The resident surgeon phacoemulsification learning curve.
OBJECTIVE
To analyze outcomes of resident-performed phacoemulsifications and to assess the resident phacoemulsification learning curve.


METHODS
Retrospective chart review of resident-performed phacoemulsification cases at the Atlanta Veterans Affairs Medical Center, Decatur, Georgia, from July 1, 1999, through June 30, 2002. Outcomes measured included postoperative uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), intraoperative complications, and adjusted phacoemulsification times (total phacoemulsification time multiplied by phacoemulsification power used).


RESULTS
We analyzed 680 cases. Postoperative mean UCVA was 20/39, and mean BSCVA was 20/25 (> or = 20/20 in 44.0% of cases and > or = 20/40 in 97.8%). There were no differences in visual acuity outcomes over the course of residency training. Intraoperative complications occurred in 34 cases (5.0%), with a significant reduction in vitreous loss rates after the first 80 resident cases (5.1% vs 1.9%; P = .03). Mean adjusted phacoemulsification time was 0.68 minutes, with a significant reduction in adjusted phacoemulsification time after the first 80 cases (0.87 vs 0.52 minutes; P < .001).


CONCLUSIONS
Quality visual outcomes after phacoemulsification can be attained throughout residency training; however, surgical competency, when measured by complication rates and phacoemulsification efficiency, continues to improve significantly with increasing surgical experience well beyond the first 80 resident phacoemulsification cases.
Randleman
J Bradley
JB
Department of Ophthalmology, Emory University, 1365B Clifton Rd NE, Ste 4500, Atlanta, GA 30322, USA. Jrandle@emory.edu
Wolfe
Jeremy D
JD
Woodward
Maria
M
Lynn
Michael J
MJ
Cherwek
D Hunter
DH
Srivastava
Sunil K
SK
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002983:Clinical Competence / Q000706:statistics & numerical data*; D004503:Education, Medical, Graduate; D005260:Female; D005845:Georgia; D006787:Hospitals, Veterans; D006801:Humans; D007396:Internship and Residency; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D009885:Ophthalmology / Q000193:education*; D018918:Phacoemulsification / Q000193:education* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013997:Time Factors; D014792:Visual Acuity