# Trachomatous trichiasis surgeons appreciate using HEAD START for extended training during periods of low surgical activity: A preliminary study

## TL;DR

A preliminary study shows that using a surgical simulator called HEAD START helps trachomatous trichiasis surgeons maintain and improve their skills during low activity periods.

## Contribution

This study explores the use of extended HEAD START simulator training to maintain surgical skills during low-volume periods for TT surgeons.

## Key findings

- 93% of surgeons found extended HEAD START training beneficial for continued education.
- EHS surgeons showed improved surgical skill over a 5-month period.
- Extended simulator practice is a promising strategy for maintaining surgeon skill during low activity periods.

## Abstract

Trachomatous trichiasis (TT) surgeons routinely experience periods of low surgical activity, which may contribute to low or variable surgical skill. Surgeons need strategies for maintaining skill during these periods.

We recruited 28 newly-trained TT surgeons for this pilot study in southern Ethiopia; we randomized 15 TT surgeons to receive extended surgical practice (Extended HEAD START or EHS group) and feedback using the HEAD START simulation device and 13 TT surgeons to follow standard practice (Standard HEAD START or SHS group) during a 5-month period of low surgical activity. A masked external examiner assessed surgical skill during two live surgeries before and after study activities. During the intervention period, three ophthalmologist trainers evaluated EHS surgeon skill on the simulation device and provided feedback monthly. Surgeons and trainers completed questionnaires on the acceptability and utility of extended HEAD START training. Additionally, we compared change in surgeon skill between baseline and follow-up live surgical assessments between EHS and SHS surgeons. On the final questionnaire, 93% of surgeons reported that extended HEAD START training was beneficial and should be implemented as continued education for trained surgeons. In this small pilot study, on average EHS surgeon skill improved across the 5-month period.

Extended practice with HEAD START is a promising strategy for refining and maintaining surgeon skill during periods of low surgical activity. More research is needed to elicit the most beneficial components of an extended training program and to address logistical challenges.

Globally, an estimated 1.5 million people are living with the blinding condition known as trachomatous trichiasis (TT). This condition occurs when repeated ocular infection causes the eyelid to scar and turn inwards and the eyelashes to touch the eye. In most settings, nonphysician healthcare workers are trained to perform the eyelid surgery that corrects TT. After initial training, these “TT surgeons” operate independently and often have long periods of low surgical volume. This preliminary study investigates TT surgeons’ response to using a surgical simulation device known as HEAD START to continue practicing surgical skills after their initial training. We also assessed whether additional practice and feedback using the HEAD START device helps TT surgeons maintain and improve surgical skills. After five months, almost all surgeons felt it was beneficial to incorporate regular surgical simulator practice as continued education.