Evidence-based cataract surgery teaching milestones: guide to evaluate resident achievement

To develop evidence-based milestones for cataract surgery teaching and identify performance indicators.

Royal Alexandra Hospital, Edmonton, Alberta, Canada.

Retrospective cohort study.

Operative records from a single surgeon were reviewed for resident participation when learning cataract surgery over a 14-year period. Time to complete a resident's first complete case was the primary outcome. Secondary outcomes included mean time to perform each categorical step of the procedure, number of cases participated in, rate of participation, complex case involvement, and complications. Strong resident performance was defined as time to first complete a case 1 SD quicker than mean performance; weak performance was the opposite.

Residents (n = 13) performed beginner steps for 3.1 ± 3.2 months and intermediate steps until month 4.3 ± 3.3, and by month, 5.1 ± 3.4 residents were able to do complete cases. Time to perform a complete case increased with lower case participation (P = .02); mean proportion of complex cases that a resident participated in was 7.9% (n = 17.6 ± 10.0); less than 1% of resident cases resulted in posterior capsular rupture (PCR; n = 1.4 ± 1.3 cases). Based on these data, weaker achievement was defined as failure to achieve beginner-step competency by month 6.3, intermediate step competency by month 7.6, or inability to perform a complete case by month 8.5. In this dataset, 23.1% of residents (n = 3) met this definition.

Residents who train with multiple teachers during a focused cataract surgery rotation can perform complete cases after a mean of 5.1 ± 3.4 months with a low PCR rate.