title: Perceived difficulty of various steps of manual small incision cataract surgery among trainees in rural China.
abstract: BACKGROUND
  The perceived difficulty of steps of manual small incision cataract surgery among trainees in rural China was assessed.
  
  
  METHODS
  Cohort study.
  
  
  METHODS
  Fifty-two trainees at the end of a manual small incision cataract surgery training programme.
  
  
  METHODS
  Participants rated the difficulty of 14 surgical steps using a 5-point scale, 1 (very easy) to 5 (very difficult). Demographic and professional information was recorded for trainees.
  
  
  METHODS
  Mean ratings for surgical steps.
  
  
  RESULTS
  Questionnaires were completed by 49 trainees (94.2%, median age 38 years, 8 [16.3%] women). Twenty six (53.1%) had performed ≤50 independent cataract surgeries prior to training. Trainees rated cortical aspiration (mean score ± standard deviation = 3.10 ± 1.14) the most difficult step, followed by wound construction (2.76 ± 1.08), nuclear prolapse into the anterior chamber (2.74 ± 1.23) and lens delivery (2.51 ± 1.08). Draping the surgical field (1.06 ± 0.242), anaesthetic block administration (1.14 ± 0.354) and thermal coagulation (1.18 ± 0.441) were rated easiest. In regression models, the score for cortical aspiration was significantly inversely associated with performing >50 independent manual small incision cataract surgery surgeries during training (P = 0.01), but not with age, gender, years of experience in an eye department or total number of cataract surgeries performed prior to training.
  
  
  CONCLUSIONS
  Cortical aspiration, wound construction and nuclear prolapse pose the greatest challenge for trainees learning manual small incision cataract surgery, and should receive emphasis during training. Number of cases performed is the strongest predictor of perceived difficulty of key steps.
authors: State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China.
authors: Wenyong
authors: W
authors: Huang
authors: Ronghua
authors: R
authors: Ye
authors: Shengsong
authors: S
authors: Huang
authors: Decai
authors: D
authors: Wang
authors: Lanhua
authors: L
authors: Wang
authors: Bin
authors: B
authors: Liu
authors: David S
authors: DS
authors: Friedman
authors: Mingguang
authors: M
authors: He
authors: Yizhi
authors: Y
authors: Liu
authors: Nathan G
authors: NG
authors: Congdon
mesh_terms: D000328:Adult; D002386:Cataract / Q000453:epidemiology*; D002387:Cataract Extraction / Q000193:education*; D002681:China / Q000453:epidemiology; D002983:Clinical Competence / Q000706:statistics & numerical data*; D015331:Cohort Studies; D004503:Education, Medical, Graduate / Q000706:statistics & numerical data*; D004521:Educational Measurement; D005260:Female; D006801:Humans; D007396:Internship and Residency; D019654:Lens Implantation, Intraocular; D008297:Male; D008875:Middle Aged; D009885:Ophthalmology / Q000193:education*; D012424:Rural Population / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
keywords: cataract; surgery; training