Abstract ID: 26-629
The Hidden Learning Curve in Dacryocystorhinostomy: A 5-Year Analysis of Trainee Progression in External and Endoscopic Techniques
Author: Wessam Mina Base Hospital / Institution: Queen’s Hospital, BHRUT
Presentation Type: ePoster Presentation
Purpose
Dacryocystorhinostomy (DCR), performed via external or endoscopic approaches, is central to oculoplastic training, yet real world trainee progression is poorly defined. This study evaluates longitudinal trainee exposure, learning curves, and acquisition of operative autonomy in both techniques over a 5 year period.
Methods
A 5year observational study conducted in a tertiary oculoplastic training center.Trainee involvement in external and endoscopic DCR was mapped using operative logs,supervision grading, and structured reflective assessments.Levels of participation were analyzed alongside faculty feedback. Semi structured trainee reflections were thematically analyzed to identify barriers and facilitators to progression.Primary outcomes included time to first keystep performance, progression to supervised autonomy, and perceived competence across both techniques.
Results
A nonlinear but predictable learning curve was observed. External DCR enabled earlier exposure & faster transition to active participation compared to endoscopic DCR, which was limited by theatre availability and interdisciplinary access.Three key inflection points were identified:transition from observation to active assistance following repeated anatomical exposure; progression to supervised key step performance with structured delegation; and consolidation of autonomy following complication management experience.Simulation and video based learning were associated with accelerated readiness for endoscopic cases but were inconsistently available. Despite variability in exposure, trainees exposed to structured stepwise entrustment achieved comparable final stage confidence in both techniques.
Conclusion
The DCR learning curve is defined by structured exposure rather than time alone. External approaches facilitate earlier skill acquisition, while endoscopic DCR requires deliberate curricular integration to avoid delayed competency development.A dual modality, stepwise entrustment model with simulation support may standardize training and improve surgical readiness across centers.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Anna | Gkountelia | Queen’s Hospital, BHRUT |