Comparing resident XXXX surgery outcomes under novice versus experienced attending supervision.

@entity1 @entity231 @entity726 @entity3460 @entity393
PURPOSE: To determine whether supervision by an attending who is new to surgical teaching, or an experienced attending measurably influences intraoperative complications rates or outcomes in phacoemulsification performed by ophthalmology residents. SETTING: Single tertiary hospital. DESIGN: Retrospective cohort study. METHODS: Resident-performed phacoemulsification cases supervised by one novice attending (N=189) and experienced attending (N=172) over 1 year were included. Data included: resident year, @entity1 age, sex, preoperative risk factors (4+ on the four point scale for dense/white/brunescent @entity231 , Flomax, zonular dialysis, pseudoexfoliation, @entity726 risk, post-vitrectomy), intraoperative risk factors ( @entity3460 , iris hooks), and intraoperative complications (capsule tears, @entity393 , zonular dialysis, zonular dehiscence, burns, nuclear fragment loss, Descemet's tear). Experienced attending data were compared against those of the novice attending. RESULTS: Regarding preoperative risks, experienced attending cases more likely involved 4+ @entity231 (P=0.005), Flomax (P<0.001), or @entity726 risk (P=0.001). For intraoperative risks, novice attending cases more likely involved @entity3460 (P<0.001). Regarding complications, novice attending cases were associated with @entity393 (P=0.002) and anterior capsule tears (P<0.001). When comparing total complications, the novice attending was more likely to have both increased number of cases with complications and total complications than the experienced attending. The novice attending's overall complication rate trended downward (rate from 28% in first 25 cases to 6.67% in last 15). CONCLUSION: Early cases for the novice attending were accompanied by greater complications ( @entity393 and anterior capsule tear), likely due to a learning curve. Surgical judgment in the operating room likely develops with experience. Training programs may focus on these specific areas to aid new instructors.
