title: Comparing resident cataract surgery outcomes under novice versus experienced attending supervision.
abstract: OBJECTIVE
  To determine whether supervision by an attending who is new to surgical teaching, or an experienced attending measurably influences intraoperative complications rates or outcomes in phacoemulsification performed by ophthalmology residents.
  
  
  METHODS
  Single tertiary hospital.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Resident-performed phacoemulsification cases supervised by one novice attending (N=189) and experienced attending (N=172) over 1 year were included. Data included: resident year, patient age, sex, preoperative risk factors (4+ on the four point scale for dense/white/brunescent cataracts, Flomax, zonular dialysis, pseudoexfoliation, glaucoma risk, post-vitrectomy), intraoperative risk factors (Trypan blue, iris hooks), and intraoperative complications (capsule tears, vitreous loss, zonular dialysis, zonular dehiscence, burns, nuclear fragment loss, Descemet's tear). Experienced attending data were compared against those of the novice attending.
  
  
  RESULTS
  Regarding preoperative risks, experienced attending cases more likely involved 4+ cataract (P=0.005), Flomax (P<0.001), or glaucoma risk (P=0.001). For intraoperative risks, novice attending cases more likely involved Trypan blue (P<0.001). Regarding complications, novice attending cases were associated with vitreous loss (P=0.002) and anterior capsule tears (P<0.001). When comparing total complications, the novice attending was more likely to have both increased number of cases with complications and total complications than the experienced attending. The novice attending's overall complication rate trended downward (rate from 28% in first 25 cases to 6.67% in last 15).
  
  
  CONCLUSIONS
  Early cases for the novice attending were accompanied by greater complications (vitreous loss and anterior capsule tear), likely due to a learning curve. Surgical judgment in the operating room likely develops with experience. Training programs may focus on these specific areas to aid new instructors.
authors.affiliation: Johns Hopkins School of Medicine, Baltimore, MD, USA.
authors.forename: Sidharth
authors.initials: S
authors.lastname: Puri
authors.affiliation: Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Amanda E
authors.initials: AE
authors.lastname: Kiely
authors.affiliation: Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Jiangxia
authors.initials: J
authors.lastname: Wang
authors.affiliation: Kaiser Permanente South Sacramento Medical Center, Sacramento, CA, USA.
authors.forename: Alonzo S
authors.initials: AS
authors.lastname: Woodfield
authors.affiliation: San Francisco School of Medicine, University of California, San Francisco, CA, USA.
authors.forename: Saras
authors.initials: S
authors.lastname: Ramanathan
authors.affiliation: Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
authors.forename: Shameema
authors.initials: S
authors.lastname: Sikder
keywords: attending experience; cataract surgery; complication rate