Ophthalmology Trainees’ Perspectives on Virtual Reality Training for Cataract Surgery: A Qualitative Study

Ophthalmology Trainees’ Perspectives on Virtual Reality Training for Cataract Surgery: A Qualitative Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Ophthalmology Trainees’ Perspectives on Virtual Reality Training for Cataract Surgery: A Qualitative Study Nooran Badeeb, Abdulrahman Alsubhi, Ahmed Basheikh This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5926857/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction Virtual reality (VR) based training for cataract surgery is a valuable technology for trainee ophthalmologists. However, the role of debriefing after simulation has not been studied in this setting. This qualitative study explored trainees’ experiences and expectations of VR simulator training using Eyesi. Methods Semi-structured interviews were conducted with ophthalmology trainees who had experience training on the machine. The study explored the trainees' perceptions in three areas: the overall experience and value of the machine training, the need for a teacher, and the need for feedback or debriefing, including the type of feedback or debriefing. Results The study identified the importance of debriefing in cataract surgery VR simulation training, as it reinforced learning and provided an opportunity for reflection. Trainees expressed the need for a teacher or coach to provide guidance during the training process. Additionally, participants identified different types of feedback and debriefing that were most valuable, including coaching on technical skills. Conclusion The study highlights the importance of debriefing and the need for a teacher or coach in cataract surgery VR simulation training. The findings can inform the development of effective training programs and the integration of debriefing in the VR training process. Scientific community and society/Scientific community/Education Health sciences/Diseases/Eye diseases/Lens diseases Ophthalmology surgical training virtual reality feedback coach. Introduction Cataract surgery is a crucial skill to master in the field of ophthalmology, with surgical competency traditionally thought to be achieved after performing eighty real-life cases ( 1 ). However, the introduction of virtual reality (VR) simulation technology has made it easier and safer for surgeons to learn this procedure( 2 – 4 ). While some studies have shown that residents trained on simulators have shorter learning curves during their first fifty real cases, the outcomes of using VR simulations as a tool to decrease complications in real-life surgery or test the readiness of novice learners to operate have been inconsistent( 5 ). The low threshold for errors in cataract surgery has led to a wide acquisition of simulators in teaching hospitals and simulation centres, however, they have not been incorporated into the teaching curriculum in many residency programs. This absence of a standardized approach to integrate simulation training is probably due to the lack of data on factors that increase the benefits of training and barriers faced by the residents. Although debriefing after simulation and surgical training has been shown to improve the uptake from experience, there is currently no specific model for debriefing in VR cataract simulation training. Therefore, this study aims to explore ophthalmology residents experience, importance of guidance and mentorship, challenges with simulation, and the need for debriefing in a VR cataract simulation training setting. Methods The study involved a qualitative virtual interview-based approach. The standards for reporting qualitative research (SRQR) guidelines were adhered to in this article ( 6 ). The study participants were ten resident trainees of the Saudi Ophthalmology residency program in the Western region of Saudi Arabia who had experience working on the cataract surgery VR simulation machine Eyesi (VRmagic, GmbH, Mannheim, Germany). The interviews were conducted individually by the principal investigator (PI) (NB) using a semi-structured interview guide. Prior to the interviews, the participants were informed about the nature of the study and data handling, and informed consent was obtained. Ethical approval was also obtained from the King Abdulaziz University Hospital Ethics Committee. The objective of the study was implicitly described to the trainees, and the interview questions did not contain any leading words. The questions focused on the participants' perception of their experience on the simulation machine, any factors that made their training experience easier, whether anyone accompanied them during the training on the machine and how that experience was, if they had any conversations about their performance on the machine and whether it was beneficial, and how they felt after the conversation. Each interview lasted between 30–60 minutes, and data collection was stopped when saturation was reached. The recorded interviews were password protected and accessible only by the PI, and they were transcribed using software and cross-checked with the recordings. The analysis of the data was carried out following an inductive thematic approach as outlined by Braun and Clarke.( 7 ) The transcripts were read by the PI and co-investigator (AB) multiple times to be familiar with the depth of the content. After becoming familiar with the data, potential themes and meaningful data were assigned a code that captured them for further analysis. Codes were then arranged into sets that formed broader themes. Further categorization and review of themes and codes were carried out. Whenever there were concepts that they did not agree on, they discussed them until a consensus was reached. The data, along with the coding, were sent to a third co-investigator for approval of the main concepts that were captured. Results The study involved ten senior-level Ophthalmology residents. Table 1 presents the participants' demographics, which showed that the majority were male and had a mean age of 29 years. Most residents began using the cataract VR simulation machine in their third year of residency, and half of the participants reached advanced levels of training on the machine. The study's data relating to the main themes were summarized in the following section. The themes were derived from the participants' responses to the semi-structured interview questions, which focused on their experiences and perceptions of using the VR simulation machine in cataract surgery training. The data analysis process identified three main themes: the experience of VR simulation training, The role of a teacher, and Debriefing. The experience of VR Simulation Training The most common response on the experience of trainees with Eyesi was that it was beneficial, P1 “My experience was excellent “. The training was especially helpful for beginners to gain skills before operating on real patients, P10 “It was a very good experience, especially since I've never touched a real patient”. Trainees also expressed that they have profited from Eyesi VR simulator to develop their approach and identify areas of improvement, P7 “ It helped me because when I finished each task, they gave me a written feedback report showing my weakness points, ” , P8 ” It assisted me in my approach, a lot of things I learned through the machine training that in real surgery I did not notice”. However, some participants reported negative aspects of their training experience. This was attributed to the simulation being difficult, time-consuming and not real, P8” It's very difficult, time-consuming”, P4 “It was time-consuming and frustrating, it did give a sense of what it's like to be performing an intraocular surgery, although in unrealistic ways”. One participant reported that, unlike beginners, seniors with surgical experience gain minimal benefit, P7 “ The maximum benefits we can get from this machine is when we have a gap in our training or when we are junior residents, but for a senior resident doing regular cataract cases, there is not much benefit from doing simulation cataract surgery,” The Role of Teaching Almost all participants favoured having a teacher during their training on the simulator. The residents reported that it is more needed at the beginning of the training, to learn the basic steps of the surgery and surgical ergonomics, P10” The thing that has helped me the most is that one of the consultants guided me through my few first phacoemulsification simulator sessions,”, P1 “I learned the proper positioning of the cataract machine that mimics reality. The positioning of the simulator head and how to handle the instruments properly with the specific fine movements of the hand or wrest,”. Others reported that they profited from having an expert who analysed their performance, P2 “I would say that the most important thing is having a senior with you, someone who does a lot of cataract surgeries, someone who is good at picking up your mistakes”. Other participants stated that the Eyesi VR simulator was easy to use, P3 “I think the machine is user-friendly,”, and one mentioned that having a teacher is time-consuming, P7” It is time-consuming if we are acquiring or asking for a supervisor to sit with us through the whole Training”. Feedback and Debriefing Participants stated that they found debriefing helpful and decreased the time to progress in the levels of the simulation, P1 “I remember I discussed my training with my seniors’ multiple times. They were really helpful, gave me some advice on how to overcome some difficulties. I was sitting on the machine for long hours for the same skill but after their advice, I became faster and progressed in my skills”. Debriefing with a senior resident was preferred as opposed to debriefing with a consultant. This was because residents thought someone close to their level would relate more to the struggles they have, P2” Being more senior means, they are professionals to the point that they are doing the basic steps by heart, they don't even think about it and they might miss it. But having a junior, who would just maybe last year or the one before went through what you're going through now, they will remember the smallest things that you are suffering with right now,”, P1” The difference if my peer is more experienced than me, he will give me easier explanation than a senior mentor to deliver the information. So, there is no seniority between us, and we can talk easily,”. Despite this perceived barrier between residents and consultants, one has stated that they would prefer a more experienced surgeon, P10” Of course, if someone has an experience with real patients and knows the complications and how things work it would be much better than just a senior resident. In the first few sessions, it is not about how the machine works only but about giving tips on the surgical steps themselves”. Trainees also expressed that they preferred the debrief to be in person, one-to-one, and during or after the training, P9” I think the discussion about the training should be in the middle or after finishing training, because if you didn't start on the simulation machine itself, you wouldn't have any idea how it works yet”. P2 “I think one to one is better. Sometimes you must criticize the resident or have to mention a couple of mistakes he did, whether in real life or in the simulator, some of the residents might feel embarrassed if they are being criticized in front of others,”. Discussion To provide a framework for VR cataract surgical simulation training, we explored trainees' experience with the Eyesi VR simulator. Our participants emphasized the importance of early training, coaching, and a structured debrief to enhance learning with VR simulators. Commencing surgical skills acquisition on simulators offers a risk-free environment for repetitive training with the addition of quantitative feedback. Previous evidence suggests that learners are less inclined to make mistakes in front of colleagues and seniors ( 8 , 9 ). This form of training allows for building confidence before performing surgery on real patients and learning generic skills (e.g., instrument and microscope handling). However, challenges such as time consumption and difficulty of some of the steps highlight the limitations of simulation compared to real surgery. Similar findings of high satisfaction with the simulator and lack of time as a limitation were reported by Ong et al in their study ( 10 ). Although these points provide insights into areas where improvements can be made in simulation, they also suggest that a reasonable expectation should be set when using the simulator. The need for guidance and constructive feedback was a recurring theme in our analysis, especially for novices. While some participants found the simulator itself easy to use and provided a helpful analysis of their performance, others emphasized the importance of having a more experienced surgeon in the initial stages. Prior studies have shown that supervised training improves residents' competence ( 11 , 12 ). Saleh et.al examined the performance consistency of junior ophthalmic trainees on Eyesi and reported poor reproducibility indicating the need for a structured debrief ( 13 ). This blended approach of combining simulators’ and seniors’ feedback on overall trainee performance can maximize learning and facilitate transforming into real surgery. Furthermore, the participants have elaborated on what constitutes a successful debrief. Most believe senior residents are easier to engage with in the reflection process, unlike consultants. Barriers from knowledge gaps and time constraints were regarded as the cause, both of which have been identified in the literature ( 14 , 15 ). Other components they reported were the location where the debrief is conducted, highlighting the need for a productive environment that supports confidentiality. Limitation of our research may include small sample sizes, potential for researcher bias, and difficulty in generalizing findings to larger populations. The subjective nature of data analysis in in this research can also be a challenge, and there may be difficulties in ensuring the validity and reliability of the findings. Conclusion There is a perceived need for coaching in the setting of a VR cataract surgery simulation training set rather than the need for a debrief. As an emerging area for improving the tuition of medical trainees, virtual reality training has not yet been extensively studied in the literature. Thus, this study serves as a benchmark for future research on the topic, filling a gap in the existing literature. The findings of this study can inform future research and help advance the understanding of the effectiveness of virtual reality training in medical education. Declarations Conflict of interest: The authors do not have any conflict of interest or source of funding to declare. Funding: No funding was received during the conduct of the study Acknowledgement: NONE References Randleman JB, Wolfe JD, Woodward M, Lynn MJ, Cherwek ; D Hunter, Srivastava SK. The Resident Surgeon Phacoemulsification Learning Curve [Internet]. Available from: https://jamanetwork.com/ Ting DSW, Sim SSKP, Yau CWL, Rosman M, Aw AT, Yeo IYS. Ophthalmology simulation for undergraduate and postgraduate clinical education. Vol. 9, International Journal of Ophthalmology. International Journal of Ophthalmology (c/o Editorial Office); 2016. p. 920–4. Lin JC, Yu Z, Scott IU, Greenberg PB. Virtual reality training for cataract surgery operating performance in ophthalmology trainees. Vol. 12, The Cochrane database of systematic reviews. NLM (Medline); 2021. p. CD014953. Iskander M, Ogunsola T, Ramachandran R, McGowan R, Al-Aswad LA. Virtual Reality and Augmented Reality in Ophthalmology: A Contemporary Prospective. Vol. 10, Asia-Pacific journal of ophthalmology (Philadelphia, Pa.). NLM (Medline); 2021. p. 244–52. Pokroy R, Du E, Alzaga A, Khodadadeh S, Steen D, Bachynski B, et al. Impact of simulator training on resident cataract surgery. Graefe’s Archive for Clinical and Experimental Ophthalmology. 2013 Mar;251(3):777–81. O’Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: a synthesis of recommendations. Acad Med. 2014 Sep;89(9):1245–51. Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101. Kostusiak M, Hart M, Barone DG, Hofmann R, Kirollos R, Santarius T, et al. Methodological shortcomings in the literature evaluating the role and applications of 3D training for surgical trainees. Med Teach. 2017 Nov;39(11):1168–73. Watson K. Perspective: Serious play: teaching medical skills with improvisational theater techniques. Acad Med. 2011 Oct;86(10):1260–5. Ong WH, Hind J, Lockington D. Attitudes of ophthalmic trainees in Scotland towards surgical simulation engagement. Eye (Lond). 2023 Aug;37(11):2358–9. Cristancho SM, Moussa F, Dubrowski A. A framework-based approach to designing simulation-augmented surgical education and training programs. Am J Surg. 2011 Sep;202(3):344–51. Puri S, Srikumaran D, Prescott C, Tian J, Sikder S. Assessment of resident training and preparedness for cataract surgery. J Cataract Refract Surg. 2017 Mar;43(3):364–8. Saleh GM, Theodoraki K, Gillan S, Sullivan P, O’Sullivan F, Hussain B, et al. The development of a virtual reality training programme for ophthalmology: repeatability and reproducibility (part of the International Forum for Ophthalmic Simulation Studies). Eye. 2013 Nov 23;27(11):1269–74. Malik MU, Diaz Voss Varela DA, Stewart CM, Laeeq K, Yenokyan G, Francis HW, et al. Barriers to Implementing the ACGME Outcome Project: A Systematic Review of Program Director Surveys. J Grad Med Educ. 2012 Dec;4(4):425–33. McCutcheon S, Duchemin AM. Overcoming barriers to effective feedback: a solution-focused faculty development approach. Int J Med Educ. 2020 Oct 23;11:230–2. Table Table 1: Characteristics of participant Descriptive n (%) Gender Male Female 6 (60) 4 (40) Age in years 28 29 30 5 (50) 4 (40) 1 (10) Level of residency when first started training on the simulator R1 R2 R3 R4 2 (20) 1 (10) 7 (70) - Software level completed Introductory Beginner Intermediate Advanced I don’t remember - 2 (20) 2 (20) 5 (50) 1 (10) Additional Declarations There is no conflict of interest Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5926857","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":436742213,"identity":"48665bfc-c222-4de6-9d5f-bcfb95e50ec3","order_by":0,"name":"Nooran Badeeb","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+ElEQVRIiWNgGAWjYBACgwMQOgGEmBkqgExm5ga8WixQtZwBaWHEr8UGRQtjG4hNSMvx5mMffu5gyONvTz74uHBebTR/O1DLj4ptOLWYnTmWPLP3DEOxxJlnycYztx3PnXGYsYGx58xt3Fpu5Bgz8LYxJDbcyDGT5t12LLcBqAXoQtxajIFaGP8Ctcy/kf/9N++cY7nzCWkxBGphBtmy4UYOGzNvQ03uBoJagH5hlm2TKDY888xYesaxA7kbgVoO4vOLwfHmw4xv22zy5I4nP/xcUFOXO+/84YMPflTg1gIFEjDGYTB5gJB6ZFBHiuJRMApGwSgYIQAAzX9hbeP3byEAAAAASUVORK5CYII=","orcid":"","institution":"University of Jeddah","correspondingAuthor":true,"prefix":"","firstName":"Nooran","middleName":"","lastName":"Badeeb","suffix":""},{"id":436742214,"identity":"5c6d507d-ab9b-4d43-b3f8-c1e5a2ae4434","order_by":1,"name":"Abdulrahman Alsubhi","email":"","orcid":"https://orcid.org/0000-0002-4143-656X","institution":"King Abdulaziz University","correspondingAuthor":false,"prefix":"","firstName":"Abdulrahman","middleName":"","lastName":"Alsubhi","suffix":""},{"id":436742215,"identity":"94d95dd6-de67-421d-9269-0420ac7af960","order_by":2,"name":"Ahmed Basheikh","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Ahmed","middleName":"","lastName":"Basheikh","suffix":""}],"badges":[],"createdAt":"2025-01-29 22:55:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5926857/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5926857/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83602064,"identity":"a5876c56-690b-4fee-be2e-d8edf448ac50","added_by":"auto","created_at":"2025-05-29 09:34:48","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":354966,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5926857/v1/9890cdce-5bbc-4c83-aae3-87294fb76ab1.pdf"}],"financialInterests":"There is no conflict of interest","formattedTitle":"Ophthalmology Trainees’ Perspectives on Virtual Reality Training for Cataract Surgery: A Qualitative Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eCataract surgery is a crucial skill to master in the field of ophthalmology, with surgical competency traditionally thought to be achieved after performing eighty real-life cases (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). However, the introduction of virtual reality (VR) simulation technology has made it easier and safer for surgeons to learn this procedure(\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). While some studies have shown that residents trained on simulators have shorter learning curves during their first fifty real cases, the outcomes of using VR simulations as a tool to decrease complications in real-life surgery or test the readiness of novice learners to operate have been inconsistent(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The low threshold for errors in cataract surgery has led to a wide acquisition of simulators in teaching hospitals and simulation centres, however, they have not been incorporated into the teaching curriculum in many residency programs. This absence of a standardized approach to integrate simulation training is probably due to the lack of data on factors that increase the benefits of training and barriers faced by the residents. Although debriefing after simulation and surgical training has been shown to improve the uptake from experience, there is currently no specific model for debriefing in VR cataract simulation training. Therefore, this study aims to explore ophthalmology residents experience, importance of guidance and mentorship, challenges with simulation, and the need for debriefing in a VR cataract simulation training setting.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThe study involved a qualitative virtual interview-based approach. The standards for reporting qualitative research (SRQR) guidelines were adhered to in this article (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The study participants were ten resident trainees of the Saudi Ophthalmology residency program in the Western region of Saudi Arabia who had experience working on the cataract surgery VR simulation machine Eyesi (VRmagic, GmbH, Mannheim, Germany). The interviews were conducted individually by the principal investigator (PI) (NB) using a semi-structured interview guide. Prior to the interviews, the participants were informed about the nature of the study and data handling, and informed consent was obtained. Ethical approval was also obtained from the King Abdulaziz University Hospital Ethics Committee.\u003c/p\u003e \u003cp\u003eThe objective of the study was implicitly described to the trainees, and the interview questions did not contain any leading words. The questions focused on the participants' perception of their experience on the simulation machine, any factors that made their training experience easier, whether anyone accompanied them during the training on the machine and how that experience was, if they had any conversations about their performance on the machine and whether it was beneficial, and how they felt after the conversation. Each interview lasted between 30\u0026ndash;60 minutes, and data collection was stopped when saturation was reached. The recorded interviews were password protected and accessible only by the PI, and they were transcribed using software and cross-checked with the recordings.\u003c/p\u003e \u003cp\u003eThe analysis of the data was carried out following an inductive thematic approach as outlined by Braun and Clarke.(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e) The transcripts were read by the PI and co-investigator (AB) multiple times to be familiar with the depth of the content. After becoming familiar with the data, potential themes and meaningful data were assigned a code that captured them for further analysis. Codes were then arranged into sets that formed broader themes. Further categorization and review of themes and codes were carried out. Whenever there were concepts that they did not agree on, they discussed them until a consensus was reached. The data, along with the coding, were sent to a third co-investigator for approval of the main concepts that were captured.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe study involved ten senior-level Ophthalmology residents. Table 1 presents the participants' demographics, which showed that the majority were male and had a mean age of 29 years. Most residents began using the cataract VR simulation machine in their third year of residency, and half of the participants reached advanced levels of training on the machine.\u003c/p\u003e\n\u003cp\u003eThe study's data relating to the main themes were summarized in the following section. The themes were derived from the participants' responses to the semi-structured interview questions, which focused on their experiences and perceptions of using the VR simulation machine in cataract surgery training. The data analysis process identified three main themes: the experience of VR simulation training, The role of a teacher, and Debriefing.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe experience of VR Simulation Training\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe most common response on the experience of trainees with Eyesi was that it was beneficial, P1 “My experience was excellent “. The training was especially helpful for beginners to gain skills before operating on real patients, P10 “It was a very good experience, especially since I've never touched a real patient”. \u0026nbsp;Trainees also expressed that they have profited from Eyesi VR simulator to develop their approach and identify areas of improvement, \u003cem\u003eP7 “\u003c/em\u003eIt helped me because when I finished each task, they gave me a written feedback report showing my weakness points,\u003cem\u003e”\u003c/em\u003e, P8 ” It assisted me in my approach, a lot of things I learned through the machine training that in real surgery I did not notice”. However, some participants reported negative aspects of their training experience. This was attributed to the simulation being difficult, time-consuming and not real, P8” It's very difficult, time-consuming”, P4 “It was time-consuming and frustrating, it did give a sense of what it's like to be performing an intraocular surgery, although in unrealistic ways”. One participant reported that, unlike beginners, seniors with surgical experience gain minimal benefit, \u003cem\u003eP7 “\u003c/em\u003eThe maximum benefits we can get from this machine is when we have a gap in our training or when we are junior residents, but for a senior resident doing regular cataract cases, there is not much benefit from doing simulation cataract surgery,”\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eThe Role of Teaching\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAlmost all participants favoured having a teacher during their training on the simulator. The residents reported that it is more needed at the beginning of the training, to learn the basic steps of the surgery and surgical ergonomics, P10” The thing that has helped me the most is that one of the consultants guided me through my few first phacoemulsification simulator sessions,”, P1 “I learned the proper positioning of the cataract machine that mimics reality. The positioning of the simulator head and how to handle the instruments properly with the specific fine movements of the hand or wrest,”. Others reported that they profited from having an expert who analysed their performance, P2 “I would say that the most important thing is having a senior with you, someone who does a lot of cataract surgeries, someone who is good at picking up your mistakes”. Other participants stated that the Eyesi VR simulator was easy to use, P3 “I think the machine is user-friendly,”, and one mentioned that having a teacher is time-consuming, P7” It is time-consuming if we are acquiring or asking for a supervisor to sit with us through the whole Training”.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFeedback and Debriefing\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants stated that they found debriefing helpful and decreased the time to progress in the levels of the simulation, P1 “I remember I discussed my training with my seniors’ multiple times. They were really helpful, gave me some advice on how to overcome some difficulties. I was sitting on the machine for long hours for the same skill but after their advice, I became faster and progressed in my skills”. Debriefing with a senior resident was preferred as opposed to debriefing with a consultant. This was because residents thought someone close to their level would relate more to the struggles they have, P2” Being more senior means, they are professionals to the point that they are doing the basic steps by heart, they don't even think about it and they might miss it. But having a junior, who would just maybe last year or the one before went through what you're going through now, they will remember the smallest things that you are suffering with right now,”, P1” The difference if my peer is more experienced than me, he will give me easier explanation than a senior mentor to deliver the information. So, there is no seniority between us, and we can talk easily,”. Despite this perceived barrier between residents and consultants, one has stated that they would prefer a more experienced surgeon, P10” Of course, if someone has an experience with real patients and knows the complications and how things work it would be much better than just a senior resident. In the first few sessions, it is not about how the machine works only but about giving tips on the surgical steps themselves”. Trainees also expressed that they preferred the debrief to be in person, one-to-one, and during or after the training, P9” I think the discussion about the training should be in the middle or after finishing training, because if you didn't start on the simulation machine itself, you wouldn't have any idea how it works yet”. P2 “I think one to one is better. Sometimes you must criticize the resident or have to mention a couple of mistakes he did, whether in real life or in the simulator, some of the residents might feel embarrassed if they are being criticized in front of others,”.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eTo provide a framework for VR cataract surgical simulation training, we explored trainees' experience with the Eyesi VR simulator. Our participants emphasized the importance of early training, coaching, and a structured debrief to enhance learning with VR simulators. Commencing surgical skills acquisition on simulators offers a risk-free environment for repetitive training with the addition of quantitative feedback. Previous evidence suggests that learners are less inclined to make mistakes in front of colleagues and seniors (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). This form of training allows for building confidence before performing surgery on real patients and learning generic skills (e.g., instrument and microscope handling). However, challenges such as time consumption and difficulty of some of the steps highlight the limitations of simulation compared to real surgery. Similar findings of high satisfaction with the simulator and lack of time as a limitation were reported by Ong et al in their study (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Although these points provide insights into areas where improvements can be made in simulation, they also suggest that a reasonable expectation should be set when using the simulator.\u003c/p\u003e \u003cp\u003eThe need for guidance and constructive feedback was a recurring theme in our analysis, especially for novices. While some participants found the simulator itself easy to use and provided a helpful analysis of their performance, others emphasized the importance of having a more experienced surgeon in the initial stages. Prior studies have shown that supervised training improves residents' competence (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Saleh et.al examined the performance consistency of junior ophthalmic trainees on Eyesi and reported poor reproducibility indicating the need for a structured debrief (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). This blended approach of combining simulators\u0026rsquo; and seniors\u0026rsquo; feedback on overall trainee performance can maximize learning and facilitate transforming into real surgery. Furthermore, the participants have elaborated on what constitutes a successful debrief. Most believe senior residents are easier to engage with in the reflection process, unlike consultants. Barriers from knowledge gaps and time constraints were regarded as the cause, both of which have been identified in the literature (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Other components they reported were the location where the debrief is conducted, highlighting the need for a productive environment that supports confidentiality.\u003c/p\u003e \u003cp\u003eLimitation of our research may include small sample sizes, potential for researcher bias, and difficulty in generalizing findings to larger populations. The subjective nature of data analysis in in this research can also be a challenge, and there may be difficulties in ensuring the validity and reliability of the findings.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThere is a perceived need for coaching in the setting of a VR cataract surgery simulation training set rather than the need for a debrief. As an emerging area for improving the tuition of medical trainees, virtual reality training has not yet been extensively studied in the literature. Thus, this study serves as a benchmark for future research on the topic, filling a gap in the existing literature. The findings of this study can inform future research and help advance the understanding of the effectiveness of virtual reality training in medical education.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eConflict of interest:\u003c/h2\u003e \u003cp\u003eThe authors do not have any conflict of interest or source of funding to declare.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eNo funding was received during the conduct of the study\u003c/p\u003e\u003ch2\u003eAcknowledgement:\u003c/h2\u003e \u003cp\u003eNONE\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eRandleman JB, Wolfe JD, Woodward M, Lynn MJ, Cherwek ; D Hunter, Srivastava SK. The Resident Surgeon Phacoemulsification Learning Curve [Internet]. Available from: https://jamanetwork.com/\u003c/li\u003e\n\u003cli\u003eTing DSW, Sim SSKP, Yau CWL, Rosman M, Aw AT, Yeo IYS. Ophthalmology simulation for undergraduate and postgraduate clinical education. Vol. 9, International Journal of Ophthalmology. International Journal of Ophthalmology (c/o Editorial Office); 2016. p. 920\u0026ndash;4. \u003c/li\u003e\n\u003cli\u003eLin JC, Yu Z, Scott IU, Greenberg PB. Virtual reality training for cataract surgery operating performance in ophthalmology trainees. Vol. 12, The Cochrane database of systematic reviews. NLM (Medline); 2021. p. CD014953. \u003c/li\u003e\n\u003cli\u003eIskander M, Ogunsola T, Ramachandran R, McGowan R, Al-Aswad LA. Virtual Reality and Augmented Reality in Ophthalmology: A Contemporary Prospective. Vol. 10, Asia-Pacific journal of ophthalmology (Philadelphia, Pa.). NLM (Medline); 2021. p. 244\u0026ndash;52. \u003c/li\u003e\n\u003cli\u003ePokroy R, Du E, Alzaga A, Khodadadeh S, Steen D, Bachynski B, et al. Impact of simulator training on resident cataract surgery. Graefe\u0026rsquo;s Archive for Clinical and Experimental Ophthalmology. 2013 Mar;251(3):777\u0026ndash;81. \u003c/li\u003e\n\u003cli\u003eO\u0026rsquo;Brien BC, Harris IB, Beckman TJ, Reed DA, Cook DA. Standards for reporting qualitative research: a synthesis of recommendations. Acad Med. 2014 Sep;89(9):1245\u0026ndash;51. \u003c/li\u003e\n\u003cli\u003eBraun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77\u0026ndash;101. \u003c/li\u003e\n\u003cli\u003eKostusiak M, Hart M, Barone DG, Hofmann R, Kirollos R, Santarius T, et al. Methodological shortcomings in the literature evaluating the role and applications of 3D training for surgical trainees. Med Teach. 2017 Nov;39(11):1168\u0026ndash;73. \u003c/li\u003e\n\u003cli\u003eWatson K. Perspective: Serious play: teaching medical skills with improvisational theater techniques. Acad Med. 2011 Oct;86(10):1260\u0026ndash;5. \u003c/li\u003e\n\u003cli\u003eOng WH, Hind J, Lockington D. Attitudes of ophthalmic trainees in Scotland towards surgical simulation engagement. Eye (Lond). 2023 Aug;37(11):2358\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eCristancho SM, Moussa F, Dubrowski A. A framework-based approach to designing simulation-augmented surgical education and training programs. Am J Surg. 2011 Sep;202(3):344\u0026ndash;51. \u003c/li\u003e\n\u003cli\u003ePuri S, Srikumaran D, Prescott C, Tian J, Sikder S. Assessment of resident training and preparedness for cataract surgery. J Cataract Refract Surg. 2017 Mar;43(3):364\u0026ndash;8. \u003c/li\u003e\n\u003cli\u003eSaleh GM, Theodoraki K, Gillan S, Sullivan P, O\u0026rsquo;Sullivan F, Hussain B, et al. The development of a virtual reality training programme for ophthalmology: repeatability and reproducibility (part of the International Forum for Ophthalmic Simulation Studies). Eye. 2013 Nov 23;27(11):1269\u0026ndash;74. \u003c/li\u003e\n\u003cli\u003eMalik MU, Diaz Voss Varela DA, Stewart CM, Laeeq K, Yenokyan G, Francis HW, et al. Barriers to Implementing the ACGME Outcome Project: A Systematic Review of Program Director Surveys. J Grad Med Educ. 2012 Dec;4(4):425\u0026ndash;33. \u003c/li\u003e\n\u003cli\u003eMcCutcheon S, Duchemin AM. Overcoming barriers to effective feedback: a solution-focused faculty development approach. Int J Med Educ. 2020 Oct 23;11:230\u0026ndash;2. \u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table","content":"\u003cp\u003e\u003cstrong\u003eTable 1: Characteristics of participant\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eDescriptive\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u003cspan dir=\"RTL\"\u003e\u0026nbsp;\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003eGender\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Male\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Female\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6 (60)\u003c/p\u003e\n \u003cp\u003e4 (40)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eAge in years\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 28\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 29\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5 (50)\u003c/p\u003e\n \u003cp\u003e4 (40)\u003c/p\u003e\n \u003cp\u003e1 (10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003eLevel of residency when first started training on the simulator\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; R1\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; R2\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; R3\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; R4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2 (20)\u003c/p\u003e\n \u003cp\u003e1 (10)\u003c/p\u003e\n \u003cp\u003e7 (70)\u003c/p\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 293px;\"\u003e\n \u003cp\u003e\u0026nbsp;Software level completed\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Introductory\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Beginner\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Intermediate\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Advanced\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;I don\u0026rsquo;t remember\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003cp\u003e2 (20)\u003c/p\u003e\n \u003cp\u003e2 (20)\u003c/p\u003e\n \u003cp\u003e5 (50)\u003c/p\u003e\n \u003cp\u003e1 (10)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Ophthalmology, surgical, training, virtual reality, feedback, coach.","lastPublishedDoi":"10.21203/rs.3.rs-5926857/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5926857/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e\u003cbr\u003e\nVirtual reality (VR) based training for cataract surgery is a valuable technology for trainee ophthalmologists. However, the role of debriefing after simulation has not been studied in this setting.\u003cbr\u003e\nThis qualitative study explored trainees’ experiences and expectations of VR simulator training using Eyesi.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003cbr\u003e\nSemi-structured interviews were conducted with ophthalmology trainees who had experience training on the machine. The study explored the trainees' perceptions in three areas: the overall experience and value of the machine training, the need for a teacher, and the need for feedback or debriefing, including the type of feedback or debriefing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003cbr\u003e\nThe study identified the importance of debriefing in cataract surgery VR simulation training, as it reinforced learning and provided an opportunity for reflection. Trainees expressed the need for a teacher or coach to provide guidance during the training process. Additionally, participants identified different types of feedback and debriefing that were most valuable, including coaching on technical skills.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion \u003c/strong\u003e\u003cbr\u003e\nThe study highlights the importance of debriefing and the need for a teacher or coach in cataract surgery VR simulation training. The findings can inform the development of effective training programs and the integration of debriefing in the VR training process.\u003c/p\u003e","manuscriptTitle":"Ophthalmology Trainees’ Perspectives on Virtual Reality Training for Cataract Surgery: A Qualitative Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-04-21 17:34:53","doi":"10.21203/rs.3.rs-5926857/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cef98f95-cc57-4a3e-96d8-9e7a05793e47","owner":[],"postedDate":"April 21st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":46502719,"name":"Scientific community and society/Scientific community/Education"},{"id":46502720,"name":"Health sciences/Diseases/Eye diseases/Lens diseases"}],"tags":[],"updatedAt":"2025-05-29T09:26:41+00:00","versionOfRecord":[],"versionCreatedAt":"2025-04-21 17:34:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5926857","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5926857","identity":"rs-5926857","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}