Abstract:
Background/Aim Glaucoma accounts for 8% of global
blindness and surgery remains an important treatment.
We aimed to determine the impact of adding simulationbased surgical education for glaucoma.
Methods We designed a randomised controlled,
parallel-group trial. Those assessing outcomes were
masked to group assignment. Fifty-one trainee
ophthalmologists from six university training
institutions in sub-Saharan Africa were enrolled by
inclusion criteria of having performed no surgical
trabeculectomies and were randomised. Those
randomised to the control group received no placebo
intervention, but received the training intervention
after the initial 12-month follow-up period. The
intervention was an intense simulation-based surgical
training course over 1 week. The primary outcome
measure was overall simulation surgical competency at
3 months.
Results Twenty-five were assigned to the intervention
group and 26 to the control group, with 2 dropouts
from the intervention group. Forty-nine were included
in the final intention-to-treat analysis. Surgical
competence at baseline was comparable between the
arms. This increased to 30.4 (76.1%) and 9.8 (24.4%)
for the intervention and the control group, respectively,
3 months after the training intervention for the
intervention group, a difference of 20.6 points (95% CI
18.3 to 22.9, p<0.001). At 1 year, the mean surgical
competency score of the intervention arm participants
was 28.6 (71.5%), compared with 11.6 (29.0%) for
the control (difference 17.0, 95% CI 14.8 to 19.4,
p<0.001).
Conclusion These results support the pursuit of
financial, advocacy and research investments to
establish simulation surgery training units and courses
including instruction, feedback, deliberate practice
and reflection with outcome measurement to enable
trainee glaucoma surgeons to engage in intense
simulation training for glaucoma surgery
