IAPB Essential List: Simulation-based Learning (Cataract Surgery)

The Essential Lists:

IAPB Essential List launch. IAPB El on Simulation learning cover, cropped

Version: First Edition (Dec 2017)

Simulation is designed to replicate clinical scenarios in order to augment learning of diagnostic or surgical procedures through deliberate practice. This list describes the items required for learning cataract surgery in a simulated environment. Skills acquired within a simulated environment have been shown to transfer to improvements in procedures on actual patients. Further, the use of simulation in health professions education:

  • has become ethically “imperative” due to patient safety concerns, the need to reduce avoidable medical errors and to protect patients whenever possible
  • provides an alternative and equivalent experience to cadaveric and animal models, which have ethical and moral issues surrounding their use.
  • provides many and immediate training opportunities: learners don’t have to wait for a particular “real-life” case or pathology to present itself.

What does this list contain?

This list contains recommendations for a range of equipment, instruments, consumables and pharmaceuticals learners can use to practice in a simulated environment to prepare them to do surgery. Ideally the skills laboratory should include as many of the same instruments and equipment that the students are likely to use in future, in order for them to become familiar with these.

  • # We recognise that some options included in the EL are expensive or may be unobtainable in certain areas, but nevertheless these represent aspirational best practice.
  • $ Where possible we have suggested alternatives to help training institutions to contain costs and ensure simulation training is as cost-effective as possible.

Three sections

To learn a new skill, quantity of practice is necessary, but optimal performance is dependent on the quality of the practice itself. Practice makes perfect, but practicing the wrong technique does not. Thus in addition to ensuring that the items required in a digital, dry and wet lab for optimal learning are available, the envisaged learning outcomes should be included within structured cataract surgery curricula, both for those initially learning cataract surgical procedures to those wishing to continue their professional development in this field. This list thus separated into the following sections: 3 sections of EL

To read more about the three sections, please download: Essential List on Simulation-Based Learning–Addendum

Description Essential (E) or Desirable (D) Quantity required
The Iowa Ophthalmology Wet Laboratory E 1
Cataract Surgery for Greenhorns E 1
Patient Communication during Cataract Surgery: An Eye Rounds Tutorial - Brinton, JP and Oetting, TA E 1
Orbis Cybersight: Lecture on setting up a wet lab from some of the world’s experts E 1
Orbis Cybersight: “Fundamentals in MSICS course” as pre-learning for hands-on training E 1
The Virtual Cataract Surgery Course Manual for Ophthalmology Residents 2016 Edition. Li, E, Paul, A. A. Greenberg, P.B. Warren Alpert Medical School of Brown University E 1
ICO OSCARs--International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubric. Small Incision Cataract Surgery (SICS), Extracapsular Cataract Extraction, Phacoemulsification (English). Some available in Chinese, French, Portuguese, Russian, Spanish, Vietnamese. E 1
Description Essential (E) or Desirable (D) Quantity Required
Virtual reality simulation#
Eyesi® ophthalmosurgical simulator (VRMagic, Mannheim, Germany). D 1
MicroVisTouch (ImmersiveTouch, Chicago). D 1
Touch Surgery D 1
Cataract Master (phacoemulsification cataract surgery) Mass. Eye and Ear, American Society of Cataract and Refractive Surgery D 1
Demonstration videos, tutorials, manuals /guides$
EyeRounds: University of Iowa Health Care E 1
Simulated Ocular Surgery E 1
The Royal College of Ophthalmologists Simulation Gallery: a repository for high quality surgical training videos from around the world, which will enable ophthalmologists to share their teaching tips for a particular procedure and for trainees to share their training experiences. E 1
Digital recording for feedback, formative and summative assessment#
Operating microscope with an external monitor that records simulation surgery E 1
Set-up phone or tablet to record through teaching scopes E 1
Other
Monitor Flat screen/flat screen/phone/tablet E 1
Internet connection to overcome space constraints and add scalability to the method, or to use for teaching and assessment D 1
Description Essential (E) or Desirable (D) Quantity Required
Room: spacious and easily accessible E 1
Sink and draining board: for washing up instruments after use, with other instrument cleaning equipment, e.g. receivers, etc. E 1
Small fridge D 1
Microwave D 1
Working bench or table: at sitting level with stools for learners. Length determined by the number of 'stations' to be set up E Per station
Stools: height-adjustable if possible E Per station
Storage Locker(s) D Per learner
Sockets: for electrical equipment E Per station
Surge protection E Per station
Systems/kits for skills labs
Kitaro kits Dry Lab - to practice instrument handling and basic steps of cataract surgery such as capsulorhexis, IOL insertion etc without the need of a microscope and phaco machine. monitors eye movement upon instrument contact to mimic a real surgical environment. Wet lab - Use artificial eyes to practice completeing surgical techniques, complication management, and common mistakes. D Per Station
Pharmabotics Limited- designed in cooperation with RCO. Dry Lab Skills Board for practicing basic skills techniques. Wet lab Skills Board use with artificial eyes and/or with animals' eyes. D Per Station
Practice eyes - to use in a dry or wet lab
For practising steps, use lower fidelity models$
For capsulorhexis use grapes/tomatoes AND/OR
Use animal eyes for practising surgery$
E as required to learn
Use animal eyes for practising surgery$ E as required to learn
Synthetic/artificial practice eyes#
Kitaro D as required to learn
Phillips Studio artificial eyes D as required to learn
Other#
Foam/Mount$ E 1 per station
Manikin head# D 1 per station
Description Essential (E) or Desirable (D) Quantity Required
Bench Top microscope
Optical microscope$, e.g. model D stereo microscope (Does not have the foot petal or full range of an ophthalmic, skills lab microscope but costs less than $300USD and when paired with a magnifying -8D lens allows for longer focal distance, and ability to practice many steps in cataract surgery) E 1 per station
Simpler operating microscope (OM)#
SCANOPTICS Skills lab model SO-1700W D 1 per station
ZEISS Stemi 305 EDU cam D 1 per station
Portable Operating Microscope: This provides higher fidelity than a bench top model, e.g. foot controls.(Choose any one--can also use existing OM in theatre$)
Low cost, surgical microscopes$
INAMI – L0940SD E 1 per station
KAPS – SOM82 E 1 per station
A lower cost, but sophisticated surgical microscope#
APPASAMY – AAOM250P LED D 1 per station
SCANOPTICS SO111TZ / SO 5000 RFZ D 1 per station
LEICA - M220 D 1 per station
Other Equipment
Observers Tube for OM (available for most brands of Microscopes – check with manufacturer) E 1 per station
OM Spare Bulb and Fuse Pack (for halogen bulbs – not LED) E 1 per station
Floor Stand for OM E 1 per station
Portable Operating Lamp with stand E 1 per station
Spare Bulbs for lamp (for halogen bulbs – not LED) E 1 per station
Instrument trolley E 1 per station
Kidney Bowl 0.5L E 1 per station
Gallipots E 1 per station
Stand for fluids E 1 per station
Focus on MSICS$ E 1
Phaco machine# D 1
Description Essential (E) or Desirable (D) Quantity Required
Basic instruments set$ or Instruments recycled from OT$ E 1 per station
Full range of surgical instruments, similar to those used in their operating theatre (Using similar instruments to those used in the operating theatre where students will be operating provides familiarity and continuity for students)#. 1 per station
Forceps
Forceps, for wet field electric cautery (Unipolar & Bipolar) E 1
Forceps, Superior rectus, Landolt style E 1
Forceps, Conjuctival, 0.3mm Toothed Moorfields E 1
Forceps, Conjuctival Non-Toothed Moorfields E 1
Forceps, Mosquito, curved (SL “Hartmann Mosquito Forceps 3.25” Curved”) E 1
Forceps, Mosquito, straight (SL “Hartmann Mosquito Forceps 3.25” Straight”) E 1
Forceps, Corneal, 0.12mm Atraumatic Tips, Angled with Tying Platform E 1
Forceps, Corneal, 1x2 Teeth, 0.12mm, with 6mm Tying Platform E 1
Forceps, suture tying, cilia or Birks E 1
Forceps, Lens Introducing, Angle to Tip 8-12mm, Smooth Jaw Kellman Mc Pherson E 1
Forceps, Capsulorhexis, Angle to Tip 11mm, Sharp Tip to use as a Cystotome, Utrata E 1
Needle holders
Needleholder, none locking Straight for 4/0, 5/0, 6/0 or 7/0 Suture E 1
Needleholder, none locking Curved or Straight, overall length 10-11mm, Jaws 8mm, for 8/0 to 10/0 Suture E 2
Blades and Handles
Troutman blade handle, non fixed handle, Bard Parker for Single Use Knives or Purchase disposable Knives & Handle combined / fixed E 3
BP 15 or 11 or 15 degree or 1.1mm paracentesis MVR tip E 3
Blade Slit /Keratome 2.5 -3.2mm angled bevel up E 3
Knife, Crescent Angled, Bevel Up 2.5-3.0mm E 3
Scissors
Scissors, Conjunctival, Westcotts E 1
Scissors, Corneal Section (Corneoscleral), 10mm blades D 1
Scissors, Angled, 10mm, Extra thin Blades, Barraquers E 1
Scissors, iridectomy, 10mm blades De-Wecker’s OR Vannas E 1
Scissors, Capsulotomy, fine D 1
Scissors, iris, sharp pointed E 2
Ordinary Scissors (for cutting big sutures and threads and eye lashes) E 2
Cannula
Cannula, Rycroft 30 gauge E 2
Cannula, Air Injection, 27G Angle to Tip 5mm E 2
Cannula Visco-Elastic, 22G, Angle to Tip 10mm D 2
Cannula, Simcoe, Irrigating / Aspirating, 23G, Angled, aspiration through top opening, 15mm E 4
Cannula, Irrigating Vectis, Three Ports 23G E 2
Other
Vertical chopper useful for any type of cataract D 1
Cannula, Air Injection, 27G Angle to Tip 5mm E 2
Pre chopper - enables to fracture the nucleus in the bag, without the need of phaco- possibly to extract half of the nucleus at a time e.g. Ernst micro nucleus cracker or Micro Akahoshi D 1
Kuglen Iris Hook and Lens Manipulator (with Clover Leaf Tip Angled) D 1
Sinskey hook straight or angled E 2
Lens expressor- hook and ansa D 1
Iris Spatula or repositor Nettleship D 1
Vectis, Lens Loop or wire, Snellen Lens Loop E 1
Muscle Hook or squint hook Graefe E 1
Cautery Ball or electric cautery E 1
Calipers 1-20mm in 1mm Increments E 1
Speculum, 12mm Blade (Adult and child) E 1
Speculum, adjustable: Barraquer’s, Weiss or wire speculum, Cook or Liberman E 1
Description Essential (E) or Desirable (D) Quantity Required
SICS
Troutman blade handle, non fixed handle, Bard Parker for Single Use Knives or Purchase disposable Knives & Handle combined / fixed
Keratome (bevel up) 2.7-3.5mm
Knife, Slit / Keratome, Angled 3.2mm (bevel up)
Knife, Crescent, Angled, 2.5mm (bevel up)
Knife, MVR 19G
Knife, 15 Degree Stab
PHACO
Phacoemulsification Machine E 1
Phaco Hand Piece, tip and accessory pack with silicone sleeve E 1
Irrigation- Aspiration tip (co-axial) E 1
Bimanual irrigation hand pieces E 1
Spatulated irrigation cannulas for hydrodissection D 2
Troutman blade handle, non fixed handle, Bard Parker for Single Use Knives or Purchase disposable Knives & Handle combined / fixed
Keratome (bevel up) 2.7-3.5mm
Knife, MVR 19G
Phaco chopper vertical and horizontal E 1
Spatula, fine iris E 1
Forceps, IOL folding and inserting E 1
Cystomes can be built with a needle and mosquito if required D 2
Blades (included in sets)
Description Essential (E) or Desirable (D) Quantity Required
Use leftover and/or expired consumables from the OT$ e.g. leftover sutures or expired IOLs E
Use substitutes$ e.g. KY Jelly or other clear lubricant in place of Viscoelastic or Blue food dye in place of Trypan blue E
Full range of surgical consumables and supplies, similar to what is used in their OT# (Using similar surgical consumables and supplies to those used in the operating theatre where students will be operating provides familiarity and continuity for students). E
Needles
Needle 30G E 50
Needle 25G E 50
Needle, 23G, 30-35mm long D
Needle, 26G D
Needle 27G D
Needles, superior rectus, for 4/0 cutting silk E 5
Syringes
5ml disposable syringes leur lock E 5
2ml disposable syringes leur lock E 5
1ml disposable syringes leur slip E 5
Sutures
9/0 Nylon double armed sutures spatulated needles D
10/0 Nylon double armed sutures spatulated needles E 10
4/0 Black Braided Silk on a Reel E 1
Prolene 5/0 , double armed with spatulated needles D
10-0, 9-0 and 8-0 nylon D
6-vicryl D
IOLs
IOLs, Single Piece (PMMA) with Dialling Holes E 10
1 piece acrylic, 3-piece acrylic D 5
AC Lenses Three or Four Point Fixation E 5
Capsular tension ring (11mm) D 5
Other
Gloves (different sizes 6.5 – 8.5) E 10 each size
Antiseptic hand scrub minimum 70% alcohol (500ml)/ handwash solution (500ml) E 1
Perasafe sterilizing powder 81g E 1
Isopropyl alcohol 70% minimum E 1
Sodium hypochlorite E 1
Chlorhexidine aqueous 0.5% E 1
Trypan blue 0.06% 1ml E 5 vials
Ringers Lactate 500ml E 5
Viscoelastic (75cc) E 10

IAPB wishes to acknowledge and thank the following experts and organisations for their input and support in compiling this list, including the International Council of Ophthalmology (ICO) and The Iowa Ophthalmology Wet Laboratory:

  • Amelia Geary, ORBIS Director Program Development & Quality
  • Dr William Dean, Honorary Senior Lecturer, Division of Ophthalmology, University of Cape Town; Clinical Research Fellow, LSHTM
  • Dr Helena Filipe, International Council of Ophthalmology (ICO) Committee for Continuing Professional Development (CPD); Chair, Hospital of the Armed Forces/PL-EMGFA; Consultant of Ophthalmology, College of Ophthalmology of the Portuguese Medical Association; Board Member
  • Dr Rènée du Toit, Independent Eye Health Consultant
  • Philip Hoare, Procurement & Standard List Manager IAPB
  • Gerhard Schlenther, RANZCO
  • Dr Neil Murray, RANZCO and Fred Hollows Foundation NZ
  • Dr John Ferris, Consultant Ophthalmologist

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