Phacoemulsification to manual small-incision cataract surgery: transfer of skills study in a simulated environment

To investigate whether phacoemulsification (PE) experience impacts and transfers to the skill acquisition of novices in manual small-incision cataract surgery (MSICS) within a simulation environment.

Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark.

Prospective controlled experimental study.

The study included 29 residents or specialist in ophthalmology with no prior MSICS experience. Participants were required to have either (1) proficiency on the EyeSi surgical simulator (PE group [PG]) or (2) no prior extensive exposure to the EyeSi simulator or any PE surgery experience as a primary surgeon (control group [CG]). Possible skill transfer was assessed using a test on the HelpMeSee virtual-reality simulator, including 9 modules and 30 steps (points). A pass/fail score was determined at 20 points (of 30 points). Performance scores were analyzed using independent samples t tests, pass rates using the Fisher exact test, and individual modules using Fisher-Freeman-Halton analysis.

The PG performed significantly better in overall performance score (mean ± SD, PG; 21.8 points ± 2.3 vs CG; 18.9 points ± 2.2, P = .002, t -value = -3.39) and pass rates (PG; 72% vs CG; 22%, P = .018). The subanalysis for individual modules demonstrated significant differences exclusively in the capsulorhexis and cortex removal modules.

The results suggest a positive interprocedural transfer of skills between PE and MSICS. Pretraining and experience in PE demonstrated a significant effect on the performance of MSICS within a simulation environment. These findings suggest that PE experience provides an advantage before MSICS training in surgical residency programs.