Educational Concerns About the Safety of Cataract Surgery During Residency: The E3CAPS Pedagogic Study

Jean-Baptiste Ducloyer; Alexandra Poinas; Léa Duchesne; Pascal Caillet; Catherine Ivan; Corinne Lejus-Bourdeau; Nadège Limousin; Thomas Desmidt; Patrick Pladys; Pierre-Jean Pisella; Anne Bernard; Hubert Lardy; Philippe Gohier; Ludovic Martin; Frederic Mouriaux; Pierre Lebranchu; Raoul Kanav Khanna; E3CAPS Group

doi:10.1007/s40123-023-00774-1

Educational Concerns About the Safety of Cataract Surgery During Residency: The E3CAPS Pedagogic Study

Ophthalmol Ther. 2023 Oct;12(5):2801-2812. doi: 10.1007/s40123-023-00774-1. Epub 2023 Aug 2.

Authors

Jean-Baptiste Ducloyer^{1

2}, Alexandra Poinas³, Léa Duchesne⁴, Pascal Caillet⁴, Catherine Ivan^{1

2}, Corinne Lejus-Bourdeau⁵, Nadège Limousin⁶, Thomas Desmidt^{7

8}, Patrick Pladys⁹, Pierre-Jean Pisella¹⁰, Anne Bernard¹¹, Hubert Lardy¹², Philippe Gohier¹³, Ludovic Martin^{14

15}, Frederic Mouriaux¹⁶, Pierre Lebranchu^{1

2}, Raoul Kanav Khanna¹⁷; E3CAPS Group

Collaborators

E3CAPS Group:
Jérôme Chartier, Lucile Gitton, Michel Weber, Driss Mazhar, Charlène Cornee, Florian Bodenes, Isabelle Orignac, Marion Servant, Lucas Bellot, Benoist Menardais, Adam Mainguy, Victor Bielefeld, Angelique Caignard

Affiliations

¹ Ophthalmology Department, Nantes University-CHU Nantes, Nantes, France.
² Centre d'Investigation Clinique 1413 (CIC 1413), Nantes University-CHU Nantes INSERM, Nantes, France.
³ Centre d'Investigation Clinique 1413 (CIC 1413), Nantes University-CHU Nantes INSERM, Nantes, France. alexandra.poinas@chu-nantes.fr.
⁴ Public Health Department, CHU Nantes-Nantes University, Nantes, France.
⁵ Department of Anaesthesia and Intensive Care, CHU Nantes-Nantes University, Nantes, France.
⁶ Department of Neurology and Clinical Neurophysiology, University Hospital Bretonneau, Tours, France.
⁷ Inserm, UMR 1253, IBrain, Université de Tours, Tours, France.
⁸ CHU de Tours, Tours, France.
⁹ LTSI-UMR 1099, INSERM, CHU Rennes-Rennes University, Rennes, France.
¹⁰ Department of Ophthalmology, CHU Tours-Bretonneau Hospital, 37000, Tours, France.
¹¹ Department of Cardiology, Tours University Hospital, Tours, France.
¹² Division of Pediatric Surgery, CHU-Centre de Pédiatrie de Clocheville, Tours, France.
¹³ Department of Ophthalmology, CHU de Angers, 49100, Angers, France.
¹⁴ Department of Dermatology, Angers University Hospital, Angers, France.
¹⁵ All'Sims Centre for Healthcare Simulation, Angers University Hospital, Angers, France.
¹⁶ Ophthalmology Department, CHU Rennes-Université Rennes 1, Rennes, France.
¹⁷ Department of Ophthalmology, UMR 1253, iBrain, Bretonneau University Hospital of Tours, Tours, France.

Abstract

Introduction: Cataract surgery is the most common surgical procedure performed in France. While the incidence of intraoperative complications affecting visual prognosis is extremely low, given the large number of patients operated on, the absolute number of patients affected by complications is quite high. Complication rates are significantly higher when ophthalmology residents (ORs) perform the surgery. Although lack of experience remains the main risk factor, sleep deprivation may adversely affect ORs' successful surgery rate. The value of the EyeSi® surgical simulator in initial training has been demonstrated to increase cataract surgery safety through the transfer of surgical skills from the simulator to the operating room. However, there is no consensus regarding how much training is needed before the first-time ORs are allowed to operate. There is also no scientific evidence that sleep deprivation is associated with a decrease in surgical performance. Establishing a validated protocol for cataract surgery training using the EyeSi surgical simulator (referred to further as the EyeSi) and identifying risk factors for intraoperative complications related to sleep deprivation will improve cataract surgery safety and lead to the reorganization of our healthcare systems.

Methods and planned outcomes: This multi-centre educational cohort study will include two distinct axes which will both aim to reduce the risks of cataract surgery. Enrollment will include 16 first-year ORs for Axis 1 and 25 experienced residents for Axis 2, all from the University Hospitals of Nantes, Tours, Angers and Rennes. Axis 1 will focus on investigating the learning curve of first-year ORs using the EyeSi, following the training program recommended by the "College des Ophtalmologistes Universitaires de France" in order to set up a future "licence to operate." Axis 2 will evaluate the impact of sleep deprivation on the surgical performance of experienced ORs using the EyeSi.

Trial registration: ClinicalTrial.gov identifier: NCT05722080.

Keywords: Cataract surgery; Learning curve; Resident ophthalmologist's learning; Simulation; Sleep deprivation.

Associated data

ClinicalTrials.gov/NCT05722080