Fake It Till You Make It

Practice makes perfect. And though the price of falling short of perfection is not always serious, when it comes to surgical outcomes, few patients would accept anything less. And that’s why the ophthalmology department at Whipps Cross Hospital, London, UK, allows junior ophthalmologists and trainees from across London to practice cataract surgery in a virtual environment – namely, the Eyesi cataract surgical simulator.

Back in May 2021, the adoption of a simulator was simply a case of addressing an unmet need. As Cordelia McKechnie, consultant ophthalmologist and educational supervisor at Whipps Cross Hospital, explains, “Simulation-based training in healthcare is a highly effective way to develop knowledge and skills. There was limited availability of the Eyesi in North East London, and we were keen to provide this for our local trainees. Currently, there are only simulators in Moorfields Eye Hospital, Imperial College London, and the Royal College of Ophthalmology. The COVID-19 pandemic only exacerbated the problem.”

At first, only trainees based at the hospital were invited to use the simulator, but Whipp’s Cross has now opened the doors to trainees from across North London and even further afield. Currently, 30 practising and aspiring ophthalmologists have signed up for training, with 10 trainees using the system regularly. Since the simulator became available, the Whipps Cross team has observed several benefits for trainees, including the ability to better understand the surgery, increased confidence when performing the procedure, and fewer complications during actual surgery. One trainee was even able to complete his first cataract surgery early in his first year – an achievement the team feels can be at least partially attributed to the simulator.

“Using the simulator has improved my hand-eye-foot coordination as well as my handling of the eye and instruments under the microscope. This has definitely increased my self-confidence in performing cataract surgery, which will ultimately improve patient safety and outcomes,” says ophthalmology registrar Rohan Hussain – a regular user of the simulator. “One thing that has surprised me though, is how difficult it is to do some of the steps, almost harder than operating on a real patient, but I do believe that once a trainee has used this and done all the modules, they should have the right skills and motor programs to deal with real patients.”

Although the Eyesi has provided demonstrable benefits to Whipps Cross, it is not perfect. Indeed, McKechnie has a few tweaks for future simulators. “It is very good, but it is also very expensive. It would be beneficial if the cost came down – especially the long-term maintenance costs, such as replacing the handpieces that can get bent through use,” she says. “Also, I think a remote supervision set up would be good, where the trainer can view what the trainee is doing on the machine from a distance, which would provide immediate live feedback.”