Impact of a Formal Presurgical Curriculum on Early Resident Cataract Outcomes

Background: Presurgical training during ophthalmology residency is crucial for a successful transition to cataract surgery in the operating room. Growing evidence suggests that residents benefit more from supervised hands-on learning than from independent practice. The supervised presurgical curriculum approach for early resident cataract surgical training has not been widely studied, especially with regard to the steepest part of the learning curve. Purpose: To investigate the impact of a formal presurgical wet lab curriculum on early resident cataract complication rates, operative time, and patient visual outcomes. Methods: In this retrospective case-control study, resident primary cataract cases before and after implementation of a yearlong presurgical curriculum at a single academic institution were reviewed. The first 90 primary cases for each resident from Accreditation Council for Graduate Medical Education logs were reviewed. Outcome measures included operative time, rates of common intraoperative and postoperative complications, and postoperative patient visual acuity. Comparison of outcome measures between residents with and without completion of the wet lab curriculum was investigated using multivariable regression analyses controlling for case difficulty and preexisting visual problems when applicable. Results: We included 815 primary cataract cases prior to wet lab implementation and 996 cases after. Residents who completed the wet lab curriculum had significantly shorter operative times (34.3 vs 45.1 minutes p < 0.001) and lower rates of posterior capsule tears (2.6 vs. 5.3% p = 0.001) and anterior capsule tears (0.8 vs. 3.8% p p < 0.001), which was sustained even to their 90th case (p = 0.003). Furthermore, wet lab completion was associated with better postoperative month 1 patient best-corrected visual acuity after cataract surgery (estimate, 1.5 [95% CI, 0.07-3.0; p = 0.041). Conclusion: Participation in a supervised presurgical wet lab curriculum was associated with fewer resident intraoperative complications and faster operative time during the steepest part of the cataract learning curve. Our findings support implementation and further study of this type of presurgical curricula at other institutions to improve resident training and outcomes