University of Colorado uses simulator to upgrade cataract surgery training for ophthalmology residents
The device features real-time feedback and other features, allowing residents to hone their skills and expand options for practicing one of the most needed procedures in the country.
Ophthalmology resident Ari Stoner, MD, is shown using the simulator at the University of Colorado Anschutz Medical Campus Department of Ophthalmology. (Image credit: University of Colorado Anschutz Medical Campus)
When ophthalmology residents graduate from the University of Colorado School of Medicine, they will have completed more than 3 or 4 times the number of required cataract surgeries as they become practicing ophthalmologists.
According to a news release, the Department of Ophthalmology earlier this year purchased a new virtual reality surgical simulator that allows residents to fine-tune their surgical techniques and conveniently practice cataract surgeries in a lifelike environment whenever it fits into their schedules.1
Residency Program Director Monica Ertel, MD, PhD, pointed out in the news release that one of the biggest roles as educators is teaching residents how to teach themselves and how to become constant learners.
“The way we do cataract surgery now is vastly different than it was a few decades ago, so giving the residents tools that allow them to take ownership of their own surgical skill acquisition is such an important priority,” said Ertel, who credits her own success in the operating room to a simulator she used throughout her residency program.
“I would spend hours in our resident room working on the simulator just to refine my skills,” she explained. “I’m glad that our residents can have that same experience.”
Prioritizing practice
The simulator features a screen, surgery instruments, microscope, and an artificial eyeball. It starts out with basic tasks and progressively increases in difficulty. This allows the trainees to work up to the point of a mock cataract surgery. Early modules direct the trainees touch small dots with an electronic scalpel – a task that assists with developing hand movement and familiarity moving around the eye.1
“When you’re operating under a microscope, there are a lot of movements with your hands that don’t feel natural at the beginning,” Ian McClain, MD, a PGY-3 ophthalmology resident, said in the news release. “But you can really become comfortable with moving your hands and getting that piece down with this simulator.”
In addition to the simulator, residents also can learn surgery techniques in a wet lab where they practice on an animal model eye.
Ertel, who is an assistant professor of ophthalmology, pointed out that the wet lab is a great way to learn, but it comes with barriers that the simulator does not.
“You must set everything up, the phaco machine, the tools, the bags of fluid, and piping and tubing,” she explained. “The simulator is easy access. If a resident is on a lunch break or in between clinic calls, they can come and spend time working on skills.”
The simulator, when used during training, can also reduce hand tremors and expand bimanual dexterity, which is crucial when working in such a small area. For PGY-3 resident Ari Stoner, MD, having feedback with simulator training is especially helpful.
“It can be hard for us to really judge how well we did individually, but here you get error messages,” he explained. “Knowing where you can improve is important because even if you touch something with your instrument that’s a couple of millimeters away, it can have profound consequences.”
An investment with high returns
By the time a resident finds themselves in an operating room with a patient, they will have completed several cataract surgeries through the wet lab and simulator. They will be more at ease with the tools they need to use to successfully complete the procedure – which is great news for patient care, Ertel said.
Several studies have shown that there are higher rates of complications in an ophthalmologist’s first 50 to 100 cataract surgeries, “so having the residents spend that time on our simulator before the operating room really does result in better, safer outcomes for our patients,” she pointed out.
It is estimated that about 3.5 million cataract surgeries are performed in the US each year, making it one of the among the most common out-patient surgical procedures.2 Residents say rigorous education and support from the department means they can better serve those
“Our faculty members are dedicated to our learning,” McClain pointed out.. “The fact that they’re willing to invest in us in this way is huge.”
Ertel added that the purchase of the device is proving to be a win-win for everyone.
“We’re preparing our residents better and giving them more confidence,” she concluded. “They’re getting more cases. And we’re providing better care, which is a major benefit for our patients as well.”
References:
Mason K. Simulator Upgrades Cataract Surgery Training for Ophthalmology Residents. Cuanschutz.edu. Published August 7, 2024. Accessed August 8, 2024. https://news.cuanschutz.edu/ophthalmology/simulator-upgrades-cataract-surgery-training-for-ophthalmology-residents
2020–2021 BCSC Basic and Clinical Science CourseTM. Aao.org. Published 2020. https://www.aao.org/education/bcscsnippetdetail.aspx?id=f390b68c-82e5-4c7b-b550-ace3330cebd7#:~:text=Cataract%20surgery%20is%20the%20most
