Maximising safety of cataract surgery training: improving patient safety by reducing cataract surgery complication rates.
OBJECTIVE
Cataract surgery is a highly successful, high-volume surgery, hence reducing surgical complications are imperative for organizations to deliver cost-effective, high-quality services that meet the needs of patients. This paper aims to describe 18-month results of a sustainable program to maximize the safety of cataract surgery training.


METHODS
Modifications to the comprehensive cataract-training program and tested were developed in a controlled, interventional case series to evaluate their effect on trainee complication rates. Data collection and interpretation were performed in a prospective and blind manner.


RESULTS
Prior to intervention, PCR rates for trainee-surgeons averaged 3.34 per cent cf international published figures of 4.6-10 per cent. This compared with 1.89 per cent PCR rate for trained cataract surgeons (p < 0.002, Mann Whitney test). Multiple interventions were introduced and enforced to maximize cataract surgery training safety. After 18 months follow-up data were consistent with a statistically significant reduction in trainee PCR rates (1.53 per cent, p < 0.007, Wilcoxon Signed Ranks test) compared with trained cataract surgeons (1.23 per cent, p < 0.074, Wilcoxon Signed Ranks test). Parameters of training efficacy were improved or maintained during this period.


CONCLUSIONS
Limitations included using trained cataract surgeons as controls as apposed to a similar group of trainee surgeons. In addition, multiple interventions were simultaneously instituted, making identification of a single influential factor impossible to identify.


CONCLUSIONS
Maximally safe and effective cataract surgery training is achieved in Singapore without compromising service and quality markers. Similar training goals can be extrapolated to other surgical disciplines.


CONCLUSIONS
This is the first study to demonstrate maximally safe and effective cataract surgery training in a large patient group, over sustained periods.
Goh
E-Shawn
ES
Department of Ophthalmology, Tan Tock Seng Hospital, Singapore. eshawng@yahoo.co.uk
D016022:Case-Control Studies; D002387:Cataract Extraction / Q000009:adverse effects* / Q000193:education; D003625:Data Collection; D004502:Education, Medical, Continuing / Q000592:standards / Q000706:statistics & numerical data*; D004503:Education, Medical, Graduate / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D013508:Ophthalmologic Surgical Procedures / Q000009:adverse effects / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology*; D016730:Program Development; D015397:Program Evaluation; D011446:Prospective Studies; D012308:Risk Management; D012449:Safety / Q000592:standards / Q000706:statistics & numerical data*; D012846:Singapore; D016037:Single-Blind Method