Triad of rubric assessment, constructive feedback and video recorded surgeries key assessment for competent ophthalmic surgeon

Ophthalmic surgery involves very precise surgical skill, which is difficult to teach and even more cumbersome in assessment of resident’s surgical skill. Hence it’s a need of time to adopt newer tool for transferring as well as assessing surgical skill. With this concept in mind International Council of Ophthalmology (ICO) has developed various tools for assessing surgical skills. If we use this tool not only as learning tool but also to give constructive feedback on the surgical skills of resident doctors it will help in creating a competent ophthalmic surgeon and eventually help society in general. 1To develop more standardized surgical training; 2. To assess efficacy and feasibility of new tool in improving surgical skills of Post Graduate(PG) student; 3. To know the effect of constructive feedback on surgical performance. Small incision cataract surgery training is done by Rubric designed by ICO- OSCAR. The same tool was used to assess video recorded cataract surgery of residents by different faculties and assess their surgical skill. The assessor simply circled the observed performance description at each step of the procedure. The ICO-OSCAR score was completed. At the end of the case assessor immediately discussed operated case with student to provide timely, structured, specific performance feedback. Oscar score was recorded and analysed with inter rater agreement. OSCAR TOOL has very good inter rater agreement i.e.(0.96). Analysis of student & Observer feedback infers that OSCAR Tool is best tool for learning as well as assessment tool and is easy to use. Recorded surgeries & constructive feedback from assessor helped Post Graduate students to improve surgically. This resulted in best outcome for patient in terms of good visual acuity post operatively. The formative assessment of surgical skills becomes an integral part of our formal residency, training framework, it would be in the interest of our trainees and trainers that we should adopt the OSCAR tools to train and assess. These tools can add immense value to our residency as well fellowship surgical training and possibly help create a generation of competent trainee.Formative Assessment and constructive feedback in surgical training will improve the competency of new ophthalmic surgeons.Structured surgical training will be relatively easy to observe and perform, as trainee learns what is required to be competent.This will ultimately improve the overall quality of patient care.

Redefining Surgical Skill Acquisition

There have been reduced opportunities for surgical skill acquisition due to the COVID-19 pandemic and the regulated training hours. Despite these challenges, self-regulated learning allows trainees to learn continuously, and motor skills development can be augmented through mental practice and motor imagery. The aim of this chapter is to introduce the theoretical concepts in skill acquisition and the role of mental and deliberate practice as an alternative for skill training. A case study is presented using a design and development framework for producing an online basic micro suturing training resource based on self-regulated learning. This case study demonstrates the use of the ADDIE instructional design model and Mayer’s multimedia theory guidelines, for creating online instructional resources. The methodological approach of a design and developmental framework to create an educationally sound online training module for micro suturing which has significant utility in hand surgery is discussed in this chapter. The tools described in this chapter are translatable to any psychomotor skills development in medical education.

Key Considerations in Practices and Principles of Endoscopic Septoplasty: Lessons, Mistakes and Future

Background: Conventional surgeries of the nasal septum improve the nasal airway but recent development and advancement of the knowledge about the endoscopic septoplasty has significantly changed the treatment modality and had brought focus over several aspects of possible advantages. This study aims to see the advantages, complications and limitations of endoscopic septoplasty. Methods: It was an observational prospective study conducted over 90 patients of symptomatic deviated nasal septum. It evaluated symptoms, anterior rhinoscopy and nasal endoscopy findings, objective and subjective improvement of symptoms using the nasal obstruction symptom evaluaiton (NOSE) score, post-operative pain using the visual analogue scale (VAS) and complication following the surgery. Results: Deviated nasal septum (DNS) either left or right side was the most common examination finding 97.78%. Post-operatively there was a good symptom relief and significant subjective improvement in NOSE scores with average decline in the score by 96.26%. Objective assessment of all patients showed improved airway. The complication rate was minimum 7.78%. Conclusion: Endoscopic septoplasty (ES) was found to have distinct advantages with good subjective and objective improvement of symptoms and lesser rate of complications. It should be an option offered to all patients requiring septoplasty. We also found that it helps in improving the learning curve and surgical skill of the trainees. Bangladesh J Otorhinolaryngol 2021; 27(2): 170-176