• Michael J Taravella, Richard Davidson, Michael Erlanger, Gretchen Guiton, and Darren Gregory.
• University of Colorado Health Science Center, Aurora, Colorado 80045, USA. michael.taravella@ucdenver.edu
• J Cataract Refract Surg. 2011 Jun 1;37(6):1069-75.

PurposeTo characterize how residents learn phacoemulsification and determine which steps of the procedure are most difficult to master.SettingUniversity of Colorado Hospital, Aurora, Colorado, USA.DesignComparative case series.MethodsCataract cases were divided into 3 levels of difficulty for comparison. Residents were given a grade for each step of the procedure by the attending surgeon. Main outcome measures were total case time and a proficiency grade. Independent variables were level of resident experience and degree of difficulty. Case times of attending cases were collected for comparison.ResultsNine residents were evaluated by 4 attending surgeons while performing 324 cases of phacoemulsification. Case times of 319 attending cases were used for comparison. The easiest-to-learn steps (highest scores versus level of experience) included intraocular lens insertion, ophthalmic viscosurgical device removal, hydrodissection, and nucleus sculpting. Wound integrity, nucleus disassembly and removal, cortex removal, and capsulorhexis had the lowest scores versus level of experience. Resident case times decreased significantly with experience, approaching average case times for attendings.ConclusionsFor this study, competency was defined as the ability of the resident to perform a case in a reasonable time without intervention or complication. Using this definition, competency was achieved when case experience exceeded 75 cataract surgeries.Financial DisclosureNo author has a financial or proprietary interest in any material or method mentioned.Copyright © 2011 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.

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