Reply : Assessing the value of simulator training on residency performance

Abstract

We thank Drs. Naseri and Chang for their comments on our article and their contribution to the discussion of the role of surgical simulators in ophthalmology resident training. Our study investigated the effect of simulator training on intraoperative surgical performance, and its primary findings were statistically significant improvements in phacoemulsification time, phacoemulsification power, and adjusted phacoemulsification time. The complication rates for the simulator and nonsimulator groups were calculated by dividing the number of cases containing intraoperative complications in each group by the total number of cases in each group. This resulted in the reported complication rates of 0.06 (6%) and 0.04 (4%), respectively, as noted in the abstract and text of the article. Admittedly, Table 2 is possibly unclear in that it denotes these values as 0.06% and 0.04%, respectively. The zero-complication rates of 44.1% and 43.8%, respectively, among residents in each group were simply measures of the number of residents in each group that did not experience any intraoperative complications during the cases included in our review. Alternatively, we might have reported that 55.9% and 56.2%, respectively, of residents in the simulator and nonsimulator groups experienced at least 1 complication in the cases studied. Therefore, it is a disparate measure from—and does not correlate with—the overall complication rates reported for each group. Regardless, the difference in intraoperative complication rates between the 2 groups was not statistically significant in our study. More work is necessary to further establish the impact of simulator training on surgical complications and patient outcomes. Furthermore, each resident spent a minimum of 2 hours each year on the simulator and had at least 4 hours or more simulator training before being included in the study during the third year of residency training. Although there was a difference between the groups in the operative experience prior to entry into the study, we found no statistical correlation in number of surgeries performed prior to the study related to phacoemulsification time, phacoemulsification power, and adjusted phacoemulsification time. As in any retrospective study, our findings are subject to confounding variables and we appreciate the elucidation of the various factors that might have contributed to our results. Still, no other study to date has investigated actual intraoperative performance among ophthalmology residents following surgical simulator training and we feel our results are an important contribution to the growing body of literature on this subject. A prospective study investigating the effects of simulator training in a more controlled setting is the ultimate goal once the practical limitations of completing such a project are overcome.