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Intense Simulation-Based Surgical Education for Manual Small-Incision Cataract Surgery: The Ophthalmic Learning and Improvement Initiative in Cataract Surgery Randomized Clinical Trial in Kenya, Tanzania, Uganda, and Zimbabwe.
Dean, William H; Gichuhi, Stephen; Buchan, John C; Makupa, William; Mukome, Agrippa; Otiti-Sengeri, Juliet; Arunga, Simon; Mukherjee, Subhashis; Kim, Min J; Harrison-Williams, Lloyd; MacLeod, David; Cook, Colin; Burton, Matthew J.
Afiliação
  • Dean WH; International Centre for Eye Health, Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
  • Gichuhi S; Division of Ophthalmology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
  • Buchan JC; Department of Ophthalmology, University of Nairobi, Kenyatta National Hospital, Nairobi, Kenya.
  • Makupa W; International Centre for Eye Health, Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
  • Mukome A; Kilimanjaro Christian Medical Centre, Moshi, Tanzania.
  • Otiti-Sengeri J; Department of Ophthalmology, Parirenyatwa Hospitals, University of Zimbabwe, Harare, Zimbabwe.
  • Arunga S; Department of Ophthalmology, Makerere University School of Medicine, Kampala, Uganda.
  • Mukherjee S; International Centre for Eye Health, Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
  • Kim MJ; Mbarara University and Referral Hospital Eye Centre, Mbarara University of Science and Technology, Mbarara, Uganda.
  • Harrison-Williams L; Bristol Eye Hospital, Bristol, United Kingdom.
  • MacLeod D; Tropical Epidemiology Group, Faculty of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
  • Cook C; Makeni Regional Hospital, Bombali, Sierra Leone.
  • Burton MJ; Tropical Epidemiology Group, Faculty of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
JAMA Ophthalmol ; 139(1): 9-15, 2021 01 01.
Article em En | MEDLINE | ID: mdl-33151321
ABSTRACT
Importance Cataracts account for 40% of cases of blindness globally, with surgery the only treatment.

Objective:

To determine whether adding simulation-based cataract surgical training to conventional training results in improved acquisition of surgical skills among trainees. Design, Setting, and

Participants:

A multicenter, investigator-masked, parallel-group, randomized clinical educational-intervention trial was conducted at 5 university hospital training institutions in Kenya, Tanzania, Uganda, and Zimbabwe from October 1, 2017, to September 30, 2019, with a follow-up of 15 months. Fifty-two trainee ophthalmologists were assessed for eligibility (required no prior cataract surgery as primary surgeon); 50 were recruited and randomized. Those assessing outcomes of surgical competency were masked to group assignment. Analysis was performed on an intention-to-treat basis.

Interventions:

The intervention group received a 5-day simulation-based cataract surgical training course, in addition to standard surgical training. The control group received standard training only, without a placebo intervention; however, those in the control group received the intervention training after the initial 12-month follow-up period. Main Outcomes and

Measures:

The primary outcome measure was overall surgical competency at 3 months, which was assessed with a validated competency assessment rubric. Secondary outcomes included surgical competence at 1 year and quantity and outcomes (including visual acuity and posterior capsule rupture) of cataract surgical procedures performed during a 1-year period.

Results:

Among the 50 participants (26 women [52.0%]; mean [SD] age, 32.3 [4.6] years), 25 were randomized to the intervention group, and 25 were randomized to the control group, with 1 dropout. Forty-nine participants were included in the final intention-to-treat analysis. Baseline characteristics were balanced. The participants in the intervention group had higher scores at 3 months compared with the participants in the control group, after adjusting for baseline assessment rubric score. The participants in the intervention group were estimated to have scores 16.6 points (out of 40) higher (95% CI, 14.4-18.7; P < .001) at 3 months than the participants in the control group. The participants in the intervention group performed a mean of 21.5 cataract surgical procedures in the year after the training, while the participants in the control group performed a mean of 8.5 cataract surgical procedures (mean difference, 13.0; 95% CI, 3.9-22.2; P < .001). Posterior capsule rupture rates (an important complication) were 7.8% (42 of 537) for the intervention group and 26.6% (54 of 203) for the control group (difference, 18.8%; 95% CI, 12.3%-25.3%; P < .001). Conclusions and Relevance This randomized clinical trial provides evidence that intense simulation-based cataract surgical education facilitates the rapid acquisition of surgical competence and maximizes patient safety. Trial Registration Pan-African Clinical Trial Registry, number PACTR201803002159198.
Assuntos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Extração de Catarata / Instrução por Computador / Educação de Pós-Graduação em Medicina / Cirurgiões / Treinamento com Simulação de Alta Fidelidade / Oftalmologistas Tipo de estudo: Clinical_trials / Guideline Limite: Adult / Female / Humans / Male País/Região como assunto: Africa Idioma: En Ano de publicação: 2021 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Extração de Catarata / Instrução por Computador / Educação de Pós-Graduação em Medicina / Cirurgiões / Treinamento com Simulação de Alta Fidelidade / Oftalmologistas Tipo de estudo: Clinical_trials / Guideline Limite: Adult / Female / Humans / Male País/Região como assunto: Africa Idioma: En Ano de publicação: 2021 Tipo de documento: Article