An Analysis of Ophthalmology Trainees' Perceptions of Feedback for Cataract Surgery Training

By

ACKNOWLEDGEMENTS

My thanks go out to all who have helped me complete this study and with whom this project may have not been possible. In particular, my gratitude goes out to friends, facilitator and family for extensive and helpful comments on early drafts. I am also deeply indebted to the authors who have shared my interest and preceded me. Their works provided me with a host of information to learn from and build upon, also served as examples to emulate.

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DECLARATION

I, (Your name), would like to declare that all contents included in this thesis/dissertation stand for my individual work without any aid, & this thesis/dissertation has not been submitted for any examination at academic as well as professional level previously. It is also representing my very own views & not essentially which are associated with university.

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TABLE OF CONTENTS

ACKNOWLEDGEMENTSii

DECLARATIONiii

CHAPTER 1: INTRODUCTION1

Background1

Theoretical framework1

Rationale2

Problem statement4

Research Questions5

CHAPTER 2: LITERATURE REIVEW6

Introduction6

Cataract surgery services7

Search strategy8

Practice volume8

Inclusion and exclusion criteria10

The Role of Feedback11

Health service consumption12

Factors Influencing change13

Nature of feedback14

Feedback sources16

Feedback specialty18

Feedback consistency19

Manner and timeliness of delivery of feedback20

Educator training20

CHAPTER 3: METHODOLOGY29

Theoretical framework29

Grounded theory29

Data collection33

Reliability34

Validity35

Ethical issues37

CHAPTER 4: RESULTS AND DISCUSSION38

General findings38

Improving the feedback41

Good trainer42

Enthusiasm44

Knowledge44

Communication44

Innovation45

Honesty45

Qualifications45

Bad trainer45

Seeking barriers to feedback46

Barriers in giving feedback47

Workplace based assessment (OSATS) forms47

Recording operations49

Effect of feedback on subsequent performance50

Simulators51

Wet labs52

CHAPTER 5: REFLECTIONS AND LIMITATION OF THE STUDY57

REFERENCES62

APPENDICES70

CHAPTER 1: INTRODUCTION

Background

A cataract is a clouding of the crystalline lens in the eye that impedes the passage of light and affects vision, ranging from slight to complete opacity in extent. Cataracts typically progress slowly to cause vision loss, and are potentially blinding if untreated. A cataract may be caused by various factors, such as age-related, drug-induced, trauma caused. According to the latest assessments, age related cataract is responsible for 48% of world blindness. As a result, cataracts are very common in elderly people. It is reported that by age 80, more than half of all Americans either have a cataract or have already had cataract surgery. This leads the cataract surgery to be one of the most common surgery operations in U.K. Cataract surgery is the removal of the natural lens of the eye with cataract, and replacement of a synthetic lens to restore the lens transparency (Strauss & Corbin 1994, 273).

Theoretical framework

With years of evolution, cataract surgery has become a standard operation. However, due to the small size of the eye, the complexity of the surgery, as well as the human cost and time restrictions, training of the surgery is still a time and resource consuming procedure. As for the time cost, it is reported that for a two-phase training, it generally takes 6 to 12 months for a resident surgeon to get familiar with the first phase of the surgery, which involves only hands-off observation. Another 6 to 12 months for the second phase, which involves supervised practice and operations (Morse 2001, 16).

After the training, it will still take a long time for a surgeon to gain broad experience, especially experience for dealing with complicated ...