Implementation of microsurgery simulation in an ophthalmology clerkship in Germany: a prospective, exploratory study

Deliberate practice for retinopathy of prematurity: Retinal laser training using schematic eyes in ophthalmology education

Skills and confidence in performing high-risk procedures are essential for ensuring safe patient care. Deliberate practice is an instructional model designed to improve performance by engaging trainees in structured, repetitive practice with immediate feedback provided by supervisors. We developed a multifaceted simulation informed by deliberate practice and tested the hypothesis that trainee skills and reported confidence would increase after training. A multicenter prospective study was conducted at three universities in Thailand from July 1, 2023, to June 30, 2024. Sixty ophthalmology trainees participated in an introductory video for self-study and then completed a multiple-choice questionnaire to assess their baseline knowledge of laser indirect ophthalmoscopy for retinopathy of prematurity (LIO-ROP) and guide feedback by supervisors. The participants subsequently performed a simulated LIO-ROP on a schematic eye and received additional feedback based on a scoring rubric. The participants practiced on the schematic eye as much as needed to feel confident in their skills. Mean rubric scores indicative of LIO-ROP skills significantly improved from 2.94 to 3.59 out of 4 (P < 0.001), and the time required for the laser procedure decreased from 17.19 to 15.14 minutes in pre- and post-LIO-ROP practice, respectively. Rubric scores for performing the LIO-ROP on a schematic eye significantly improved across all steps of the procedure between pre- and post-LIO-ROP practice. Reported confidence in performing the LIO-ROP increased by 81.5%. Multifaceted simulated training informed by deliberate practice is a suitable instructional model for enhancing skill performance and confidence among postgraduate residents.

A review of selection criteria for ophthalmology training in the Western world

BACKGROUND

To (a) analyse, compare and learn from the global variations in ophthalmology training applicant selection criteria, specifically CV assessment, and (b) provide a discussion of evidence supporting such selection criteria.

METHODS

An observational analysis on the selection criteria used to assess candidates applying to ophthalmology training programs within the US, Canada, European Union / European Economic Union (EU/EEA), United Kingdom (UK) and Australia and New Zealand (ANZ). Presence of a publicly available selection criteria policy for the 2025 intake was searched for on national and local college, society, federation and training program websites. The selection criteria employed for assessing applicant CV, and its associated scoring (if existent), were recorded for the included programs. Descriptive statistics was applied to these data.

RESULTS

174 accredited ophthalmology training programs were identified, and 51/174 publish a publicly available selection criteria policy. Overall, the most important criteria from ophthalmic training bodies in the Western world include research experience, academic achievements, particularly in the form of awards and prizes, references supporting evidence of favourable personal and professional characteristics, and evidence of involvement in extracurricular activities that produce evidence of a well-founded interest in ophthalmology.

CONCLUSIONS

Each region adopts varying selection processes and frameworks, which, rather than reflect a standardised international approach to selecting an "ideal" ophthalmology trainee, perhaps select for the specific needs of the country and or training program. The study is limited by its observational nature.

The impact of extended reality simulators on ophthalmic surgical training and performance: a systematic review and meta-analysis of 17,623 eyes

BACKGROUND

Extended reality (XR) simulators, including virtual reality and augmented reality, hold significant promise for enhancing surgical training by providing trainees with a controlled practice environment. This is particularly vital in microsurgery, where the steep learning curve and the challenge of mastering surgical skills are significant. Despite notable advancements in XR technology, its role in ophthalmic surgical training remains uncertain.

METHODS

In our systematic review and meta-analysis, eight electronic databases were searched, and studies were evaluated against predefined criteria. Data extraction and random-effects meta-analysis assessed the odds ratio (OR) for posterior capsular rupture (PCR), an important surgical complication.

RESULTS

A meta-analysis of 17,623 eyes that underwent cataract surgery across seven studies revealed a significant decrease in PCR post-Eyesi practice, with low heterogeneity across studies (OR = 0.71, 95% CI = 0.60-0.85, I2 = 9%). Studies that predominantly utilized XR for cataract surgery training (84%) consistently improved surgical outcomes by reducing complications such as PCR, retained lens material, and aphakia. XR training also significantly improved operating scores (p < 0.05), self-efficacy (p < 0.01), and non-dominant hand dexterity (p < 0.01). Of the 25 studies in this review, 22 (88%) found overall XR training benefits.

CONCLUSIONS

XR simulators enhance ophthalmic surgical training by reducing complications like PCR, and improving surgical performance, self-efficacy, and non-dominant hand dexterity. These findings challenge conventional training methods and advocate for integrating XR into residency curricula to optimize learning and patient outcomes.

Immersive teaching using virtual reality technology to improve ophthalmic surgical skills for medical postgraduate students

Medical education is primarily based on practical schooling and the accumulation of experience and skills, which is important for the growth and development of young ophthalmic surgeons. However, present learning and refresher methods are constrained by several factors. Nevertheless, virtual reality (VR) technology has considerably contributed to medical training worldwide, providing convenient and practical auxiliary value for the selection of students' sub-majors. Moreover, it offers previously inaccessible surgical step training, scenario simulations, and immersive evaluation exams. This paper outlines the current applications of VR immersive teaching methods for ophthalmic surgery interns.

Simulator-Based Versus Traditional Training of Fundus Biomicroscopy for Medical Students: A Prospective Randomized Trial

INTRODUCTION

Simulation training is an important component of medical education. In former studies, diagnostic simulation training for direct and indirect funduscopy was already proven to be an effective training method. In this prospective controlled trial, we investigated the effect of simulator-based fundus biomicroscopy training.

METHODS

After completing a 1-week ophthalmology clerkship, medical students at Saarland University Medical Center (n = 30) were block-randomized into two groups: The traditional group received supervised training examining the fundus of classmates using a slit lamp; the simulator group was trained using the Slit Lamp Simulator. All participants had to pass an Objective Structured Clinical Examination (OSCE); two masked ophthalmological faculty trainers graded the students' skills when examining patient's fundus using a slit lamp. A subjective assessment form and post-assessment surveys were obtained. Data were described using median (interquartile range [IQR]).

RESULTS

Twenty-five students (n = 14 in the simulator group, n = 11 in the traditional group) (n = 11) were eligible for statistical analysis. Interrater reliability was verified as significant for the overall score as well as for all subtasks (≤ 0.002) except subtask 1 (p = 0.12). The overall performance of medical students in the fundus biomicroscopy OSCE was statistically ranked significantly higher in the simulator group (27.0 [5.25]/28.0 [3.0] vs. 20.0 [7.5]/16.0 [10.0]) by both observers with an interrater reliability of IRR < 0.001 and a significance level of p = 0.003 for observer 1 and p < 0.001 for observer 2. For all subtasks, the scores given to students trained using the simulator were consistently higher than those given to students trained traditionally. The students' post-assessment forms confirmed these results. Students could learn the practical backgrounds of fundus biomicroscopy (p = 0.04), the identification (p < 0.001), and localization (p < 0.001) of pathologies significantly better with the simulator.

CONCLUSIONS

Traditional supervised methods are well complemented by simulation training. Our data indicate that the simulator helps with first patient contacts and enhances students' capacity to examine the fundus biomicroscopically.