Practice makes perfect: Development of microsurgical skills for cataract surgery using a surgical simulator

BACKGROUND Ophthalmological procedures are difficult to master due to the complexity of ophthalmological skills. Simulation offers a great opportunity for unlimited practice in a controlled environment. Therefore, simulation is becoming an important part of novel medical curricula. We conducted a prospective randomized controlled study to demonstrate the effects of structured cataract surgery training on the development of eye-hand coordination. METHODS Twenty-eight medical students were randomized to experimental and control groups. Each student completed 4-week structured training on The Eyesi Ophthalmic Surgical Simulator. The control group performed one training the 1 st and the 4 th week of the study (2 training sessions) and the experimental group completed one training each week of the study (4 training sessions). Every training was composed of 5 different tasks (3 abstract and 2 clinical). In task 1 students practiced basic instrument navigation and in task 2 microsurgical forceps manipulation. In task 3 they performed antitremor training. In clinical tasks, students performed capsulorhexis with premade flap in task 4. In task 5 they had to create a flap themselves. RESULTS There was no statistical difference in performance between the groups on the first training. Control group improved their score for 16.6 % on their last (second) training and experimental group improved their score for 38.7 % on their last (fourth) training.Comparing last trainings, control group improved their result in tasks 1 and 2, whereas experimental group improved their result in all tasks. CONCLUSIONS We showed that structured training on a cataract surgery simulator improves students’ microsurgical skills. Both groups improved their performance on the last training. Experimental group with more repetitions surpassed control group with fewer training sessions. Two training sessions were enough to achieve significant improvement in abstract tasks only. However, four repetitions were enough to significantly improve in all tasks. Our study certifies the positive impact of simulator training on microsurgical skills needed in cataract surgery. Furthermore, it shows that such skills could be achieved in students with no preceding cataract training in vivo.