Ophthalmology Skill Lab (OSL)
Surgical education requires nonhuman and practice models in order to reduce frustrations and professional ethics problems. Patient dignity and clinical governance necessitate initial training on the practice model (including animals) for the students of surgery prior to their operations on human beings. Using practice eye models to simulate ophthalmic surgery on human eyes in ophthalmology skill labs is an established approach for improving residents’ technical proficiency and confidence, and patient safety. This approach is a routine and accepted perspective in the developed communities. Moreover, surgical teachers have always emphasized on the necessity of such mechanisms in the educational process.
Training ophthalmic residents on/for basic surgical skills on animal eye models before performing real ophthalmic surgeries.
· Operating room etiquette, sterilization, hands wash, gown and gloves wear training
· Surgical threads and basic tools training
· Establishing coordination among hands, eyes and the microscope.
· Trial and error, learning surgical skills in eyelid, anterior segment, posterior segment, intraocular injections and eye injury and its sutures.
· Complications exposure and their basic training
· Diagnostic skills and basic examinations training
· Tests/Trails and innovations in surgical techniques for ophthalmic faculty
· Acquisition of knowledge, skills and new surgical techniques (offered by equipment and surgery innovators companies)
· Surgical skills specialized training
In 2008, a specific area was renovated in the old building of Farabi hospital and in 2009, part of which was dedicated to ophthalmology skill lab. Training on practice animal eye models was started after it was equipped (with 6 tables, 5 surgical microscopes, operation room sink, CCTV, LCD, phaco machine, etc.).
Subsequently, different subspecialty department were asked to announce the necessary skills which are feasible to be carried out in the lab (the list would be reviewed/updated annually).
On an annual basis (usually) in the autumn, at the beginning of the second year of residency before starting real surgeries in the operating room, the training program is developed and implemented for residents according to the skills and mentors provided.
Effectiveness level (university, national, international)
Training in the ophthalmology skill lab is an established and indivisible part of residency training in Farabi Hospital (TUMS). This approach has been seriously considered by peer universities responsible for residency training in ophthalmology.
Recent survey from surgical tutors on the impact of ophthalmology skill lab on surgery training:
Cornea Clinic Recommended Skills for Skill Lab 2011
1. Hand washing
2. Gowning & the closed glove technique
3. Prep & drape
4. Conventional instruments, sutures, & phaco panel
5. Needle-based anesthesia
6. Hand-motor (foot pedal, hand, & microscope) coordination
Cornea & anterior segment
7. Limbal-based peritomy & conjunctiva suturing
8. Keratotomy & scleral tunnel
9. Suturing: separate (burying), shoe-lace, x & mattress fashion
10. Use of viscoelastic & capsulardye
11. Anterior capsulorrhexis
13. Phaco: hand-piece handling, bimanual exercise, sculpting,
14. Irrigation aspiration
15. IOL implantation (IOL loading & injection; forceps fixation)
16. Anterior vitrectomy (guided by triamcinolone & air)
17. Stromal hydration
Others (in the future or for the fellows) for anterior segment: LRI, DSEK, DALK, ICRS, post-capsulorrhexis, PIOL, LASIK, piggy back, ICL, etc.
Trabeculectomy flap, adjustable suture, sclerotomy, scleral suture (in muscle surgery, posterior fixation, trauma, buckling), muscle resection (guided by calipers)