{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T12:43:48Z","timestamp":1773319428171,"version":"3.50.1"},"update-to":[{"DOI":"10.1371\/journal.pntd.0013948","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T00:00:00Z","timestamp":1773187200000}}],"reference-count":23,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T00:00:00Z","timestamp":1772064000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100011373","name":"International Agency for the Prevention of Blindness","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100011373","id-type":"DOI","asserted-by":"publisher"}]},{"name":"NIH Pre-Doctoral Training Grant","award":["F30AI164818"],"award-info":[{"award-number":["F30AI164818"]}]}],"content-domain":{"domain":["www.plosntds.org"],"crossmark-restriction":false},"short-container-title":["PLoS Negl Trop Dis"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Trachomatous trichiasis (TT) surgeons routinely experience periods of low surgical activity, which may contribute to low or variable surgical skill. Surgeons need strategies for maintaining skill during these periods.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methodology\/Principal findings<\/jats:title>\n                    <jats:p>We recruited 28 newly-trained TT surgeons for this pilot study in southern Ethiopia; we randomized 15 TT surgeons to receive extended surgical practice (Extended HEAD START or EHS group) and feedback using the HEAD START simulation device and 13 TT surgeons to follow standard practice (Standard HEAD START or SHS group) during a 5-month period of low surgical activity. A masked external examiner assessed surgical skill during two live surgeries before and after study activities. During the intervention period, three ophthalmologist trainers evaluated EHS surgeon skill on the simulation device and provided feedback monthly. Surgeons and trainers completed questionnaires on the acceptability and utility of extended HEAD START training. Additionally, we compared change in surgeon skill between baseline and follow-up live surgical assessments between EHS and SHS surgeons. On the final questionnaire, 93% of surgeons reported that extended HEAD START training was beneficial and should be implemented as continued education for trained surgeons. In this small pilot study, on average EHS surgeon skill improved across the 5-month period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Conclusions\/Significance<\/jats:title>\n                    <jats:p>Extended practice with HEAD START is a promising strategy for refining and maintaining surgeon skill during periods of low surgical activity. More research is needed to elicit the most beneficial components of an extended training program and to address logistical challenges.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pntd.0013948","type":"journal-article","created":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T18:40:22Z","timestamp":1772131222000},"page":"e0013948","update-policy":"https:\/\/doi.org\/10.1371\/journal.pntd.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Trachomatous trichiasis surgeons appreciate using HEAD START for extended training during periods of low surgical activity: A preliminary study"],"prefix":"10.1371","volume":"20","author":[{"given":"Samantha 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