Cataract Surgery Training in Germany: A Survey by the European Board of Ophthalmology

Phacoemulsification is a fundamental surgical skill for ophthalmology residents and the most commonly performed operation in the ever-evolving field of ophthalmology. A comprehensive study conducted between 2018 and 2022 showed wide variation in the experiences of European residents. The aim of this study was to study the data from Germany in the European data context.

This study analyses survey results from German participants in European Board of Ophthalmology (EBO) examinations (2018 - 2022) and classifies the results in overall European comparison. We also performed a regional analysis by federal state.

Of a total of 445 addressees, 136 (30.6%) responded to the questionnaire. Around two-thirds or 67.7% had taken the EBO exam between 2021 and 2022; most of the study participants were women (59.6%) and the average age was 34 ± 2. By far the most at 89.7% were right-handed and came from fourteen different federal states, mostly from North Rhine-Westphalia, Baden-Württemberg, Bavaria, and Berlin. Under a quarter of respondents at 22.8% stated that they had carried out at least ten training sessions on animal eyes. Very few at 5.1% reported completing training sessions on synthetic eyes compared to 16.9% stating that they had trained on a virtual reality simulator. Having taken more than ten training sessions correlated significantly with higher confidence at performing cataract surgery (p < 0.001). Eighty-three respondents (61%) had not performed any of the steps taken in cataract surgery on patients during specialty training in Germany. This was well above the European average. Women were statistically significantly overrepresented in this subgroup, accounting for 67.5% (p = 0.019) of the subgroup.

In the European context, the German national specialty training curriculum does not require cataract operations in any set numbers. This model may have contributed to the significant gender differences. Simulation-based medical training may address this problem as an additional tool for more equitable access to surgical training.

Intra-European comparison and exchange may help improve guidelines for ophthalmological specialty training. This might standardise and improve training standards in both conservative and surgical ophthalmology throughout Europe.