Cataract surgery training in Europe

Purpose: To survey recently graduated European ophthalmologists on their cataract surgery (CS) training opportunities. Methods: A 23-question online survey was emailed to all candidates who sat the EBO Diploma examination as a resident between 2018 and 2022. Results: Eight hundred twenty-one ophthalmologists from 30 countries completed the survey. The mean duration of residency was 4.73 years. More than 25% of the respondents had received no live CS training on patients during their residency. The mean reported number of entire CS procedures performed was 80.7 at the end of the residency. The self-confidence (scale, 1-10) to perform a simple case, a challenging case, to manage posterior capsular rupture, and to realize a corneal stitch were rated 4.1, 3.2, 4.2, 2.4, respectively. We observed extensive variation in clinical exposure to CS and in self-reported confidence to perform CS between trainees of various European countries. Females reported a mean of 18% fewer entire procedures than their male colleagues and were also less confident in their surgical skills (p<0.05). Trainees in residency programs longer than 5 years performed fewer procedures and were less confident than trainees in residences of shorter duration (p<0.001). The importance of a fellowship to complete surgical education was rated 7.7 out of 10. Conclusions: CS training across European countries lacks harmony. European level recommendations seem necessary to raise and harmonize competency-based CS training programs and to promote post-residency fellowship training programs.