{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T08:54:00Z","timestamp":1791968040506,"version":"4.3.4"},"reference-count":21,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T00:00:00Z","timestamp":1791936000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100008397","name":"Velux Fonden","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008397","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Ophthalmologica"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Virtual reality simulation (VRS)\u2010based 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\u2010regulated learning approach, where progression is based on self\u2010assessed competence. In contrast, mastery learning requires trainees to reach a predefined proficiency benchmark. This study evaluated whether participants using directed self\u2010regulated learning attained proficiency on a simulation\u2010based test with established validity evidence, whether baseline aptitude predicted proficiency attainment, and the time required to reach the benchmark.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This prospective cohort study included ophthalmology residents and research associates at the Department of Ophthalmology, Rigshospitalet\u2013Glostrup, with \u22656\u2009months of clinical ophthalmology experience. Participants completed a baseline test on the EyeSi Surgical Simulator and trained until they felt ready to attempt a simulation\u2010based test. Passing required reaching a predefined proficiency benchmark. Participants who did not reach the benchmark repeated testing until proficiency attainment or training was discontinued.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Forty participants were included; 25 (63%) reached the proficiency benchmark. Baseline score was not significantly associated with proficiency attainment (OR per 1 SD\u2009=\u20091.60, 95% CI 0.82 to 3.32;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.18). Median time to proficiency was 13\u2009h 21\u2009min (range, 6\u2009h 57\u2009min\u201331\u2009h 37\u2009min).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Directed self\u2010regulated 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/aos.70254","type":"journal-article","created":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T08:34:11Z","timestamp":1791966851000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Variable proficiency attainment following virtual reality cataract training: Implications for a mastery learning approach"],"prefix":"10.1111","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1864-7131","authenticated-orcid":false,"given":"Amalie","family":"Carlsson","sequence":"first","affiliation":[{"name":"Department of Ophthalmology Rigshospitalet  Glostrup Denmark"},{"name":"Copenhagen Academy for Medical Education and Simulation Centre for HR and Education  Copenhagen Capital Region of Denmark Denmark"},{"name":"Department of Clinical Medicine University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"Konge","sequence":"additional","affiliation":[{"name":"Copenhagen Academy for Medical Education and Simulation Centre for HR and Education  Copenhagen Capital Region of Denmark Denmark"},{"name":"Department of Clinical Medicine University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morten","family":"la Cour","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Rigshospitalet  Glostrup Denmark"},{"name":"Department of Clinical Medicine University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anton Quoc Dung","family":"Le","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Rigshospitalet  Glostrup Denmark"},{"name":"Copenhagen Academy for Medical Education and Simulation Centre for HR and Education  Copenhagen Capital Region of Denmark Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann Sofia Skou","family":"Thomsen","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology Rigshospitalet  Glostrup Denmark"},{"name":"Copenhagen Academy for Medical Education and Simulation Centre for HR and Education  Copenhagen Capital Region of Denmark Denmark"},{"name":"Department of Clinical Medicine University of Copenhagen  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,14]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1016\/j.jss.2015.03.082","article-title":"Perception does not equal reality for resident vascular trauma skills","volume":"198","author":"Bowyer M.W.","year":"2015","journal-title":"The Journal of Surgical Research"},{"key":"e_1_2_6_3_1","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1159\/000493431","article-title":"Simulation\u2010based mastery learning of flexible bronchoscopy: deciding factors for completion","volume":"97","author":"Cold K.M.","year":"2019","journal-title":"Respiration; International Review of Thoracic Diseases"},{"key":"e_1_2_6_4_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1159\/000542045","article-title":"Mastery learning guided by artificial intelligence is superior to directed self\u2010regulated learning in flexible bronchoscopy training: an RCT","volume":"104","author":"Cold K.M.","year":"2024","journal-title":"Respiration"},{"key":"e_1_2_6_5_1","doi-asserted-by":"crossref","first-page":"1178","DOI":"10.1097\/ACM.0b013e31829a365d","article-title":"Mastery learning for health professionals using technology\u2010enhanced simulation: a systematic review and meta\u2010analysis","volume":"88","author":"Cook D.A.","year":"2013","journal-title":"Academic Medicine"},{"key":"e_1_2_6_6_1","doi-asserted-by":"crossref","first-page":"1078","DOI":"10.1186\/s12909-024-06064-z","article-title":"Learning curves of novice residents on cataract surgery simulator: the E3CAPS pedagogic study","volume":"24","author":"Ducloyer J.\u2010B.","year":"2024","journal-title":"BMC Medical Education"},{"key":"e_1_2_6_7_1","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1016\/j.amjsurg.2008.01.024","article-title":"Can everyone achieve proficiency with the laparoscopic technique? 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