Internship-Based Clinical Audit of Vision 2020 Cataract Discharge Standards: A novel Pedagogical tool in Undergraduate Medical Education in India
Keywords:
Cataract surgery; clinical audit; discharge standards; quality improvement; Vision 2020; health service efficiencyAbstract
Background: Vision 2020 guidelines recommend early discharge after uncomplicated cataract surgery to improve efficiency in high-volume centres without compromising safety. Clinical audits systematically assess adherence to standards and may strengthen quality improvement (QI) competencies when integrated into undergraduate medical training.
Objective: To assess adherence to Vision 2020 discharge standards following manual small incision cataract surgery (MSICS), identify factors associated with delayed discharge beyond the first postoperative day, and evaluate the feasibility of conducting a structured clinical audit during internship training.
Methods: A retrospective clinical audit was conducted at a tertiary ophthalmology centre in India by a medical intern during routine clinical posting. Data from all MSICS procedures performed in February 2024 were extracted from electronic clinical records, including postoperative slit-lamp findings, complications, surgeon experience, and discharge timing. Current practices were compared with the Vision 2020 standard of discharge on postoperative day one.
Results: Of 319 patients undergoing MSICS, 293 (91.9%) were discharged on postoperative day one. Delayed discharge occurred in 26 patients (8.1%), mainly due to postoperative complications such as hyphema (38%). Among delayed cases, 53% were discharged within 48 hours, 38% involved surgeons with 1–2 years of experience, and one patient required re-intervention for intraocular lens haptic displacement. All patients received standardized counseling regarding danger signs.
Conclusion: High adherence to Vision 2020 discharge standards was observed. Internship-embedded clinical audit appears feasible and may support integration of QI training into undergraduate medical education.
References
1. American Academy of Ophthalmology. Vision 2020 [Internet]. 2011. Available from: https://www.aao.org/education/vision-2020
2. International Agency for the Prevention of Blindness. Ending avoidable sight loss: our strategic plan [Internet]. 2025. Available from: https://www.iapb.org/about/2030in-sight/
3. Jolley E, Virendrakumar B, Pente V, Baldwin M, Mailu E, Schmidt E, et al. Evidence on cataract in low- and middleincome countries: an updated review of reviews using the evidence gap maps approach. Int Health. 2022;14(Suppl 1):i68–83.
4. Thengil DPSJS. Comparative analysis of visual acuity outcomes in cataract surgery: phacoemulsification vs manual small incision cataract surgery. J Contemp Clin Pract. 2025;11(10):331–7.
5. Liu R, Sule AA, Shannon CS, Ravilla T, Taylor H, RojasCarabali W, et al. A practical model for effective eye care delivery in Southeast Asian rural communities: a proposal based on experts' recommendations. Indian J Ophthalmol. 2024;72(Suppl 3):S473–81.
6. Jain BK, Jain E, Kuyyadiyil S, Sen A, Sood D, Bajaj A. High volume and high quality eye care—bridging the paradox: a unique rural-based approach: the Chitrakoot model. Indian J Ophthalmol. 2020;68(2):294–8.
7. Royal College of Ophthalmologists. Ophthalmic services guidance: clinical audit and clinical effectiveness in ophthalmology [Internet]. London: Royal College of Ophthalmologists; 2019.
8. CBM Global Disability Inclusion. 2030 in sight: ending avoidable sight loss [Internet]. 2025. Available from: https://www.cbm.org/our-work/what-we-do/eyehealth/2030-in-sight.html
9. Abu-Jeyyab M, Al-Jafari M, El Din Moawad MH, Alrosan S, Al Mse'adeen M. The role of clinical audits in advancing quality and safety in healthcare services: a multiproject analysis from a Jordanian hospital. Cureus. 2024;16(2):e54764.
10. Vision 2020: The Right to Sight. Guidelines for implementation of primary eye care [Internet]. 2023.
11. Ravulaparthi GS, Sravanthi V, Vattikonda S. Evaluation of causes of early postoperative hyphema in manual small incision cataract surgery. Int J Sci Res. 2020;9:18–20.
12. Srivastava RM, Gupta A, Sharma N, Titiyal JS, Vajpayee RB. Senior residency: an opportunity missed? Indian J Ophthalmol. 2020;68:2319–20.
13. Gurnani B, Kaur K. Comments on: senior residency: an opportunity missed? Indian J Ophthalmol. 2021;69(2):458–9.
14. Lions Aravind Institute of Community Ophthalmology. Manual for planning of tertiary eye care services: Vision 2020 – The Right to Sight. Chennai: Aravind Institute of Community Ophthalmology; 2013.
15. Kurian DE, Amritanand A, Mathew M, Keziah M, Rebekah G. Correlation between visual acuity at discharge and on final follow-up in patients undergoing manual small incision cataract surgery. Indian J Ophthalmol. 2021;69(3):586–9.
16. Gilkes LA, Lira H, Emery JD. Audit and feedback by medical students to improve preventive care practices of general practice supervisors. Aust Fam Physician. 2017;46(1–2):52–7.
17. Chapman SJ, Glasbey JC, Khatri C, Kelly M, Nepogodiev D, Bhangu A, et al. Promoting research and audit at medical school: evaluating the educational impact of participation in a student-led national collaborative study. BMC Med Educ. 2015;15:47.
18. Davis S, O'Ferrall I, Hoare S, Caroline B, Mak DB. Perceptions of medical graduates and their workplace supervisors towards a medical school clinical audit program. Int J Med Educ. 2017;8:244–51.
19. Deameh MG, Mansour OS, Abu Rahma H, Bani Irshid BA, Da'meh MW, Amaireh EA, et al. Clinical audits in medical education: barriers and opportunities among Jordanian medical students. Int J Med Stud. 2025;13(4):369–75.
20. Bray B. Untapping the potential of medical trainees to improve the quality of healthcare. Future Hosp J. 2017;4(1):51–2.
21. Greenwood JP, Lindsay SJ, Batin PD, Robinson MB. Junior doctors and clinical audit. J R Coll Physicians Lond. 1997;31(6):648–51.
22. Prakash V, editor. AETCOM module. New Delhi: National Medical Commission; 2019.
