Innovative Curriculum to Train Medical Students on Lateral Canthotomy and Cantholysis

Purpose: Orbital compartment syndrome (OCS) is an ocular emergency requiring prompt decompression with a lateral canthotomy and cantholysis (LCC) within 2 hours. This study evaluates the feasibility and effectiveness of a standardized LCC curriculum to train medical students to identify and treat OCS.

Methods: This was a prospective, non-randomized, non-comparative cohort study of 39 novice first-year medical students with no prior LCC training who underwent a standardized LCC curriculum incorporating both didactic and hands-on procedural training. Didactic knowledge of orbital anatomy and OCS was evaluated with written pre- and post-knowledge testing. Expert performance criteria were determined by expert consensus based on the performance of three oculoplastic surgeons and were defined as correctly performing all 12 critical checklist steps of an LCC within 3 minutes twice consecutively on a Sonalyst LCC training system eye model. Utilizing the principles of mastery learning, participants learned how to perform an LCC in a classroom environment and were evaluated on a final test of proficiency in a training lane designed to simulate an austere military environment.

Results: Participants required a median of 3.0 practice iterations to achieve expert performance in the classroom environment. During the testing phase, all participants correctly identified the eye with OCS, and 77% (n = 30) of learners successfully performed an LCC at the expert level within their first attempt. The median completion time of those who passed on their first testing was 130 seconds. The mean LCC knowledge test scores significantly improved from 48.7% to 71.2% (P < .001).

Conclusion: This study successfully developed a standardized LCC curriculum utilizing the principles of hands-on mastery learning to train novice learners to perform an LCC efficiently and effectively.