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Simulation-based training for intraoperative posterior capsule rupture management: an analysis of nontechnical skills development and the relationship between technical and nontechnical skills

Eye (2024)Cite this article

Subjects

Abstract

Objectives

To analyse development of individual nontechnical skills (NTS) domains after undertaking a previously developed simulation-based training model and analyse the relationship between technical skills (TS) and NTS in ophthalmic surgery.

Methods

The simulation-based training model involved a cataract surgery case complicated by intraoperative posterior capsule rupture. Cataract surgeons underwent the simulation twice, separated by a training intervention. Two blinded independent experts assessed participants’ NTS using HUFOES, NOn-Technical Skills for Surgeons (NOTSS), and the OSATS global rating scale for TS. Paired t-tests assessed differences in individual NTS domains, with p < 0.05 indicating significance. The Pearson Product Moment Correlation Coefficient was used to assess the correlation between scores from each scoring system.

Results

All NTS domains within HUFOES and NOTSS demonstrated statistically significant improvements secondary to the training intervention. Positive correlations were demonstrated between HUFOES and OSATS scores in the pre- and post-training simulations, r = 0.870 (p < 0.001) and r = 0.861 (p < 0.001), respectively. Positive correlations were also demonstrated between NOTSS and OSATS scores in pre- and post-training simulations, r = 0.849 (p < 0.001) and r = 0.757 (p = 0.001), respectively. Positive correlations were demonstrated between HUFOES and NOTSS scores; r = 0.979 (p < 0.001) (n = 17) and r = 0.959 (p < 0.001) for pre- and post-training simulations, respectively.

Conclusion

All NTS domains contained within HUFOES and NOTSS demonstrated significant increases following the completion of the simulation-based training model. Positive correlations exist between an ophthalmic surgeon’s TS and NTS. This is the first study to report these findings within ophthalmic surgery.

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Data availability

Data collected, used and analysed for the present article is not openly available due to reasons of participant confidentiality, however anonymized data can be accessed upon reasonable request submitted directly to the Corresponding Author.

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Acknowledgements

The authors thank the Simulation department at the University Hospitals Sussex (UHSussex) NHS Trust for helping with simulation semantics. The authors are also grateful to: Theatre staff: Jenny Brookes, Vasiliki Xenaki, Chris Tully, Letizia Buccoliero, Tina McMilan, Regis Chaco, Myrna McHarg and Philip Harris. Consultants: Edward Hughes, Dominic Heath. Trainees: Hasan Naveed, Simerdeep Kaur, Hanbin Lee, Christopher Holmes, Ahmed Roble, Vidushi Golash, Patrick Idam, Jamal Sawan, Radhika Dashputra, Huw Oliphant, Tristian Mann, Gabriela Ortiz, Krystian Kyza. Management: Emma Goudman, Alex Shaw, Jane McNevin, and Neil Vine.

Author information

Author notes

  1. These authors contributed equally: Thomas Charles Wood, Sundas Maqsood.

Authors and Affiliations

  1. Sussex Eye Hospital, University Hospitals Sussex (UHSussex) NHS Trust, Eastern Road, BN2 5BF, Brighton, UK

    Thomas Charles Wood, Sundas Maqsood, Mayank A. Nanavaty & Saul Rajak

  2. Department of Ophthalmology, Maidstone and Tunbridge Wells Hospital, Hermitage Lane, ME16 9QQ, Maidstone, Kent, UK

    Sundas Maqsood

  3. Resuscitation Services Department, Southpoint Building, Royal Sussex County Hospital, BN2 1HA, Brighton, UK

    Alexander Saunders

  4. Heathrow Airport, TW6, London, UK

    William Sancha

  5. Brighton and Sussex Medical School, Falmer, BN1 9PX, Brighton, UK

    Mayank A. Nanavaty & Saul Rajak

  6. Eastbourne District General Hospital, King’s Drive, BN21 2UD, Eastbourne, East Sussex, UK

    Michael Wearne

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Contributions

TCW contributed to the study’s concept and design, data acquisition and statistical analysis, drafting and revision of the manuscript, administrative and technical support throughout the study, and final approval of the manuscript. SM contributed to the study’s concept and design, data acquisition and statistical analysis, drafting and revision of the manuscript, administrative and technical support throughout the study, provided regular supervision, and approved the final manuscript. AS contributed to the study’s concept and design, data acquisition, revision of the manuscript, administrative and technical support throughout the study, provided regular supervision, and approved the final manuscript. WS contributed to the study’s concept and design, revision of the manuscript, administrative and technical support throughout the study, provided regular supervision, and approved the final manuscript. MAN contributed to the study’s concept and design, data analysis, drafting and revision of the manuscript, administrative and technical support throughout the study, provided regular supervision, and approved the final manuscript. MW contributed to data acquisition, drafting and revision of the manuscript, technical support throughout the study, provided supervision, and approved the final manuscript. SR contributed to the study’s concept and design, data acquisition and statistical analysis, drafting and revision of the manuscript, administrative and technical support throughout the study, provided regular supervision, and approved the final manuscript.

Corresponding author

Correspondence to Thomas Charles Wood.

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Competing interests

None of the authors have any financial interest in any product or procedures mentioned in this manuscript. Other disclosures are as follows: TCW, AS, WS, MW and SR: None. SM: Research grant from NuVision biotherapies. MAN is a member of the Eye editorial board. Research grants from Alcon Laboratories, USA; European Society of Cataract and Refractive Surgery; Johnson & Johnson, USA; Rayner Intraocular lenses, UK, Ziemer, Switzerland. Lecture fees from Alcon Laboratories, USA. Consultant to Alcon, Johnson & Johnson, Hoya & Ziemer. Travel grant from Alcon Laboratories, USA & Bausch & Lomb, USA

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Wood, T.C., Maqsood, S., Saunders, A. et al. Simulation-based training for intraoperative posterior capsule rupture management: an analysis of nontechnical skills development and the relationship between technical and nontechnical skills. Eye (2024). https://doi.org/10.1038/s41433-024-03051-y

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