The teaching of strabismus surgery in ophthalmology is based on the resident first observing and then performing the required techniques in the operating room under direct supervision of a mentor. Strabismus surgery is usually assigned to junior residents prior to their performing intraocular surgery. Pediatric ophthalmologists are frequently the primary hands-on instructors of proper ophthalmic surgical techniques for novice students. Most of us willingly accept this responsibility, but often come to realize that all residents are not equal in surgical skills. Alternative teaching methods such as instructional courses and workshops may help us to obtain uniformly high proficiency levels in our residency classes.
Progress has been made in resident evaluation since the American Board of Ophthalmology added “surgery” as the seventh competency to the original six core competencies identified by the Accreditation Council for Graduate Medical Education (ACGME). But how can we improve the path to mastering strabismus surgery? In this issue, Vagge et al. call for the implementation of “effective and validated surgical training programs” for residents prior to entering the operating room to compensate for differences in the level of knowledge and skill.
Vagge et al. report the use of a didactic and wet laboratory 70-minute course during which strabismus surgery is simulated using actual instruments and sutures on surgical tissue models and animal eyes. This study describes the effectiveness of this eye muscle surgery course to facilitate better preparation in strabismus surgery in first- and second-year postgraduate ophthalmology residents. Following the course, most residents (73%) felt less anxious about going to the operating room, and all responded that the course was helpful in preparation for strabismus surgery.
Clearly, the ACGME's requirements are shifting from the acquisition of medical knowledge to a system that measures actual performance. How to best reach the desired level of surgical proficiency will most certainly require workshops with “hands-on” training prior to entering the operating room. We at the Journal of Pediatric Ophthalmology & Strabismus would be happy to hear from our readers about effective surgical simulations that they have used to teach residents strabismus surgery.
Rudolph S. Wagner, MD