The Asia-Pacific Journal of Ophthalmology

Asia-Pacific Journal of Ophthalmology:

Issue 6, November/December 2018 Review Article

Simulation in Ophthalmic Training

Flanagan, Judith L.; De Souza, Neilsen

Author Information

From the *Brien Holden Vision Institute, †School of Optometry and Vision Science, University of New South Wales; and ‡Brien Holden Vision Foundation, Sydney, New South Wales, Australia.

Reprints: Judith Flanagan, Brien Holden Vision Institute, Level 4 North Wing, Rupert Myers Building, Gate 14 Barker St, Sydney, NSW, AUS 2052. E-mail:


Vision impairment and blindness arise both as a cause and a consequence of poverty. Achievement of the United Nations Sustainable Development Goals in providing universal access and equity in eye care, both within and between countries, remains challenging. A severe shortage of eye care providers is creating unnecessary blindness and vision impairment in developing communities worldwide. Education and training develops and strengthens the capacity of emerging nations to contribute to global eye health and the World Health Organization Development Goals in an effective and sustainable way. Compared with other medical professions, adoption of simulation in ophthalmic training has been relatively slow. Simulation potentially reduces training costs, increases accessibility, offers objective measurement of training outcomes, and improves patient safety during and after clinician training, all of which can help address the global burden of vision impairment and blindness. Simulation training offers advantages over apprenticeship models, the traditional mode of transferring knowledge and skills in medicine and health, which suffers from imperfect transference due to inherent biases, heuristic and idiosyncratic expectations of experts, and subjective measures of outcomes. Simulation does not completely remove these confounders because it is made to fit into established curricula, making it difficult to measure effectiveness of the simulation in isolation. The power of simulation training for resource-limited regions and countries is immense in offering cost-effective training in-country; however, it is important that any such tools are developed within the context of the limitations in situ.

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