Structured proficiency based progression phacoemulsification training curriculum using virtual reality simulator technology

The current method of surgical training is based on the Halstedian model where novice surgeons learn by observing and performing surgery under supervision. Cataract extraction by phacoemulsification is a type of minimally invasive surgery where direct observation is inadequate in revealing how things are done. Operating under the microscope takes away the direct hand-eye coordination. During the operation, a novice surgeon has to pay disproportionate amount of attention to psychomotor performance, depth and spatial judgment, operative judgment and decision-making, comprehending instruction, and gaining additional knowledge. The attentional capacity quickly becomes saturated, leaving very little to spot dangers ahead or to get out of difficulty situation. Consequently, patients are at higher risk when novice surgeons perform the operation.

The solution to improve novice surgeon's attentional capacity is to pre-trained pertinent operative skills in a controlled setting using simulator technology. EYESi phacoemulsification simulator offers high fidelity rendition of intra-ocular microsurgical environment. Novice surgeons can practice on the simulator until proficiency level is achieved.

The aim of this project is to design and validate didactic and skill training curriculum for cataract surgery. The didactic curriculum employs 3-dimentional animations in order to explain complex surgical procedures. The proficiency level for skill training is set based on the simulator performance of ten expert cataract surgeons. A structured proficiency based simulator curriculum is designed and validated with randomized control trialin this study.