Eyeworld

FEB 2012

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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February 2012 EW RESIDENTS 91 continue with the surgery? the skills to do this, and it is an op- portunity to model this behavior and demonstrate the specific tech- nique to correct the problem. Taking over the surgery should Maria M. Aaron, M.D. Associate professor of ophthalmology Emory University School of Medicine, Atlanta Vikas Chopra, M.D. Associate residency program director Assistant professor of ophthalmology Doheny Eye Institute Keck School of Medicine University of Southern California, Los Angeles The ultimate challenge is not only to make sure that the surgery is performed primarily by the resident surgeon, but that it yields a compa- rable outcome to a case performed by a more experienced attending surgeon. Susan M. MacDonald, M.D. Assistant professor Tufts University School of Medicine, Boston Director, comprehensive ophthalmology Lahey Clinic, Burlington, Mass. Teaching cataract surgery can be a rewarding experience for the teacher as well as the student, yet it has the potential to be stressful and full of anxiety. Developing trust between the resident and attending is critical to keep this a safe, successful, and stress-free experience. The resident must trust the judgment and expert- ise of the attending, and the attend- ing must trust the skill set and responsiveness of the resident. When should an attending take over versus letting a trainee con- tinue with the surgery? In the beginning of a resident's surgical ex- perience, I believe it should be hap- pening constantly. I use a stepwise teaching approach that starts during the first year of training. I like to switch back and forth with the resi- dent to safely allow the resident to build successful snippets of surgery. It also allows for demonstration and correction and modification of resi- dents' technique. As the residents master each of these steps, they will progress and have the skills to complete a full case. When an appropriate full case is chosen for a resident, it is under- stood that the patient's welfare is the first and primary focus. The resident knows if I am concerned that the pa- tient is at risk, I will take over. This is also for the benefit of the resident, as having a major complication early in one's career can negatively impact learning, creating anxiety and fear that can undermine per- formance in future cases. If residents are capable and fo- cused I will allow them to problem solve a difficult situation. But allow- Susan M. MacDonald, M.D. Assistant professor Tufts University School of Medicine, Boston Director, comprehensive ophthalmology Lahey Clinic, Burlington, Mass. ing residents to proceed with a case when they are having difficulty managing complications serves no purpose. I strongly believe having residents overwhelmed and flustered is not good for anyone. If residents do not know what to do, they must stop. This does not mean they can't start again, but continuing with no clear-cut plan and being flustered is a bad habit. I want residents to pause and define the problem, pro- pose the solution, and regain focus before proceeding with the surgery. Sometimes the residents do not have not be seen as a punitive action or one that is to humiliate or embarrass the resident. It should be done for the best interest of the patient and to prevent a complication that the resident is incapable of preventing or managing. It is an excellent op- portunity for teaching. It is also a style of teaching to demonstrate and fine tune surgical techniques. EW Reference 1. The Resident Surgeon Phacoemulsification Learning Curve, Randleman et al, Arch Oph- thalmol. 2007;125(9):1215-1219. Editors' note: Drs. Aaron, Chopra, and MacDonald have no financial interests related to this article. Contact information Aaron: mmendic@emory.edu Chopra: vikchoprausc@gmail.com MacDonald: susan.m.macdonald@lahey.org ASCRS Resident and Fellow Program Sponsored by the ASCRS Resident Task Force, the ASCRS Young Physicians and Residents Clinical Committee, and the ASOA Physician Relations Committee Resident membership application form (U.S.-based residents in training) New in Chicago – FREE ASCRS Resident and Fellow Program (For domestic U.S. residents and fellows) www.ascrs.org/12am/inner.cfm?page=residents-fellow-program

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