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    Estudo Das Vias De Sinalização Intracelular Envolvidas Na Atividade Citoprotetora Do Lopap (Lonomia Obliqua Prothrombin Activator Protease) E Peptídeos Derivados
    (Universidade Federal de São Paulo (UNIFESP), 2017-08-31) Malavazzi, Gustavo Ricci [UNIFESP]; Nose, Walton [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Objective: To develop and implement a systematic method for the training of residents to perform the phacoemulsification surgery (PHACO), used for the treatment of cataracts, in a medical residency service in ophthalmology, based on stepwise evolution in chronological reverse order (reverse chaining), and in increasing degrees of difficulty; to develop a logbook for the registering of the completed steps by the residents, and to describe the preliminary results of the teaching method in a teaching unit comparing the period before and after the implementation. Methods: A method of training residents of ophthalmology in the PHACO technique was created, in which the procedures are described as steps in a learning process, in reverse chronological order, and in which one can advance in the teaching modules only when the learning of each one has been completed; thus moving from the final step to the start of surgery. The rates of possible surgery complications, especially posterior capsule rupture, were evaluated descriptively in the two years and compared with the period before the implementation of the teaching program. Results: The method of reverse chaining teaching was created and the logbook was developed. Before this, 392 medical records were analyzed in the institution, and the posterior capsule rupture rate was 19.89% in surgeries performed by second and third year residents. In 2009, after the method implementation, 1,817 PHACO surgeries were performed in the service, and other 1,860 in 2010 (total: 3,677 procedures). The average was 151 surgeries per month in 2009 and 155 in 2010. The absolute frequency of posterior capsule rupture was 153 events in 2009 and 147 in 2010, with rates of 8.42% and 7.9% of the surgeries performed, respectively. The posterior capsule rupture rate in the period before the introduction of the new training method (2007) compared to the years after (2009 and 2010) had a significant decrease (p < 0.001; chi-square test). When the resident is trained by the new method, the chance of the patient suffering a posterior capsule rupture is 63% (2009) and 65% (2010) lower. Conclusions: This study shows that controlling the steps when teaching PHACO techniques to residents results in low rates of intraoperative complications comparable to those in the literature. The method is sustainable and should be tested in other teaching facilities in Brazil.