotaped performanceobjectively assessed
Videotaped performanceobjectively assessed
VideotapedPhacoemulsification
procedure
Every Subject Will Have
1st month Aptitude test Baseline simulator assessment + Didactic training Submit 3 video recordings of surgery
2nd month Randomization to simulator training or control
group
3rd month Repeat simulator assessment Submit 3 video recordings of surgery
Data Collection and Analysis
Video recordings (either modular or complete case) will be assessed by two scorers who are blinded to the surgeons’ training status
3 videos pre and post training each. But only 1 will be randomly selected for scoring
The score of pre and post training video will be analyzed for difference in the experimental and control group
The result is strictly confidential and will not be used to evaluation by the ICO or hospital
Conclusion
Proficiency-based progression training aim to improve: Patient safety Training environment for trainee and
trainer Knowledge and skill acquisition Objective feedback and appraisal of
surgical skills