Enhancing Phaco Training Outcomes

1. Enhancing Phaco Training Outcomes M. K. Kummelil, S. Nagappa, A. Shetty, A. Braganza Cataract and Refractive Surgery Services, Narayana Nethralaya, Post-Graduate Institute of Ophthalmology Bangalore, India.

2. Purpose • To document the impact of the ICO OSCAR rating system on the outcomes of an intense 2 week structured phaco training with wet lab support.

3. Methods • Trainees joining for the 2 week phaco training program were assessed and feedback was provided by using the ICO-OSCAR rating system. • The primary outcome measure was the reduction in the intraoperative complications during the training period. • The secondary outcome measure was the number of steps completed independent of the preceptor

4. The Program • Pre-screening of candidates • Equipment & surgical skills • Pre-selection of cases for immediate post-training surgery • Intense 2 week Cognitive Skills Training • Supervised by senior surgeons • Intra-operative videos analyzed • ICO-OSCAR phaco rating used for feedback • Post training support • Onsite • Tele-Surgical Support

5. Cognitive Skills Training

7. Mean ICO OSCAR scores + SD (max=100) = 70 + 1.8 Stepwise mean ICO OSCAR scores + SD (max=5)

8. Training results

10. POST TRAINING: TELE – SURGICAL SUPPORT • Camera • Without beam splitter • Compatible to all microscopes • USB recording to a laptop • Technology • Video digital conversion → Real time video streaming (3G) → ipad → senior consultant comments → 2 way audio

11. Conclusion • Improved surgical competence of the trainees • Improved completion of cases • Lower complication rates Achieved by: • Intense structured phaco training with wet lab support • ICO OSCAR based intra & post training feedback