Use of the Eyesi® simulator in training ophthalmology residents: Results of a pilot study on self-efficacy, motivation, mental effort and performance.

Introduction
To describe the development of motivation, self-efficacy and mental effort during cataract surgery training in ophthalmology residents. Secondly, to assess the relationship of self-efficacy, motivation and mental effort on both simulator (Eyesi®) and real-life surgical performance.

Method
Prospective cohort study using a within subject design. Eight residents were asked to fill out questionnaires on self-efficacy, mental effort and motivation towards the Eyesi® simulator and real-life cataract surgery at three different moments: prior to any simulator or surgical experience, after completing the simulator training with a standardized examination, and after three months of real-life cataract surgery. Simulator performance was derived from the instrument’s output. Patient charts were reviewed to assess real life surgical performance.

Results
Comparative analysis showed a significant increase in self-efficacy towards real life cataract surgery after completing the cataract training on the simulator (p=0.005). Furthermore, we found a significant correlation between total tasks to complete the cataract training and self-efficacy scored after working with the simulator (p=0.038). Motivation towards the simulator remained stable over time and seemed not to be influenced by simulator or real-life performance.

Discussion/Conclusion
Cataract surgery simulation seems to increase the self-efficacy beliefs in performing cataract surgery in ophthalmology residents. Furthermore, we found evidence that performance on the simulator correlates with self-efficacy scored after the simulator training, thereby supporting prior theories on self-efficacy being determined by prior performances. By including more residents over time, this study might provide better insight in the role of self-efficacy and motivation in training complex surgical skills.