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
