title: Update on simulation-based surgical training and assessment in ophthalmology: a systematic review.
abstract: OBJECTIVE
  This study reviews the evidence behind simulation-based surgical training of ophthalmologists to determine (1) the validity of the reported models and (2) the ability to transfer skills to the operating room.
  
  
  CONCLUSIONS
  Simulation-based training is established widely within ophthalmology, although it often lacks a scientific basis for implementation.
  
  
  METHODS
  We conducted a systematic review of trials involving simulation-based training or assessment of ophthalmic surgical skills among health professionals. The search included 5 databases (PubMed, EMBASE, PsycINFO, Cochrane Library, and Web of Science) and was completed on March 1, 2014. Overall, the included trials were divided into animal, cadaver, inanimate, and virtual-reality models. Risk of bias was assessed using the Cochrane Collaboration's tool. Validity evidence was evaluated using a modern validity framework (Messick's).
  
  
  RESULTS
  We screened 1368 reports for eligibility and included 118 trials. The most common surgery simulated was cataract surgery. Most validity trials investigated only 1 or 2 of 5 sources of validity (87%). Only 2 trials (48 participants) investigated transfer of skills to the operating room; 4 trials (65 participants) evaluated the effect of simulation-based training on patient-related outcomes. Because of heterogeneity of the studies, it was not possible to conduct a quantitative analysis.
  
  
  CONCLUSIONS
  The methodologic rigor of trials investigating simulation-based surgical training in ophthalmology is inadequate. To ensure effective implementation of training models, evidence-based knowledge of validity and efficacy is needed. We provide a useful tool for implementation and evaluation of research in simulation-based training.
authors: Department of Ophthalmology, Glostrup University Hospital, Glostrup, Denmark; Centre for Clinical Education, Centre for HR, Capital Region of Denmark, Copenhagen, Denmark. Electronic address: skouthomsen@dadlnet.dk.
authors: Ann Sofia S
authors: AS
authors: Thomsen
authors: Centre for Clinical Education, Centre for HR, Capital Region of Denmark, Copenhagen, Denmark.
authors: Yousif
authors: Y
authors: Subhi
authors: Department of Ophthalmology, Glostrup University Hospital, Glostrup, Denmark.
authors: Jens Folke
authors: JF
authors: Kiilgaard
authors: Department of Ophthalmology, Glostrup University Hospital, Glostrup, Denmark.
authors: Morten
authors: M
authors: la Cour
authors: Centre for Clinical Education, Centre for HR, Capital Region of Denmark, Copenhagen, Denmark.
authors: Lars
authors: L
authors: Konge
mesh_terms: D002102:Cadaver; D002983:Clinical Competence / Q000592:standards*; D003198:Computer Simulation; D003194:Computer-Assisted Instruction / Q000379:methods*; D016208:Databases, Factual; D006801:Humans; D023421:Models, Animal; D013508:Ophthalmologic Surgical Procedures / Q000193:education*; D009885:Ophthalmology / Q000193:education*; D014584:User-Computer Interface