白内障手术医师培训模式初探

目的:探索一条适合在我国开展的行之有效的白内障手术医生培训模式。方法:对尚未掌握白内障手术的本院眼科医生、进修生、实习生以及乡镇医院的五官科医生共106名,针对不同的基础制定计划、有序地进行培训。结果:全部受训人员能正确地完成白内障辅助检查;掌握白内障术前的筛查方法及人工晶状体正确计算;白内障手术基本操作比较准确和熟练,显微手术操作合格,掌握环形撕囊技术101名;掌握白内障囊外摘除+人工晶状体植入术69名;能独立操作"削梨法"超声乳化白内障+人工晶状体植入术37名,个别医生手术量已超1000台。结论:培训应针对不同的基础制定计划、逐步进行,并将理论与实践相结合,才能更快更好地培训出合格的白内障手术医师。     

现阶段眼科住院医师临床技能培训的几点思考

目前眼科住院医师临床技能培训中存在的问题体现在医疗环境总体状况不利、眼科带教老师的积极性尚需提高、眼科住院医师的自律性和学习积极性有待加强。在现阶段的医疗环境下,为顺利完成眼科住院医师的临床技能培训,眼科住院医师应加强眼科理论基本功的掌握,充分利用眼科手术与诊断治疗操作的辅助教学系统,以积极主动的心态参与临床技能操作,以循序渐进的方式进行眼科技能训练。（眼科,2013,22：67-69）     

循序渐进地进行眼科研究生的培训

在临床医学中,眼科学是相对独立的学科,严密精细是眼科诊断治疗的特色,眼科医生既要着眼于局部,又要放眼于整体。因此在眼科研究生的培训中,我们不仅改进教学方法、利用现有资源进行研究生的理论培训,还要更好地完善临床技能培训,让研究生通过不同阶段的培训具备独立思考和应对的能力,并掌握利用现有教学资源获取前沿知识的技能。（眼科, 2016,25： 425-426）     

虚拟-现实手术模拟系统在眼科住院医师微创白内障手术培训中的应用效果

目的：探讨虚拟-现实手术操作训练在眼科住院医师微创白内障手术技能培训中的应用及效果。

方法：前瞻性对照研究。选取2019/2021年在南京医科大学附属眼科医院已完成3a住院医师规范化培训的20名年资相同的眼科住院医师为研究对象,通过理论考核后随机分为虚拟-现实手术操作训练(Dry-lab)组和实体动物手术操作训练(Wet-lab)组,每组各10名。Dry-lab组和Wet-lab组医师分别使用Eye SI虚拟手术模拟器和猪眼进行训练。训练结束后使用Eye SI虚拟手术模拟器和实体猪眼操作对两组住院医师的总体培训效果进行评分,使用虚拟手术模拟器对两组住院医师的模块培训效果进行评分,并采用问卷调查对两种培训方式进行客观评价。

结果：Dry-lab组医师两项操作考核总评分、模拟器考核评分、实体猪眼操作考核评分均显著高于Wet-lab组(88.03±1.34分 vs 80.35±2.87分,87.50±3.03分 vs 77.60±5.62分,88.57±1.89分 vs 83.10±3.22分,均P<0.01)。模拟器模块考核结果显示,Dry-lab组医师各模块考核评分及用时均显著优于Wet-lab组(P<0.01)。问卷调查结果显示,在培训新颖性、是否贴近真实手术体验、对显微手术技能提高的帮助程度、经过该培训是否有信心进行真实手术及手术培训的整体满意度方面,Dry-lab组医师对于培训方式的效果评价均优于Wet-lab组(P<0.05)。

结论：将虚拟-现实手术操作训练应用于眼科住院医师白内障手术技能培训可以显著提升住院医师的白内障显微手术操作技能,提高培训整体满意度,帮助住院医师在执业初期提升真实手术时的信心、心理素质、决策及处理能力,为建立眼科住院医师正式、规范化的白内障手术培训体系提供了新的标准和模式。     

手术模拟器培训眼科青年医师显微手术技能的观察研究

目的：：利用眼科显微手术模拟器提高眼科青年医师白内障显微手术能力的量化观察。方法：眼科青年医师进行经过理论授课、模拟器训练及动物眼球操作,模拟器对学员完成白内障手术操作各项步骤行综合打分,并对学员培训前后完成白内障手术模拟器综合得分结果进行分析。结果：学员通过理论授课阶段后在模拟器完成白内障手术操作测试评分平均75.91±6.53分,再经过模拟器反复训练阶段后模拟器给予的测试评分平均85.57±4.64分,这两阶段学习后学员在模拟器上完成白内障手术操作的综合测试评分对比具有显著统计学差异(P<0.01),第三阶段学员经过动物眼球实际操作后,在模拟器上完成白内障手术的测试评分平均89.77±7.61分,与动物眼球操作前仅进行模拟器操作训练测试评分相比较具有统计学差异(P<0.05)。结论：利用眼科显微手术模拟器进行短期培训可显著提高眼科医师白内障手术能力,但长期效果及实际临床手术能力有待进一步观察。     

印度短期白内障手术培训模式的体会与思考

2007年1月3日至2007年3月27日，作者在印度马杜赖Aravind眼科医院完成了为期三个月的白内障手术培训：从一个在国内仅做过10余例超声乳化手术的眼科医生过度到能独立完成囊外手术、小切口手术及超声乳化手术的白内障医生。做为一个白内障手术新手，印度的手术培训模式给我打下了深深的烙印。     

眼科专科医院住院医师规范化培训实践与思考

眼科住院医师规范化培训(以下简称“规培”)是培养眼科医师的必要环节。我国规培模式日臻成熟,但眼科规培过程管理中仍存在诸多问题,包括专科医院和综合医院的规培协调问题、师资激励、规培学员类型多样、研究生和规培“双轨制”、如何开展显微手术技能培训等,很多具体方案和措施仍在摸索中。眼科专科医院学科体系建设相对完善,配备更充足的教学资源,有一定的规培经验,是眼科规培的主力军。汕头国际眼科中心结合国家要求创建了一套规培模式,注重规范化、标准化和个性化相结合,并通过借鉴香港及海外住院医师培训经验,丰富理论培训形式,优化操作培训环境,突出外语和科研能力训练,强调系统性临床思维。本文基于汕头国际眼科中心五年来开展眼科规培的实践经验与思考,总结当前眼科专科医院规培现状,并提出对策和建议。     

年轻眼科医师基于手术模拟器的小切口白内障囊外摘除手术培训的有效性评估

目的：探讨基于手术模拟器操作训练在眼科年轻医师小切口白内障囊外摘除手术培训的有效性评估。方法：前瞻性对照研究。选取2020/2022年在沈阳何氏眼科医院已完成至少3a住院医师规范化培训的眼科专业住院医师或刚取得主治证书的眼科主治医师共48名为研究对象,通过小切口白内障囊外摘除手术相关理论培训及考核后,随机分为模拟器手术操作训练组(试验组)和实体动物眼手术操作训练组(对照组),每组各24名。试验组和对照组医师分别使用手术模拟器和猪眼进行训练。训练结束后使用手术模拟器和实体猪眼操作对两组研究对象进行考核评分,并对两组医师的总体培训效果进行有效性评估。结果：手术模拟器考核评分及用时比较,试验组研究对象在各步骤考核用时均低于对照组(均P&#x003C;0.05)。试验组研究对象在角膜穿刺注入黏弹剂、娩核及水密角膜穿刺口操作评分与对照组比较均无差异(P&#x003E;0.05),其余步骤评分,试验组均高于对照组(均P&#x003C;0.05)。实体动物眼考核评分,试验组研究对象各步骤考核评分均高于对照组(均P&#x003C;0.05)。试验组研究对象在巩膜切口、角巩膜隧道、连续环形撕囊、水分离及转核至前房、娩核步骤手术模拟器与实体动物眼考核评分比较均无差异(P=0.068、0.126、0.960、0.520、0.206); 在穿刺注入黏弹剂、隧道穿刺进入前房及水密角膜穿刺口考核中,模拟器评分均低于实体动物眼(P=0.007、0.014、&#x003C;0.01); 在皮质吸除、人工晶状体植入操作考核时模拟器评分要高于实体动物眼操作评分(P=0.035、&#x003C;0.01)。结论：将手术模拟器操作训练应用于眼科年轻医师小切口白内障囊外摘除手术技能培训,可以显著提升医师的白内障显微手术操作技能,为建立眼科年轻医师规范化的白内障手术培训提供了新的模式及思路。     

亚洲防盲基金会和香港盲人辅导会在中国防盲治盲计划中取得的进展

1.流动眼科治疗中心计划。2.培训中国眼科医生并在县医院配备白内障手术设备。2.1.为陕西、广东、江苏及山东省的6个县医院培训了眼科医生并配置了手术设备。2.2.在新疆自治区的和田地区培训眼科医生并为6个县医院提供了白内障手术设备。3.亚太地区低视力工厂和视觉2020地区性低视力资源中心。4.为了最大限度地扩大共同努力的成果,香港盲人辅导会和亚洲防盲基金会将与中国卫生部、中国残疾人联合会、各省卫生厅、省残联和各医院及其它国际非政府机构等紧密合作为中国的防盲治盲及低视力康复而努力奋斗。     

眼科八年制学生临床和科研培养的思考

针对眼科八年制学生的培养要求,结合自身从事眼科八年制学生的教学经验,就眼科基础理论学习、医患沟通能力培养、临床基本技能训练、显微手术技巧学习、眼科亚专业兴趣培养及基本实验技能培训等方面进行了思考,以期提高眼科八年制学生的综合能力。     

眼科青年医师的综合培养

对于眼科青年医师的培养,除了本专业学习培养外,还要掌握其他相关科室的基本技能,在技能培训过程中要克服压力,积极乐观的心态对眼科技能学习有很大帮助。同时良好的医患沟通非常重要,掌握必要的沟通技巧。此外,培养青年医师良好的科研思维和创新意识对于眼科的创新发展至关重要。（眼科,2017, 26：286-288）     

眼科医师对糖尿病视网膜病变防治知识问卷调查

目的 了解眼科医师对糖尿病视网膜病变诊治知识的认知情况,指导糖尿病视网膜病变的防治工作.方法 采用问卷调查方式,共调查省、市、县区级专业方向为眼底病、白内障和无专业方向的眼科医生共131人.结果 对"糖尿病患者眼底随诊检查时间、DR的治疗方法、糖尿病患者行白内障手术与眼底激光治疗的关系、Ⅵ期DR患者治疗方法、DR患者玻璃体切割术后需补充眼底激光治疗"等问题的认知率较低.医院级别及专业方向为其影响因素.结论 应加强基层医院眼科医师的教育和培训,不同专业眼科医师间加强协作.

Abstract：

Objective To evaluate the information of basic concepts about prevention and cure of diabetic retinopathy among ophthalmologist at different levels and to provide the basis for controlling retinopathy and protecting visual function in diabetic patients.Methods 131 ophthalmologists, including retinal specialists and cataract specialists, were randomly interviewed with a questionnaire concerning DR and general characteristics of ophthalmologists.Results The different specialty of ophthalmologists at different level hospitals had some confused ideas in the time that patients should do regular retinal examinations with different type DM and combined management in the treatment of DR.Conclusions It was emergent to pay special attention on the education of ophthalmologist in the basic level hospital.All subspecialty doctors in ophthalmology should completely know the influence of diabetes on the eyes, and go in collaboration with each other and perform combined management for diabetics.     

Attitudes to research and research training among ophthalmologists and ophthalmology trainees in New Zealand

Purpose: To determine the attitudes to research and research training among ophthalmologists and ophthalmology trainees in New Zealand. Methods: A structured, self‐administered questionnaire was devised and after preliminary validation a postal survey was sent to all ophthalmologists and ophthalmology registrars and fellows in New Zealand. Results: A total of 82 replies were received from 115 questionnaires sent out; a response rate of 71.3%. An overwhelming majority found research to have benefited their education, clinical practice and career; 67.1% of the respondents intended to do research in the future. Although a majority (56.4%) felt research to be beneficial to ophthalmology training, 42.3% felt research would be of limited or no benefit when selecting candidates for vocational training. However, 97.5% of respondents felt that ophthalmology trainees should undertake some form of research during training, with most supporting small studies or case reports (44.4%) or a short structured training course in research (42.0%). Interestingly, 86.6% felt that research methodology and data analysis should be taught in a structured fashion with most supporting courses or seminars of a few weeks duration during the vocational training period. Many ophthalmologists felt inadequately equipped or trained to mentor and supervise trainees undertaking research and 41.5% of consultant ophthalmologists felt further training to fulfil this role would be beneficial. Conclusions: This survey suggests that New Zealand ophthalmologists generally approve of and support a place for research, possibly of a more structured design, during ophthalmology training.     

Cataract surgery training using surgical simulators and wet-labs: Course description and literature review

Cataract surgery is the most common surgery to face the ophthalmology training resident. To facilitate achieving surgical competency and reduce complication rates, wet laboratories and surgical simulators are used in surgical disciplines worldwide. We developed a simulator and wet-lab course that aims to build the microsurgery skills of trainees and improve safety during real surgical procedures. Herewith, we describe the standardized hands-on course that incorporates these tools for advanced training. Additionally, we review the literature on wet-lab and surgical simulators in ophthalmology, focusing on their importance in training centers. The course is offered four times per year since it started in December 2015, and t total of 88 trainees participated to date. Feedback received from the trainees’ supervising surgeons showed that this course addresses a major training challenge, and that a permanent version of this course should be established at each training center. We suggest incorporating fixed wet-lab and surgical simulator competencies in ophthalmology training programs. Additionally, we recommend that residents be allowed to operate on real patients only after passing the course. We believe that these steps would foster ophthalmologists with advanced training, decrease their learning curve, and empower them to safely conduct cataract surgery with low complication rates.     

Ophthalmology training in sub-Saharan Africa: a scoping review

Sub-Saharan Africa is home to 12% of the global population, and 4.3 million are blind and over 15 million are visually impaired. There are only 2.5 ophthalmologists per million people in SSA. Training of ophthalmologists is critical. We designed a systematic literature review protocol, searched MEDLINE Ovid and Embase OVID on 1 August 2019 and limited these searches to the year 2000 onwards. We also searched Google Scholar and websites of ophthalmic institutions for additional information. We include a total of 49 references in this review and used a narrative approach to synthesise the results. There are 56 training institutions for ophthalmologists in eleven Anglophone, eleven Francophone, and two Lusophone SSA countries. The median duration of ophthalmology training programmes was 4 years. Most curricula have been regionally standardised. National, regional and international collaborations are a key feature to ophthalmology training in more than half of ophthalmology training programmes. There is a drive, although perhaps not always evidence-based, for sub-specialisation in the region. Available published scientific data on ophthalmic medical and surgical training in SSA is sparse, especially for Francophone and Lusophone countries. However, through a broad scoping review strategy it has been possible to obtain a valuable and detailed view of ophthalmology training in SSA. Training of ophthalmologists is a complex and multi-faceted task. There are challenges in appropriate selection, capacity, and funding of available training institutions. Numerous learning outcomes demand curriculum, time, faculty, support, and appropriate assessment. There are opportunities provided by modern training approaches. Partnership is key.Subject terms: Education, Health occupations     

Geographical distribution of eye health professionals and cataract surgery in Lao People’s Democratic Republic

Purpose: To assess the geographical distribution of eye health professionals and cataract surgery procedures in Lao People’s Democratic Republic (PDR) over the last decade.

Methods: The number of ophthalmologists (defined as physicians who have completed full education and training in ophthalmology), eye doctors (defined as physicians who have completed education and training in only cataract surgery), ophthalmic nurses, and cataract surgery procedures across 16 provinces and Vientiane municipal for the middle/late 1990s, the year 2000, and the most recent year (2005–2006) were obtained from the registration system of eye health professionals and the track record in cataract surgeries in the Ophthalmology Center, Ministry of Health. The number of cataract surgeons (total number of ophthalmologists and eye doctors) per million population, the number of ophthalmic nurses per million population, and the cataract surgical rate were calculated for various geographical units using available population data from the census in 1995, 2000, and 2005. The Gini coefficients, measures of inequality that range from 0 (total equality) to 1 (total inequality), were computed at three time points.

Results: The number of ophthalmologists, ophthalmic nurses, and cataract surgery procedures increased in this country as a whole, although the number of eye doctors did not change after 2000. The Gini coefficients for them also improved (Cataract surgeons: 0.792, 0.415, and 0.361; Ophthalmic nurses: 0.448, 0.354, and 0.259 and; Cataract surgery: 0.366, 0.309, and 0.248 in the 1990s, 2000, and 2005-6, respectively).

Conclusion: Imbalances in the geographical distribution of eye health professionals and cataract surgery decreased over the last decade.     

Evidence-based Management of Glaucoma

Purpose: The evidence-based medicine (EBM) is a new medical mode that is completely different from traditional experience-based medicine. The core of EBM is that decision-making during clinical practices must be based on objective research results. With the rapid development of modern ophthalmology, some former viewpoints according to experience-based medicine face challenges. Evidence-based ophthalmology (EBO) is imperative under the situation. Glaucoma, as a disease resulting in blindness, which can not be cured by operation, is thought more and more of by medical management officials and doctors. One challenge for ophthalmologists entering the 21st century will be to make clinical decisions based on valid information or evidence rather than intuition, hearsay, or peer practice. How can we do? Here reviews the application of EBM in medical management of glaucoma since EBM' s naissance and give a reference. Eye Science 2005;21:20-26.