Multiple metrics assessment method for a reliable evaluation of corneal suturing skills

This study aimed to evaluate the efficiency of a multiple metrics assessment method to differentiate between surgeons of differing experience while performing a corneal suturing task. Volunteer ophthalmologists were assigned to three groups (senior [SG], junior [JG] and novice [NG]) according to their experience in corneal suturing. All participants performed three sessions of corneal wound closure by three stitches. Suturing and participant posture were recorded with cameras, and assessed by two blind assessors for stitch quality (using Zhang score) and ergonomics (using Rapid Upper Limb Assessment [RULA] score). Task duration was recorded. Objective analyses of stitches geometry and instrument position were carried out. We included 24 participants: 5 in the SG, 8 in the JG and 11 in the NG. Stitch quality was significantly better and time to perform the procedure significantly lower in more experienced groups (p < 0.001 and p = 0.002, respectively). SG participants better respected regular distance and parallelism between stitches compared to others (p = 0.01). Instrument position was similar between groups, although SG participants minimized their back-and-forth movements compared to NG participants. Ergonomics assessment was similar. Multiple metrics assessment efficiently determined how to differentiate between novices and experienced surgeons on corneal suturing skills, providing hints for future training studies.