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Practice is key to learning surgery
Experienced surgeons should also continue to practice to refine their skills and abilities.
A major concern for all ophthalmic trainees is the progression of our surgical skills and abilities. The best methods for surgical training and optimizing performance remain unclear. OSN Europe Edition Board Member Jack S. Parker, MD, shares his views on this and tells us why even the most gifted surgeons should practice more.
Anthony Khawaja, PhD, FRCOphth
Chair of the SOE Young Ophthalmologists committee
Consider learning a new language. Every day, more resources become available: books, audiotapes, computer software, private tutors and so on. Given this diversity of options — and the variability that individuals manifest in their learning styles — one might expect that the best way to learn a language might differ from person to person. Vocabulary games for some, serious lectures for others. But interestingly, that does not seem to be true. On the contrary, the evidence seems to suggest the opposite — that, overwhelmingly, there is a single most effective way to learn a language regardless of an individual’s intellectual makeup, namely a technique called “immersion,” which consists of living abroad and conversing with the natives in the local tongue. This seems to be the consensus opinion among language teachers: While there are many different ways in which a language can be learned, there is probably a single strategy that is ideal for almost everyone.
What is truly fascinating, however, is that despite this consensus, most language teaching does not employ immersion. Rather, many schools still rely on mindless memorization, rote repetition or other low-yield strategies. In their defense, perhaps immersion experiences are too expensive or inconvenient to easily incorporate. But as a consequence, it is not totally uncommon for students to finish years of formal language instruction and yet be completely unequal to the task of even a casual conversation in their adopted tongue. (I myself took 4 years of Latin in primary school, and by the end, I was still hopeless.)
In our own profession, one is bound to wonder: “Is learning surgery like learning a language?” Is there a single best way for everyone that, nevertheless, has been largely abandoned by most ophthalmic educators in favor of more convenient but less effective alternatives?
To answer these questions, it may be helpful to reflect upon the way that eye surgery is typically taught today. In short, the curriculum usually consists of a period of observation followed by gradually increasing participation under the supervision of an attending surgeon. Although this program sounds at first blush both reasonable and appropriate, it is interesting to note that this strategy is completely unlike the way that most physical skills are taught, especially at the top levels of human achievement. Take learning to play a sport, for example. Most education takes place not within the game itself, but at practice. As any player knows, practice involves a special program of carefully chosen activities that are designed to isolate and emphasize key skills. Through repetitive drilling, the fundamentals of good form are encoded in unconscious behavior. Thereby, technique can be meticulously improved, bad habits prevented or eliminated, and mistaken strategies dispelled. Practice is the obsession of every coach, the primary preoccupation of every elite player and the undisputed best method for raising physical performance. But if this is true, why then is formal and dedicated practice such a neglected part of modern ophthalmic training?
Perhaps the explanation lies in the fact that practicing eye surgery is logistically difficult. Few computer simulators are advanced enough to faithfully replicate elements of a real operation. Practice tissue can be scarce, surgical wet labs may be unavailable and the necessary supplies too expensive. In short, practicing is inconvenient. Therefore, while it is unquestionably the single best way to master a given skill, many ophthalmology programs fail to indulge the activity. The effect is to diminish the quality of education, similar to the effect of language classes forsaking immersion.
But while some training programs have neglected the importance of surgical practice, the best ones have not. Drs. Francis and Marianne Price, for example, require their corneal fellows to drill the critical elements of their surgeries in the wet lab before and after operating on live patients. Likewise, Dr. Gerrit Melles uses the wet lab as his primary teaching resource with his fellows and also at the instructional courses he delivers. Both organizations produce excellent surgeons: skilled individuals with refined technique and impeccable form, arising from their obligation to practice.
At age 93, Pablo Casals — arguably one of the greatest cellists of all time — was asked why he still practiced 3 hours every day. He replied, “Because I’m starting to notice some improvement.” This quote may help to dispel a common misperception: that practice is only for the unskilled or inexperienced. On the contrary, it is probably those with the greatest skills who practice most because nothing else amplifies ability as efficiently or effectively. Lionel Messi still practices. Playing in games is no substitute. Perhaps, then, it is time to rethink the common ophthalmology policy of “observation and gradual participation,” and instead, spend more time in the wet lab.
- For more information:
- Jack S. Parker, MD, can be reached at Parker Cornea, 700 18th St. S #503, Birmingham, AL 35233; email: jack.parker@gmail.com.
Disclosure: Parker reports no relevant financial disclosures.