The learning curve of a high-fidelity cataract surgical simulator

OBJECTIVE: To identify the number of iterations required to reach a performance plateau for each module on the HelpMeSee MSICS high‑fidelity cataract surgical simulator, and to evaluate the inter-rater reliability of the assessment rubric and the consistency of the simulator's visuo-haptic feedback. METHODS: Twenty medical students (Group A) and 12 residents (Group B) were recruited. All participants performed 10 iterations on five modules of the HelpMeSee MSICS high-fidelity surgical simulator. All operation videos were recorded and scored by two observers using the simulator assessment rubric. Intraclass correlation coefficient, Friedman test, and Mann-Whitney U test were used to evaluate inter-rater reliability, intra-module learning curves, and inter-group differences, respectively. RESULTS: Learning curves were demonstrated in both groups across all five modules and total score (all P < 0.01). Residents achieved higher initial performance and reached performance plateaus earlier than students. Inter-rater reliability was excellent for all modules and total score (ICC > 0.80, all P < 0.05). CONCLUSION: Medical students and residents without independent cataract surgery experience improved and reached performance plateaus on the simulator through repeated practice, suggesting that the simulator provided consistent visuo-haptic feedback conducive to initial skill acquisition. However, these simulator-based improvements did not directly translate to improved real-life surgical performance and required separate validation through clinical outcome studies.