Comparison of Simulation-Based versus Live Tissue–Based Ocular Trauma Training on Novice Ophthalmologists: Repair of Marginal Eyelid Laceration Model

Abstract

Introduction Simulation training in medical education provides the ability to teach valuable surgical skills in an environment free of risk to patients. Surgical simulation in ophthalmology continues to evolve as new technologies advance, though widespread use in ophthalmology outside of cataract surgery simulation is lacking. Here, we present a study into the efficacy of surgical simulation for eyelid laceration repair when compared with standard tissue-based instruction.

Materials and Methods The study included 43 ophthalmology residents and 16 staff ophthalmologists from the Ocular Trauma Surgery Laboratory (OTSL) at the Uniformed Services University of the Health Sciences (USUHS). After initial evaluation on their ability to repair marginal eyelid lacerations on a porcine eye, residents were randomized to receive training in marginal eyelid repair technique from faculty preceptors using either traditional porcine tissue or the Ocular and Craniofacial Trauma Treatment Training System (Medical Device and Simulation Laboratory). They were then reevaluated after training. Participating staff also underwent initial evaluation, self-guided training, and post-training evaluation. Outcome measures included successful repair of laceration, number of sutures required to close a 10-mm wound, time required to repair, and the following graded on a scale of 1–4 (1—poor, 2—fair, 3—good, 4—excellent): tarsal plate reconstruction and margin approximation.

Results Among residents, improved scores in marginal approximation were noted after training when comparing scores both within the simulator-trained group (pre-training score: 2.0, post-training score: 3.0; p = 0.03) and between the simulator (SIM) and live tissue (LIVE) groups (SIM: 3.0, LIVE: 2.0 p = 0.03). Neither residents nor staff demonstrated significant differences between SIM versus LIVE in other metrics evaluated. Response in a post-study survey was favorable to simulator training, with 79% noting the simulator was helpful in teaching skills, and 83% noting they would use the simulator again.

Conclusion Simulator technology for teaching marginal eyelid laceration repair appears to be noninferior to traditional tissue-based instruction. Additionally, it appears to be superior when evaluating the ability to approximate the eyelid margin appropriately. Simulators are safe and ethical alternatives to tissue-based instruction, and are favorably received among trainees, and therefore warrant additional investigation and development for ophthalmic surgical training.

Keywords

ophthalmology - simulation - training

Meeting Presentation

Portions of this material were presented at the annual meetings of the Military Health System Research Symposium, Orlando, Florida, August 2016 and 2017.

Disclaimer

The opinions or assertions contained herein are the private ones of the author and are not to be construed as official or reflecting the views of the Department of Defense, the Uniformed Services University of the Health Sciences, or any other agency of the U.S. Government.

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