Table 2 Ophthalmic Simulated Surgical Competency Assessment Rubric (OSSCAR)– Phacoemulsification
|
Novice (score = 0) |
Advanced Beginner (score = 1) |
Competent (score = 2) | Score (Not done score = 0) | ||
|---|---|---|---|---|---|
| 1 | Incision and paracentesis formation technique | Poor wound construction and paracentesis placement. Traumatizes conjunctiva | Correct positioning of incision and paracentesis but incision architecture is not yet correct | Well-constructed incision and paracentesis with careful tissue handling | |
| 2 | Viscoelastic: appropriate use and safe insertion | Incomplete fill +/− damage to capsule | Appropriate fill but still hesitant | Safe and smooth insertion of viscoelastic | |
| 3 | Capsulorhexis: Commencement of flap | Poor positioning of initial flap with disruption of underlying cortex | Good positioning of flap but slightly hesitant in raising the flap | Neat creation of a flap of an appropriate size in the correct position. | |
| 4 | Capsulorhexis: Formation and circular completion | Unable to create a complete capsulorhexis with poor understanding of tearing vectors | Capsulorhexis is completed but is either too small, too large or eccentric | Smooth creation of an appropriately sized and circular capsulorhexis | |
| 5 | Hydrodissection: visible fluid wave and free nuclear rotation | Cannot insert cannula in the correct tissue plane / excessive or insufficient force used / incomplete freeing of the nucleus | Cannula inserted correctly under the anterior capsule but more than one attempt is needed to achieve free nucleus rotation | Efficient and safe hydrodissection with free nuclear rotation | |
| 6 | Phaco probe and second instrument: effective use and stability within the eye | Unsure of the positioning of the instruments within the eye / phaco probe is frequently close to the capsulorhexis / inefficient use of the second instrument | Phaco probe and second instrument generally positioned correctly / no iris trauma / capsulorhexis not endangered | Confident instrument handling with phaco probe always kept in a safe position | |
| 7 | Nucleus: sculpting or primary chop | Hesitant use of the phaco probe / tendency to push the lens / timid sculpting with poor use of full range of phaco power | More efficient use of phaco power and appropriate vacuum settings to create a groove or perform a primary chop / still some stress placed on zonules | Fast and efficient sculpting or chopping technique | |
| 8 | Nucleus: Rotation and manipulation | Incorrect positioning of the instruments / excessive posterior pressure on the lens / rounds off the edges of the quadrants leaving a bowl | Good positioning of instruments but still some hesitancy using the second instrument / some posterior pressure whilst rotating the nucleus | Confident use of both phaco probe and second instrument to rotate the lens with no posterior pressure on the zonules | |
| 9 | Nucleus: cracking or chopping | Attempts to crack the lens before groove is deep enough / places instruments too superficially in the groove / excessive posterior pressure during cracking | Forms a grove of the correct depth and width before cracking / still requires several attempts to crack the nucleus | Good groove construction and cracks / chops nucleus at first attempt | |
| 10 | Nucleus: segment removal | Chases segments with phaco probe / poor use of the second instrument / endangers capsule / phaco probe positioned too close to posterior capsule or endothelium | Appropriate use of vacuum to engage segments / second instrument being used more efficiently / less of a tendency to phaco too deep in capsular bag or too close to the endothelium | Safe engagement of nuclear segments and efficient removal with good use of the second instrument | |
| 11 | Irrigation and aspiration technique with adequate removal of cortex | Aspiration port not safely positioned in the capsular bag / inappropriate vacuum used / hesitant engagement of cortex | Better positioning of aspiration port / still not using vacuum efficiently / occasionally engages the anterior capsule | Efficient removal of the cortex with no danger to the capsular bag or capsulorhexis | |
| 12 | Lens insertion, rotation and final position of IOL | IOL not placed in the capsular bag / unable to rotate the lens into the correct position | IOL placed in the capsular bag but haptics still require manipulation | IOL completely placed within the capsular bag at the first attempt | |
| 13 | Wound closure: hydration, suturing if required and checking security | Ineffective hydration technique / does not check would security / poor placement and tying of 10/0 suture | Wound hydration performed correctly / suture tying hesitant / suture slightly too tight or too loose | Wound hydration performed correctly / good suturing technique with correct tension | |
| Global Indices | |||||
| 14 | Tissue handling: | Tissue handling is often unsafe with inadvertent damage to the conjunctiva, cornea, iris or capsule/excessively aggressive or timid. | Tissue handling is safe but sometimes requires multiple attempts to achieve desired manipulation of tissue. | Tissue handling is efficient, fluid and almost always achieves desired tissue manipulation on first attempt. | |
| 15 | Eye positioning and use of the microscope | Eye is frequently in an eccentric position. Focusing and X-Y movement of the microscope is erratic. | Eye is mainly kept in a central position and focusing of the microscope is becoming smoother. | Eye is maintained in a central position throughout the procedure and the point of interest is always in focus. | |
| 16 | Overall speed and fluidity of the procedure | Hesitant and lacks fluidity with multiple pauses between maneuvers | Beginning to string the different steps together with minimal guidance from trainer | All steps completed in a timely manner with minimal input from trainer | |