Objective assessment of technical skill targeted to time in cataract surgery

PURPOSE: To evaluate time as an objective measure of technical skill assessment in cataract surgery. SETTING: Single academic center DESIGN:: Cross-sectional study METHODS:: One hundred videos of cataract surgery (29 performed by a faculty and 71 performed by trainee surgeons) performed at the Wilmer Eye Institute between July 2011 and December 2017 were analyzed for surgical technical skill as a function of time using task-specific indices, global skill indices and appointment status. RESULTS: Expert surgeons, defined by global skill, did not consistently have shorter times to complete phases in cataract surgery compared with novice surgeons. Times to complete phases in cataract surgery were predictive of global skill (area under the curve [AUC] of 0.73, 95% CI: 0.63-0.83) and to predict surgeons' appointment status (AUC 0.82, 95% CI: 0.70-0.91). Time for capsulorhexis correctly distinguished between expert-novice skill class only 58% (AUC 0.58, 95% CI: 0.47-0.69) of the times when capsulorhexis indices were used and 51% (AUC 0.51, 95% CI: 0.39-0.63) of the times when global indices were used. Time to complete quadrants in capsulorhexis also had a low ability to discriminate between novice and expert instances for capsulorhexis skill and global skill. The AUC was 0.54 (95% CI: 0.44-0.66) and 0.53 (95% CI: 0.41-0.65) for capsulorhexis skill and global skill, respectively. CONCLUSIONS: Time as an objective measure of skill is limited in its ability to distinguish between expert novice skill class in a meaningful way.