Variable proficiency attainment following virtual reality cataract training: Implications for a mastery learning approach

PURPOSE: Virtual reality simulation (VRS)-based training is widely used to prepare novice cataract surgeons, yet unstandardized training regimens result in variable competence at the transition to surgery. In many settings, training follows a directed self-regulated learning approach, where progression is based on self-assessed competence. In contrast, mastery learning requires trainees to reach a predefined proficiency benchmark. This study evaluated whether participants using directed self-regulated learning attained proficiency on a simulation-based test with established validity evidence, whether baseline aptitude predicted proficiency attainment, and the time required to reach the benchmark. METHODS: This prospective cohort study included ophthalmology residents and research associates at the Department of Ophthalmology, Rigshospitalet-Glostrup, with ≥6 months of clinical ophthalmology experience. Participants completed a baseline test on the EyeSi Surgical Simulator and trained until they felt ready to attempt a simulation-based test. Passing required reaching a predefined proficiency benchmark. Participants who did not reach the benchmark repeated testing until proficiency attainment or training was discontinued. RESULTS: Forty participants were included; 25 (63%) reached the proficiency benchmark. Baseline score was not significantly associated with proficiency attainment (OR per 1 SD = 1.60, 95% CI 0.82 to 3.32; p = 0.18). Median time to proficiency was 13 h 21 min (range, 6 h 57 min-31 h 37 min). CONCLUSION: Directed self-regulated learning did not ensure proficiency attainment among all participants. No statistically significant association was found between baseline score and proficiency attainment, and variation in training time supports the rationale for evaluation and implementation of a mastery learning approach.