Cataract Surgery Training in Germany: A Survey by the European Board of Ophthalmology

Abstract

Introduction Phacoemulsification is a fundamental surgical skill for ophthalmology residents and the most commonly performed operation in the ever-evolving field of ophthalmology. A comprehensive study conducted between 2018 and 2022 showed wide variation in the experiences of European residents. The aim of this study was to study the data from Germany in the European data context.

Methods This study analyses survey results from German participants in European Board of Ophthalmology (EBO) examinations (2018 – 2022) and classifies the results in overall European comparison. We also performed a regional analysis by federal state.

Results Of a total of 445 addressees, 136 (30.6%) responded to the questionnaire. Around two-thirds or 67.7% had taken the EBO exam between 2021 and 2022; most of the study participants were women (59.6%) and the average age was 34 ± 2. By far the most at 89.7% were right-handed and came from fourteen different federal states, mostly from North Rhine-Westphalia, Baden-Württemberg, Bavaria, and Berlin. Under a quarter of respondents at 22.8% stated that they had carried out at least ten training sessions on animal eyes. Very few at 5.1% reported completing training sessions on synthetic eyes compared to 16.9% stating that they had trained on a virtual reality simulator. Having taken more than ten training sessions correlated significantly with higher confidence at performing cataract surgery (p < 0.001). Eighty-three respondents (61%) had not performed any of the steps taken in cataract surgery on patients during specialty training in Germany. This was well above the European average. Women were statistically significantly overrepresented in this subgroup, accounting for 67.5% (p = 0.019) of the subgroup.

Discussion In the European context, the German national specialty training curriculum does not require cataract operations in any set numbers. This model may have contributed to the significant gender differences. Simulation-based medical training may address this problem as an additional tool for more equitable access to surgical training.

Conclusion Intra-European comparison and exchange may help improve guidelines for ophthalmological specialty training. This might standardise and improve training standards in both conservative and surgical ophthalmology throughout Europe.

Fazit

Bereits bekannt:

• Die Phakoemulsifikation ist derzeit mit Abstand das am häufigsten erlernte Verfahren.

• Die Ausbildungsmöglichkeiten in der Kataraktchirurgie variieren zwischen den verschiedenen europäischen Ländern und hängen von den individuellen Facharztausbildungen ab, die junge europäische Augenärzte absolvieren.

• Bis zum Ende der deutschen Facharztausbildung werden durchschnittlich 20 Kataraktoperationen als Primärchirurg durchgeführt.

• Mehr als 61% der deutschen Assistenzärzte haben während ihres Curriculums keine Kataraktoperation oder Schritte der Kataraktoperation an Patienten durchgeführt.

• Die beiden Schritte der Phakoemulsifikation, die von den angehenden Chirurgen als am schwierigsten zu erlernen angesehen werden, sind die Kapsulorhexis und das Cracking.

Neu beschrieben:

• Die Untersuchung konnte zeigen, dass es keine regionalen Unterschiede zwischen den Auszubildenden in Deutschland in Bezug auf die klinische Erfahrung in der Kataraktchirurgie und Selbsteinschätzung bei der Durchführung von Kataraktoperationen gibt.

• In der deutschen Studienkohorte zeigten sich, auch im Vergleich mit anderen europäischen Ländern, deutliche Geschlechterunterschiede in der Anzahl der durchgeführten Kataraktoperationen in der assistenzärztlichen Ausbildung und damit verbunden Unterschiede in der Selbsteinschätzung und dem Selbstvertrauen in der Durchführung von Kataraktoperationen.

• Von den beiden Schritten der Phakoemulsifikation, die von den angehenden Chirurgen als am schwierigsten zu erlernen angesehen werden, zeigt die Kapsulorhexis eine steilere Lernkurve als das Cracking.

Conclusion

Already known:

• Phacoemulsification is currently the most commonly learned procedure by far.

• Training options in cataract surgery vary between European countries and depend on individual specialty training completed by young European ophthalmologists.

• Residents perform an average of twenty cataract operations by the end of specialty training in Germany.

• More than 61% of German residents do not perform any cataract surgery operations or any of the steps involved on patients in the specialty training curriculum.

• Resident surgeons consider capsulorhexis and cracking to be the two most challenging phacoemulsification steps to learn.

New:

• The study showed no regional differences between German ophthalmology residents regarding clinical experience and confidence at performing cataract surgery.

• The German study cohort showed clear gender differences in the number of cataract operations performed during specialty training and associated differences in self-assessment and confidence at performing cataract operations; this observation held up in comparison with other European countries.

• Resident surgeons consider the learning curve in capsulorhexis to be steeper than that of cracking in the steps involved in phacoemulsification.

Keywords

Cataract surgery - surgery training - European Board of Ophthalmology - simulation-based training

Publication History

Received: 26 May 2024

Accepted: 08 October 2024

Article published online:
28 February 2025

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