Assessing Surgical Competency Among Fellows in Vitreoretinal Surgery: A Survey of Fellowship Program Directors and Fellows.

Purpose: We surveyed vitreoretinal (VR) fellowship program directors (PDs) to elucidate how they assess surgical competency among VR fellows. In addition, we also surveyed fellowship program graduates for the years 2022 and 2023 regarding assessment metrics and tools used during VR fellowship training.

Design: Web-based, cross-sectional descriptive study.

Subjects: Fellowship PDs and recent fellowship graduates in the United States and Canada METHODS: The survey, distributed via email, queried participants about several aspects of assessing surgical competency in VR training including surgical numbers, teaching/assessment methods used to assess fellow surgical competency, comfort of fellows for various surgical procedures, appropriate degree of supervision, and criteria for a hypothetical national competence standard. A Likert scale was utilized for questions capturing participants opinion. Mean response scores were reported.

Main outcome measure: Comparison of responses between PDs and fellows RESULTS: Forty-two PDs (42.1%) (33: University-based and 9: Private institutions) and forty fellows (16.8%) (28: Academic and 12: Private institutions) responded to survey. Fellows expect a higher minimum number of vitrectomies (at least 300) by graduation compared to PDs (at least 200). Both PDs and fellows ranked direct observation of fellow (4.95), discussion with other faculty on fellow surgical performance (3.93), and outcomes of fellow surgical cases (3.88) (p>0.05), as top three teaching tools. Both PDs and fellows expressed high comfort levels with various complex surgeries, such as primary scleral buckle (4.45), proliferative vitreoretinopathy detachments (4.57), advanced diabetic retinal detachments (4.57), and giant retinal tears (4.64), by the time of graduation. Autonomy was also considered an important indicator of surgical competence by both groups. However, apart from direct surgical experience, fellows rated other educational tools lower than PDs. There was overall agreement between the groups on several aspects of a hypothetical national competence standard.

Conclusion: This survey identified key tools utilized to assess surgical proficiency were direct observation of surgery by attending, discussions about fellow performance among faculty, and outcomes of fellow surgical cases. Both groups emphasized that by graduation, fellows should be proficient in several complex vitreoretinal surgeries. These findings suggest a need for a more systematic approach to assess surgical competency of VR fellow.