title: Evaluating teaching methods of cataract surgery: validation of an evaluation tool for assessing surgical technique of capsulorhexis.
abstract: OBJECTIVE
  To develop and assess the validity of an evaluation tool to quantitatively assess the capsulorhexis portion of cataract surgery performed by residents.
  
  
  METHODS
  University of California at Los Angeles (UCLA), Department of Ophthalmology, Jules Stein Eye Institute, Los Angeles, California, USA.
  
  
  METHODS
  Masked prospective case series.
  
  
  METHODS
  Ophthalmology faculty members at UCLA were surveyed and literature was reviewed to develop a grading tool comprising 12 questions to evaluate surgical technique, including 4 from the Global Rating Assessment of Skills in Intraocular Surgery and 2 from the International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubric. Video clips of continuous curvilinear capsulorhexis (CCC) performed by 2 postgraduate year (PGY) 3 residents, 2 PGY 4 residents, and 2 advanced surgeons were independently graded in a masked fashion by a 7-member faculty panel.
  
  
  RESULTS
  Four questions had low interobserver variability and a significant correlation with surgical skill level (intraclass correlation coefficient >0.75; P<.05, analysis of variance; 42 observations). The 4 questions were visual Likert-scale questions grading flow of operation, set up for regrasp, commencement of flap and formation, and circular completion of the CCC.
  
  
  CONCLUSIONS
  Surgical performance can be validly measured using an evaluation tool. However, not all evaluation questions produced reliable results. The reliability and accuracy of the measurements appear to depend on the form and content of the question. Studies to optimize assessment tools identifying the best questions for evaluating each step of cataract surgery may help ophthalmic educators more precisely measure outcomes for improving teaching interventions.
  
  
  BACKGROUND
  No author has a financial or proprietary interest in any material or method mentioned.
authors.affiliation: University of California at Los Angeles, Department of Ophthalmology, Jules Stein Eye Institute, and the Veterans Administration of Greater Los Angeles, Los Angeles, California, USA. lasik@pacbell.net
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Smith
authors.forename: Colin A
authors.initials: CA
authors.lastname: McCannel
authors.forename: Lynn K
authors.initials: LK
authors.lastname: Gordon
authors.forename: David A
authors.initials: DA
authors.lastname: Hollander
authors.forename: JoAnn A
authors.initials: JA
authors.lastname: Giaconi
authors.forename: Sadiqa K
authors.initials: SK
authors.lastname: Stelzner
authors.forename: Uday
authors.initials: U
authors.lastname: Devgan
authors.forename: John
authors.initials: J
authors.lastname: Bartlett
authors.forename: Bartly J
authors.initials: BJ
authors.lastname: Mondino
mesh_terms: D019923:Capsulorhexis / Q000193:education*; D002983:Clinical Competence / Q000592:standards*; D003479:Curriculum; D004503:Education, Medical, Graduate / Q000592:standards*; D004521:Educational Measurement / Q000379:methods*; D006801:Humans; D007396:Internship and Residency; D015588:Observer Variation; D009885:Ophthalmology / Q000193:education*; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013663:Teaching; D014741:Video Recording