Seven- and eight-year trends in resident and fellow glaucoma surgical experience

Nisha Chadha,^1,2 Joshua L Warren,³ Ji Liu,² James C Tsai,¹ Christopher C Teng<sup>2

1</sup>Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York Eye and Ear, Eye and Vision Research Institute, NY 10029, USA; ²Department of Ophthalmology and Visual Science, Yale University School of Medicine, New Haven, CT 06510, USA; ³Department of Biostatistics, Yale University, New Haven, CT 06510, USA

Purpose: This study evaluated US resident and fellow glaucoma surgical experience over a 7- and 8-year period, respectively.
Methods: US ophthalmology resident glaucoma case logs from 2009 to 2016 and glaucoma fellow case logs from 2008 to 2016 were reviewed. The number of total, average, median, and minimum cases, along with percentile data for filtering surgery, shunting surgery, and novel procedures were analyzed for year-to-year trends.
Results: Among residents training from 2009 to 2016, there was a decline in the average number of primary filtering surgeries by 20%, from 6.0±5.0 to 4.8±4.0 cases, with a concurrent increase in average primary glaucoma drainage implant (GDI) surgeries by 40%, from 4.5±4.0 to 6.3±5.0 cases, which represented an increase of 6.5% per year, P<0.001. Glaucoma fellow data from 2008 to 2015 demonstrated a decline in average primary trabeculectomy surgeries by 3.7%, from 30.1 to 29.0 cases, but then increased to 32.1 cases in 2015–2016. There was an increase in average GDI surgeries by 57.9%, from 30.2 to 47.7 cases for fellows over this 8-year period, which represented a 5.9% increase per year, P<0.001. There was no microinvasive glaucoma surgery (MIGS) or other novel procedures reported in the Accreditation Council for Graduate Medical Education (ACGME) resident case logs. From 2008 to 2016, Association of University Professors of Ophthalmology (AUPO) glaucoma fellow case logs demonstrated an increase in endocyclophotocoagulation (ECP) from 2.3 to 5.4 cases, a 15.5% increase per year, P<0.001.
Conclusions: Over a 7–8-year period, trainee surgical experience with GDI surgery has steadily increased, whereas surgical experience with trabeculectomy has been fluctuating and may be on a downward trend. Educators should be aware of shifts in trainee surgical experience in order to maintain appropriate training experience.

Keywords: resident education, fellow education, surgical education, ophthalmology education