Impact of virtual reality simulation on learning barriers of phacoemulsification perceived by residents

• Published in: Clinical ophthalmology (Auckland, N.Z.) Vol. 12; pp. 885 - 893
• Main Authors: Ng, Danny Siu-Chun, Sun, Zihan, Young, Alvin Lerrmann, Ko, Simon Tak-Chuen, Lok, Jerry Ka-Hing, Lai, Timothy Yuk-Yau, Sikder, Shameema, Tham, Clement C
• Format: Journal Article
• Language: English
• Published: New Zealand Dove Medical Press Limited 2018; Taylor & Francis Ltd; Dove Medical Press
• Subjects: Analysis; Cataract extraction; Cataract surgery; Cataracts; Clinical outcomes; Eye surgery; Hospitals; Ophthalmology; Original Research; Simulation; Simulation surgical education; Surgery; Surgical outcomes; Surveys; Teaching; Training; Virtual reality; Hong Kong; Wales; simulation surgical education; cataract surgery; virtual reality
• ISSN: 1177-5467; 1177-5483; 1177-5483
• DOI: 10.2147/OPTH.S140411

To identify residents' perceived barriers to learning phacoemulsification surgical procedures and to evaluate whether virtual reality simulation training changed these perceptions.
The ophthalmology residents undertook a simulation phacoemulsification course and proficiency assessment on the Eyesi system using the previously validated training modules of intracapsular navigation, anti-tremor, capsulorrhexis, and cracking/chopping. A cross-sectional, multicenter survey on the perceived difficulties in performing phacoemulsification tasks on patients, based on the validated International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubric (ICO-OSCAR), using a 5-point Likert scale (1 = least and 5 = most difficulty), was conducted among residents with or without prior simulation training. Mann-Whitney
tests were carried out to compare the mean scores, and multivariate regression analyses were performed to evaluate the association of lower scores with the following potential predictors: 1) higher level trainee, 2) can complete phacoemulsification most of the time (>90%) without supervisor's intervention, and 3) prior simulation training.
The study was conducted in ophthalmology residency training programs in five regional hospitals in Hong Kong.
Of the 22 residents, 19 responded (86.3%), of which 13 (68.4%) had completed simulation training. Nucleus cracking/chopping was ranked highest in difficulty by all respondents followed by capsulorrhexis completion and nucleus rotation/manipulation. Respondents with prior simulation training had significantly lower difficulty scores on these three tasks (nucleus cracking/chopping 3.85 vs 4.75,
= 0.03; capsulorrhexis completion 3.31 vs 4.40,
= 0.02; and nucleus rotation/manipulation 3.00 vs 4.75,
= 0.01). In multivariate analyses, simulation training was significantly associated with lower difficulty scores on these three tasks.
Residents who had completed Eyesi simulation training had higher confidence in performing the most difficult tasks perceived during phacoemulsification.