{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T13:56:21Z","timestamp":1789480581968,"version":"build-2803163510"},"reference-count":26,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2025,5,29]],"date-time":"2025-05-29T00:00:00Z","timestamp":1748476800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Faculty of Medicine of Chiang Mai University","award":["021\/2567"],"award-info":[{"award-number":["021\/2567"]}]},{"DOI":"10.13039\/501100004071","name":"Khon Kaen University","doi-asserted-by":"publisher","award":["67\/1-2-2-2-001"],"award-info":[{"award-number":["67\/1-2-2-2-001"]}],"id":[{"id":"10.13039\/501100004071","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Prince of Songkla Univerisity","award":["65\/1-PSU-2-1-1"],"award-info":[{"award-number":["65\/1-PSU-2-1-1"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:p>Skills and confidence in performing high-risk procedures are essential for ensuring safe patient care. Deliberate practice is an instructional model designed to improve performance by engaging trainees in structured, repetitive practice with immediate feedback provided by supervisors. We developed a multifaceted simulation informed by deliberate practice and tested the hypothesis that trainee skills and reported confidence would increase after training. A multicenter prospective study was conducted at three universities in Thailand from July 1, 2023, to June 30, 2024. Sixty ophthalmology trainees participated in an introductory video for self-study and then completed a multiple-choice questionnaire to assess their baseline knowledge of laser indirect ophthalmoscopy for retinopathy of prematurity (LIO-ROP) and guide feedback by supervisors. The participants subsequently performed a simulated LIO-ROP on a schematic eye and received additional feedback based on a scoring rubric. The participants practiced on the schematic eye as much as needed to feel confident in their skills. Mean rubric scores indicative of LIO-ROP skills significantly improved from 2.94 to 3.59 out of 4 (P\u2009&lt;\u20090.001), and the time required for the laser procedure decreased from 17.19 to 15.14 minutes in pre- and post-LIO-ROP\u00a0practice, respectively. Rubric scores for performing the LIO-ROP on a schematic eye significantly improved across all steps of the procedure between pre- and post-LIO-ROP practice. Reported confidence in performing the LIO-ROP increased by 81.5%. Multifaceted simulated training informed by deliberate practice is a suitable instructional model for enhancing skill performance and confidence among postgraduate residents.<\/jats:p>","DOI":"10.1371\/journal.pone.0323365","type":"journal-article","created":{"date-parts":[[2025,5,29]],"date-time":"2025-05-29T17:43:08Z","timestamp":1748540588000},"page":"e0323365","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Deliberate practice for retinopathy of prematurity: Retinal laser training using schematic eyes in ophthalmology education"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-9851-6883","authenticated-orcid":true,"given":"Narisa","family":"Rattanalert","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1409-512X","authenticated-orcid":true,"given":"Supaporn","family":"Tengtrisorn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phanthipha","family":"Wongwai","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atchareeya","family":"Wiwatwongwana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Penny","family":"Singha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sirinya","family":"Suwannaraj","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thunyaluck","family":"Jiwanarom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Warachaya","family":"Phanphruk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Parichat","family":"Damthongsuk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorene F.","family":"Balmer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,5,29]]},"reference":[{"key":"pone.0323365.ref001","first-page":"219","volume-title":"Deliberate practice and mastery learning: origins of expert medical performance","author":"WC McGaghie","year":"2015"},{"issue":"11","key":"pone.0323365.ref002","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1111\/j.1553-2712.2008.00227.x","article-title":"Deliberate practice and acquisition of expert performance: a general overview","volume":"15","author":"KA Ericsson","year":"2008","journal-title":"Acad Emerg Med"},{"key":"pone.0323365.ref003","volume-title":"Deliberate practice in medical simulation","author":"SA Mitchell","year":"2024"},{"issue":"1","key":"pone.0323365.ref004","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1186\/s12909-019-1537-7","article-title":"Perfecting practice: a protocol for assessing simulation-based mastery learning and deliberate practice versus self-guided practice for bougie-assisted cricothyroidotomy performance","volume":"19","author":"A Petrosoniak","year":"2019","journal-title":"BMC Med Educ"},{"issue":"8","key":"pone.0323365.ref005","first-page":"467","article-title":"The emotional impact of medical errors on practicing physicians in the United States and Canada","volume":"33","author":"AD Waterman","year":"2007","journal-title":"Jt Comm J Qual Patient Saf"},{"issue":"6","key":"pone.0323365.ref006","doi-asserted-by":"crossref","first-page":"1048","DOI":"10.1016\/j.jamcollsurg.2016.12.039","article-title":"The Surgeon as the Second Victim? Results of the Boston Intraoperative Adverse Events Surgeons\u2019 Attitude (BISA) Study","volume":"224","author":"K Han","year":"2017","journal-title":"J Am Coll Surg"},{"issue":"5","key":"pone.0323365.ref007","article-title":"Effects of high-fidelity simulation education on medical students\u2019 anxiety and confidence","volume":"16","author":"JH Yu","year":"2021","journal-title":"PLoS One"},{"key":"pone.0323365.ref008","doi-asserted-by":"crossref","first-page":"16","DOI":"10.3352\/jeehp.2021.18.16","article-title":"The relationships of nursing students\u2019 satisfaction and self-confidence after a simulation-based course with their self-confidence while practicing on real patients in Vietnam","volume":"18","author":"TTH Oanh","year":"2021","journal-title":"J Educ Eval Health Prof"},{"issue":"9","key":"pone.0323365.ref009","article-title":"Exploring the Role of Simulation Training in Improving Surgical Skills Among Residents: A Narrative Review","volume":"15","author":"SA Cardoso","year":"2023","journal-title":"Cureus"},{"issue":"1","key":"pone.0323365.ref010","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1186\/s13019-024-02647-5","article-title":"Role of surgical simulation on self-reported confidence level on cardiothoracic surgical trainees","volume":"19","author":"LE Yean","year":"2024","journal-title":"J Cardiothorac Surg"},{"issue":"1","key":"pone.0323365.ref011","doi-asserted-by":"crossref","first-page":"599","DOI":"10.1186\/s12909-022-03634-x","article-title":"Implementation of microsurgery simulation in an ophthalmology clerkship in Germany: a prospective, exploratory study","volume":"22","author":"S Deuchler","year":"2022","journal-title":"BMC Med Educ"},{"issue":"4","key":"pone.0323365.ref012","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0011125","article-title":"The impact of incorporating surgical simulation into trichiasis surgery training on operative aspects of initial live-training surgeries","volume":"17","author":"EW Gower","year":"2023","journal-title":"PLoS Negl Trop Dis"},{"issue":"1","key":"pone.0323365.ref013","doi-asserted-by":"crossref","first-page":"56","DOI":"10.3129\/i10-051","article-title":"Virtual reality ophthalmic surgical simulation as a feasible training and assessment tool: results of a multicentre study","volume":"46","author":"TDB Le","year":"2011","journal-title":"Can J Ophthalmol"},{"issue":"3","key":"pone.0323365.ref014","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/j.survophthal.2006.02.005","article-title":"Virtual reality in ophthalmology training","volume":"51","author":"YM Khalifa","year":"2006","journal-title":"Surv Ophthalmol"},{"issue":"2","key":"pone.0323365.ref015","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1136\/bjophthalmol-2013-303700","article-title":"Surgical simulators in cataract surgery training","volume":"98","author":"S Sikder","year":"2014","journal-title":"Br J Ophthalmol"},{"issue":"1","key":"pone.0323365.ref016","doi-asserted-by":"crossref","first-page":"36","DOI":"10.5935\/0004-2749.20150010","article-title":"Evaluation of a simulation tool in ophthalmology: application in teaching funduscopy","volume":"78","author":"JE Androwiki","year":"2015","journal-title":"Arq Bras Oftalmol"},{"issue":"1","key":"pone.0323365.ref017","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5693\/djo.01.2018.11.001","article-title":"A simple eye model for practicing indirect ophthalmoscopy and retinal laser photocoagulation","volume":"25","author":"JA Kylstra","year":"2019","journal-title":"Digit J Ophthalmol"},{"issue":"2","key":"pone.0323365.ref018","doi-asserted-by":"crossref","first-page":"162","DOI":"10.1016\/j.oret.2017.06.002","article-title":"The Ophthalmology Surgical Competency Assessment Rubric for Panretinal Photocoagulation","volume":"2","author":"JC Law","year":"2018","journal-title":"Ophthalmol Retina"},{"key":"pone.0323365.ref019","doi-asserted-by":"crossref","DOI":"10.21236\/ADA084551","volume-title":"A five-stage model of the mental activities involved in directed skill acquisition","author":"HL Dreyfus","year":"1980"},{"key":"pone.0323365.ref020","volume-title":"User experience questionnaire handbook","author":"M Schrepp","year":"2023"},{"key":"pone.0323365.ref021","first-page":"51","volume-title":"Sample size calculations in clinical research","author":"SC Chow","year":"2003"},{"key":"pone.0323365.ref022","volume-title":"N4studies: sample size and power calculations for android","author":"C Ngamjarus","year":"2014"},{"issue":"6","key":"pone.0323365.ref023","doi-asserted-by":"crossref","first-page":"860","DOI":"10.4103\/ijo.IJO_325_19","article-title":"Safety and efficacy of 532\u2009nm frequency-doubled Nd-YAG green laser photocoagulation for treatment of retinopathy of prematurity","volume":"67","author":"SR Singh","year":"2019","journal-title":"Indian J Ophthalmol"},{"issue":"2","key":"pone.0323365.ref024","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1016\/j.jaapos.2017.12.005","article-title":"Ocular complications following treatment in the Postnatal Growth and Retinopathy of Prematurity (G-ROP) Study","volume":"22","author":"D Morrison","year":"2018","journal-title":"J AAPOS"},{"issue":"1","key":"pone.0323365.ref025","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1111\/medu.14592","article-title":"Confidence-competence alignment and the role of self-confidence in medical education: A conceptual review","volume":"56","author":"M Gottlieb","year":"2022","journal-title":"Med Educ"},{"issue":"4","key":"pone.0323365.ref026","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1016\/j.jaapos.2012.04.005","article-title":"The ophthalmology surgical competency assessment rubric for strabismus surgery","volume":"16","author":"KC Golnik","year":"2012","journal-title":"J AAPOS"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0323365","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,29]],"date-time":"2025-05-29T17:43:19Z","timestamp":1748540599000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0323365"}},"subtitle":[],"editor":[{"given":"Anandhi","family":"Upendran","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,5,29]]},"references-count":26,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,5,29]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0323365","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,29]]}}}