A Modular Cataract Surgery Training Model Incorporating Human Factors and a Pedagogical Theory

Abstract

Synopsis

High volume cataract lists are cost-effective, reduce waiting times, and facilitate surgical teaching. We propose a stepwise training model that incorporates human factor principles and a reflective pedagogical approach, which has not been documented previously.

Background/Aims

Surgical training in ophthalmology is effective when a modular approach is utilised. High volume lists further enhance training by increasing exposure to a newer way of learning and working. We evaluated the efficiency and safety of trainee-assisted cataract surgery across a single NHS eye unit and an independent sector (IS) provider.

Methods

We examined results from audits of surgical efficiency and safety in trainee-assisted high-volume lists, including a single-centre comparative evaluation of consultant-only and trainee lists. The quantitative and qualitative information gained from these projects helped us to implement a modular, structured training programme that utilises a reflective cycle of pedagogy, suitable for any grade of trainee.

Results

Our projects included an audit following cataract surgery performed by a surgical trainee over a 5-month period, which showed excellent post-op refractive results and no cases of intra-operative and post-operative complications. A single-centre observational study demonstrated comparable surgical throughput and safety results for trainee and solo consultant high volume lists. Systemic and ocular complication rates were reported to be similar for low and medium risk cataract surgery among trainee supervised IS and NHS lists.

Conclusion

Cataract surgery outcomes and patient feedback support the effectiveness of the surgical training model. Combining Gibbs’ reflective cycle of critical reflection with the International Council of Ophthalmology’s principles helped us to develop the QM Model of modular teaching for cataract surgery, which we believe is suitable for utilisation in all surgical centres in the NHS and IS settings, for both low volume and high-volume surgical lists regardless of trainee experience.

Plain Language Summary

What Is Already Known on This Topic

• High volume lists are increasingly popular for cataract surgery; however, trainee exposure to high flow cataract surgery lists is limited.

What This Study Adds

• A modular approach to training via high volume training lists is possible.

• Origination and implementation of a stepwise cataract surgery training model that incorporates human factors and a pedagogical learning approach within high volume lists in the independent sector and NHS setting.

How This Study Might Affect Research, Practice, or Policy

• Promote the widespread adoption of the QM model which integrates modular-based experiential learning approaches for surgical training in both NHS and independent sector settings, applicable to low and high volume surgical lists, irrespective of trainee experience.

Keywords:

• Cataract
• surgery
• training
• education
• teaching
• pedagogy

Acknowledgments

The authors gratefully acknowledge third-party editorial assistance provided by Rod McNeil Associates, which was funded by Thea Pharmaceuticals Ltd.

Disclosure

Dr Qasim Mansoor is a consultant advisor for Thea Pharmaceuticals, outside the submitted work. The authors report no other conflicts of interest in this work.