title: Simulation-based certification for cataract surgery.
abstract: OBJECTIVE
  To evaluate the EyeSi(™) simulator in regard to assessing competence in cataract surgery. The primary objective was to explore all simulator metrics to establish a proficiency-based test with solid evidence. The secondary objective was to evaluate whether the skill assessment was specific to cataract surgery.
  
  
  METHODS
  We included 26 ophthalmic trainees (no cataract surgery experience), 11 experienced cataract surgeons (>4000 cataract procedures) and five vitreoretinal surgeons. All subjects completed 13 different modules twice. Simulator metrics were used for the assessments.
  
  
  RESULTS
  Total module score on seven of 13 modules showed significant discriminative ability between the novices and experienced cataract surgeons. The intermodule reliability coefficient was 0.76 (p < 0.001). A pass/fail level was defined from the total score on these seven modules using the contrasting-groups method. The test had an overall ability to discriminate between novices and experienced cataract surgeons, as 21 of 26 novices (81%) versus one of 11 experienced surgeons (9%) did not pass the test. The vitreoretinal surgeons scored significantly higher than the novices (p = 0.006), but not significantly lower than the experienced cataract surgeons (p = 0.32).
  
  
  CONCLUSIONS
  We have established a performance test, consisting of seven modules on the EyeSi(™) simulator, which possess evidence of validity. The test is a useful and reliable tool for assessment of both cataract surgical and general microsurgical skills in vitro.
authors.affiliation: Department of Ophthalmology, Glostrup University Hospital, Glostrup, Denmark.|Centre for Clinical Education, Centre for HR, Capital Region of Denmark, Copenhagen, Denmark.
authors.forename: Ann Sofia Skou
authors.identifier: http://orcid.org/0000-0002-4249-581X
authors.initials: ASS
authors.lastname: Thomsen
authors.affiliation: Department of Ophthalmology, Glostrup University Hospital, Glostrup, Denmark.
authors.forename: Jens Folke
authors.identifier: http://orcid.org/0000-0003-1054-1460
authors.initials: JF
authors.lastname: Kiilgaard
authors.affiliation: Department of Ophthalmology, Glostrup University Hospital, Glostrup, Denmark.
authors.forename: Hadi
authors.initials: H
authors.lastname: Kjaerbo
authors.affiliation: Department of Ophthalmology, Glostrup University Hospital, Glostrup, Denmark.
authors.forename: Morten
authors.initials: M
authors.lastname: la Cour
authors.affiliation: Centre for Clinical Education, Centre for HR, Capital Region of Denmark, Copenhagen, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Konge
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D002568:Certification / Q000592:standards; D002983:Clinical Competence / Q000592:standards; D004503:Education, Medical, Graduate; D004521:Educational Measurement; D007396:Internship and Residency; D009885:Ophthalmology / Q000193:education; D018918:Phacoemulsification / Q000193:education; D011446:Prospective Studies; D015203:Reproducibility of Results; D000066908:Simulation Training / Q000592:standards; D025321:Surgery, Computer-Assisted / Q000592:standards; D014584:User-Computer Interface
keywords: assessment; cataract surgery; proficiency-based training; standard setting; virtual reality simulation