Objective structured assessment of posterior capsular rupture management

Area of Science:

• Ophthalmology
• Surgical Education
• Medical Simulation

Background:

• Posterior capsular rupture (PCR) management demands specialized surgical skills.
• Simulation-based training offers a potential avenue for skill acquisition.
• Validated, procedure-specific assessment tools are crucial for effective simulation training.

Purpose of the Study:

• To develop and validate a structured assessment scale for technical performance during posterior capsular rupture management.
• To create the Objective Structured Assessment of Posterior Capsular Rupture (OSA-PCR) tool.

Main Methods:

• The OSA-PCR was developed using a Delphi consensus process with 20 cataract surgeons.
• Validation involved 12 residents and surgeons performing standardized PCR scenarios on a virtual-reality simulator.
• Four experts evaluated 24 recorded performances, with psychometric analysis including reliability, internal consistency, construct validity, and responsiveness.

Main Results:

• The final OSA-PCR includes 19 items with 100% expert consensus.
• Excellent interrater (ICC=0.90-0.95) and intrarater (ICC=0.98) reliability were observed.
• High internal consistency (Cronbach α=0.93) and strong correlation with simulator scores (r=0.90) were found.
• Scores significantly improved post-training (P=0.0005), demonstrating responsiveness.

Conclusions:

• The OSA-PCR is a valid, reliable, and responsive instrument for assessing simulated posterior capsular rupture management.
• This tool facilitates structured, procedure-specific evaluation in cataract surgery training.
• The OSA-PCR can support competency-based training and assessment in surgical education.