Innovative Techniques and TechnologyA surgical skills assessment rubric for pterygium surgery
Introduction
Pterygium is a common ophthalmologic disorder defined by the growth of fibrovascular tissue from the conjunctiva over the cornea [1]. Besides its adverse effects on cosmesis, pterygium can induce significant corneal astigmatism, decrease visual acuity and, in extreme cases, cause blindness [2,3]. The prevalence of this disease varies in different regions of the world, but it is particularly common in areas with higher UV radiation [4].
Surgical excision is the treatment of choice in symptomatic cases. It is considered one of the most essential procedures that get taught during ophthalmology residency training worldwide. The International Council of Ophthalmology (ICO) has determined pterygium surgery as one of its Must Know skills in the ICO Residency Curriculum [5]. The remarkable prevalence of pterygium on the one hand, and the lack of need for advanced surgical equipment, on the other hand, have made pterygium surgery one of the fundamental operations for ophthalmology residents [6].
A rubric or assessment tool is generally defined as a scoring tool for rating of a trainee's performance. Rubrics include criteria and standards to achieve those criteria. They help both the trainers and trainees realize what is important in learning a task [7]. Great efforts have been made by surgeons to introduce international assessment tools or rubrics for various ophthalmic surgeries. The International Council of Ophthalmology (ICO) has developed ophthalmology surgical competency assessment rubrics (OSCARs) for different ophthalmic surgeries such as extracapsular cataract extraction, phacoemulsification, strabismus surgery, lateral tarsal strip, ptosis surgery and pediatric cataract extraction [[8], [9], [10], [11], [12], [13]].
Due to the importance of pterygium surgery education in ophthalmology residency and the lack of an international and valid assessment tool for assessing ophthalmology residents' surgical competency in pterygium surgery, we aimed to introduce a rubric for this procedure. We further evaluated its inter-rater reliability and examined its utility in assessing residents’ experience.
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Methods
Designed by a group of experienced surgeons, the initial draft of the rubric divided pterygium surgery into 13 different stages and provided descriptive tasks for each stage. The rubric was designed to include both conjunctival autograft and amniotic membrane transplant techniques. The scoring assignment at each descriptive stage was developed based on the previous rubrics introduced by the ICO [[8], [9], [10], [11], [12], [13]]; in particular, the Dreyfus scale of skill acquisition was used
Results
An international panel of experienced surgeons evaluated the rubric and made modifications until the final version of the rubric was agreed upon [Table 1]. This rubric is designed to include two most commonly used and recommended techniques in pterygium surgery; conjunctival autograft and amniotic membrane transplantation (AMT). The first eight stages and final two stages are common in both methods. These common steps are Disinfection and draping, Traction suture, Anesthesia technique, Removing
Discussion
In 2002, the American Board of Ophthalmology added surgery and surgical skills as the seventh independent category to the six categories previously defined by the Accreditation Council for Graduate Medical Education (ACGME) for evaluating competency as an educational outcome of residency programs [15,16]. Teaching surgical skills to ophthalmology residents, assessment of their progression and recognizing factors that may influence the results of their surgery, are principal aims of
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Contributed equally to the manuscript.