This article is more than 5 years old. Information may no longer be current.
The learning curve: Ways to perfect premium surgery
Meeting courses, online resources, colleague interaction and residency training programs offer great opportunities for learning.
Click Here to Manage Email Alerts
A learning curve, by definition, is a graphical representation of the increase of learning with experience. A learning curve can be used in two main ways: either the same task is repeated over and over again, or a body of knowledge is learned over time. As premium surgeons, we know practice improves our surgical skill set, but “perfect practice makes perfect.” We must perform the necessary due diligence before performing any ocular surgery to make sure the surgery goes as planned. Likewise, the phrase “knowledge is power” is not far from the truth because the more knowledge we obtain as premium surgeons, the better we become at common and complex surgical cases. Below I discuss the various ways premium surgeons can lessen the steep learning curve associated with the microsurgical maneuvers we deal with every day.
ASCRS courses
By participating either as a faculty member or as a course registrant, there are a slew of courses at the upcoming American Society of Cataract and Refractive Surgery meeting in New Orleans that can hone a premium surgeon’s skill set. Personally, I am participating as a faculty member in a phacoemulsification course organized by my colleagues Drs. Anita Nevyas-Wallace and William Roper in which participants have the opportunity to trial in wet lab fashion the various current phacoemulsification machines available in the United States: Stellaris PC (Bausch + Lomb), WhiteStar (Abbott Medical Optics) and Centurion (Alcon). One-on-one hands-on uses of the various surgical instruments and IOLs from the same companies can also be tried out, with personalized attention by experienced faculty and surgical clinical application specialists from the companies. Kitaro kits (FCI) and porcine eyes are available during this course as well to master and improve upon various cataract surgical techniques. I will also be participating as a faculty member in a hands-on femtosecond laser cataract course in which each of the participants will have the opportunity to experience the various approved platforms in the United States: Lensar (Alphaeon), LenSx (Alcon), Catalys (Abbott Medical Optics), Victus (Bausch + Lomb) and Z8 (Ziemer).
When I started practicing in preparation to create my first continuous circular capsulorrhexis 25+ years ago, I used grapes and would repeatedly practice peeling the skin off them in a circular fashion until I could do it with my eyes literally closed. Remember, perfect practice is what makes perfect results.
Online resources
This category is simply an understatement for what is available online in terms of publications (PubMed) or access to the various known publications directly or the huge libraries of video cases at popular locations such as Healio.com. The popular phrase “see one, do one, teach one” is not far from the truth when having access to any type of ocular surgical procedure through these websites. Whether it is suturing or gluing in a secondary posterior chamber IOL, learning how to use a capsular tension ring or segments, mastering the modified Siepser sliding knot, closing iris tears, sealing a cataract incision more effectively with ReSure sealant (Ocular Therapeutix), or using the Wong technique — these are just some of the things I have learned from these websites to better myself as a premium surgeon.
Colleague interaction
In the last few years, I have dedicated myself to visiting at least one other premium surgeon in his or her surgical facility setting and observing similar anterior segment surgery techniques. The number of “pearls” I have taken home with me has grown exponentially with this simple annual trip. Before initiating femtosecond laser in my surgical center, I went to visit Dr. Jonathan Solomon to help fine-tune my use of the Lensar platform. I choose a colleague of mine I trust and visit a different one each year, and I recommend this wholeheartedly. I have even learned ways to improve efficiency in my surgery center from such observation trips.
If you lack the time to travel, then at least make calls to various colleagues before starting a new technique, procedure or maneuver and even ask for a video of theirs to watch beforehand. For example, I picked the brains of Dr. Jeff Machat in detail before starting my first cases with the Kamra inlay (AcuFocus), which definitely lessened my learning curve with this recently approved technology. At the minimum, make sure you converse with your favorite colleagues in the hallways of the various ophthalmic meetings, such as Hawaiian Eye/Retina, ASCRS, American Academy of Ophthalmology, European Society of Cataract and Refractive Surgeons and OSN New York, to name a few that I routinely attend.
Residency training programs
Some manufacturers offer quarterly training programs so that the various residency programs can send their residents to the company facilities to see the various technologies available to them before graduating to the real world. Bausch + Lomb offers the Surgical Mentor Resident Program in which live surgery is observed at Drs. Robert Weinstock and Neel Desai’s location in Tampa, Fla., followed by a series of lectures given by experienced faculty and then hands-on wet labs with the Stellaris PC phacoemulsification unit, the Victus femtosecond laser and the various IOLs (Crystalens, Trulign, SofPort AO, enVista, Akreos AO) offered by the company. Alcon also has a similar program offered at its site in Fort Worth, Texas.
In the end, no matter what your starting skill level is today, you are a premium surgeon who needs to keep your learning curve growing by experience and due diligence to ultimately avoid the steep learning curve we all dread.
- For more information:
- Mitchell A. Jackson, MD, can be reached at Jacksoneye, 300 N. Milwaukee Ave., Suite L, Lake Villa, IL 60046; email: mjlaserdoc@msn.com.
Disclosure: Jackson reports he is a consultant for AcuFocus, Bausch + Lomb, Lensar and Ocular Therapeutix.