Analysis of competency in phacoemulsification trainees using the cumulative sum analysis

Abstract

Purpose: To determine the number of cases required to achieve competency in phacoemulsification in terms of the posterior capsule rupture rate.

Setting: Singapore National Eye Centre, Singapore.

Design: Retrospective cohort study.

Methods: The posterior capsule rupture rate of the first 300 phacoemulsification cases performed by each trainee in the Singapore National Eye Centre (2004 to 2012) was charted using cumulative sum graphs. Competency was primarily defined as a posterior capsule rupture rate of 2% or lower and secondarily as 5% or lower.

Results: Twenty trainees fulfilled the inclusion criteria. Four trainees (20%) and 19 trainees (95%) achieved a posterior capsule rupture rate of 2% and 5%, respectively. At least 41 cases were required to achieve a 5% posterior capsule rupture rate (mean 106, median 83).

Conclusions: There was considerable variation in the trainees' abilities. Only 20% of the trainees achieved a posterior capsule rupture rate of 2% or lower and required at least 212 cases.