Posters

How long does it take for a junior to do a phaco? How can we use this information to improve surgical training?

Poster Details

First Author: M.Islam UK

Co Author(s):    L. Maubon                    

Abstract Details

Purpose:

To identify the time taken for a junior cataract surgeon to undertake a routine phacoemulsification and to explore if these same surgeons perceive any time pressures whilst performing cataract surgery. We aim to utilise this information to enable better planning of surgical training lists, improve the awareness of the trainers of any such pressures and in turn improve training.

Setting:

Moorfields Eye Hospital, South London Division.

Methods:

Retrospective data was collected from 84 cataract surgeries performed by junior surgeons over 11 consecutive weeks operating on consultant led NHS theatre lists. Junior surgeons were defined as operating independently with a supervisor present with less than 100 total cases of previous phaco-emulsification experience. Length of surgery was recorded from the time iodine preparation was applied to the skin after WHO checklist sign in until the time the drape was removed.  A questionnaire exploring the junior surgeons perceived experiences of time pressures whilst operating was completed by all the surgeons whose data was included.

Results:

84 cataracts were performed by three junior surgeons with a median surgical time of 33 minutes [range 21-55 minutes]. Three intraoperative complications were recorded. The longest recorded surgery was the case involving a posterior capsule rupture. All junior surgeons reported experiencing feeling pressurized by lack of time whilst operating and felt this affected their training negatively at least 50% of the time. The theatre environment itself, the patient themselves in addition to self-generated pressure were all identified as contributing factors. Surgeons did not feel that these time pressures had contributed to any surgical complications.

Conclusions:

Our junior surgeons performed surgery in a comparable timeframe to published literature. Whilst is important to ensure timely surgery, it is equally important we do not apply unnecessary time pressures on junior surgeons but allow adequate training time enabling them to become confident and skilled surgeons. Through careful patient selection for surgical training lists which accommodates adequate time for junior surgeons to confidently and safely undertake surgery, we can hypothesize that this will inevitably reflect better patient outcomes.

Financial Disclosure:

None