title: Is there inter-procedural transfer of skills in intraocular surgery? A randomized controlled trial.
abstract: OBJECTIVE
  To investigate how experience in simulated cataract surgery impacts and transfers to the learning curves for novices in vitreoretinal surgery.
  
  
  METHODS
  Twelve ophthalmology residents without previous experience in intraocular surgery were randomized to (1) intensive training in cataract surgery on a virtual-reality simulator until passing a test with predefined validity evidence (cataract trainees) or to (2) no cataract surgery training (novices). Possible skill transfer was assessed using a test consisting of all 11 vitreoretinal modules on the EyeSi virtual-reality simulator. All participants repeated the test of vitreoretinal surgical skills until their performance curve plateaued. Three experienced vitreoretinal surgeons also performed the test to establish validity evidence. Analysis with independent samples t-tests was performed.
  
  
  RESULTS
  The vitreoretinal test on the EyeSi simulator demonstrated evidence of validity, given statistically significant differences in mean test scores for the first repetition; experienced surgeons scored higher than novices (p = 0.023) and cataract trainees (p = 0.003). Internal consistency for the 11 modules of the test was acceptable (Cronbach's α = 0.73). Our findings did not indicate a transfer effect with no significant differences found between cataract trainees and novices in their starting scores (mean ± SD 381 ± 129 points versus 455 ± 82 points, p = 0.262), time to reach maximum performance level (10.7 ± 3.0 hr versus 8.7 ± 2.8 hr, p = 0.265), or maximum scores (785 ± 162 points versus 805 ± 73 points, p = 0.791).
  
  
  CONCLUSIONS
  Pretraining in cataract surgery did not demonstrate any measurable effect on vitreoretinal procedural performance. The results of this study indicate that we should not anticipate extensive transfer of surgical skills when planning training programmes in intraocular surgery.
authors.affiliation: Department of Ophthalmology, Rigshospitalet - Glostrup University Hospital, Glostrup, Denmark.|Copenhagen Academy of Medical Education and Simulation, Centre for HR, Copenhagen, Capital Region of Denmark, 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, Rigshospitalet - 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, Rigshospitalet - Glostrup University Hospital, Glostrup, Denmark.
authors.forename: Morten
authors.initials: M
authors.lastname: la Cour
authors.affiliation: Department of Medicine and the Wilson Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Ryan
authors.initials: R
authors.lastname: Brydges
authors.affiliation: Copenhagen Academy of Medical Education and Simulation, Centre for HR, Copenhagen, Capital Region of Denmark, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Konge
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003198:Computer Simulation; D004503:Education, Medical, Graduate / Q000379:methods*; D005260:Female; D006801:Humans; D007396:Internship and Residency; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D013508:Ophthalmologic Surgical Procedures / Q000193:education*; D009885:Ophthalmology / Q000193:education*; D025321:Surgery, Computer-Assisted / Q000193:education*; D014163:Transfer, Psychology
keywords: assessment/formative feedback; cataract surgery; simulation-based training; vitreoretinal surgery