Eyeworld

EW RESIDENTS 71 Sheila Borboli, M.D., Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston The following tips can be helpful in efficiently teaching phacoemulsifica- tion to a beginning ophthalmic sur- geon. These pearls can minimize complications encountered during surgery and reduce the stress and anxiety for both the preceptor and the resident. 1. Case selection: Residents enjoy a challenge, but don't "over- challenge" them in the beginning. Avoid involving the resident in cases such as overtly dense nuclei, small pupils, pseudoexfoliation, or pa- tients with compromised corneal en- dothelium. The increased risk of ad- verse events adds to the stress in such a setting. The traumatic experi- ence of an intraoperative complica- tion can be intimidating to a beginner surgeon. Success is a more potent confidence builder than fail- ure. 2. Divide the early cataract cases into steps and have the resi- dent focus on one step at a time: This is an extremely helpful strategy in teaching phacoemulsification. The steps are introduced in order of difficulty, with the easier steps, e.g., IOL insertion and viscoelastic re- moval, introduced first. The most Cataract tips from the teachers September 2011 E arlier this year, Dr. Chang approached us about a column focused on cataract surgery pearls based on the Harvard Intensive Cataract Surgical Training Course for young cataract surgeons and for those teaching surgeons-in-training. We planned a series of articles focused on helping teachers and students glean the most from their cataract learning experiences. Since the beginning of the academic year is often very stressful for both residents and their instructors, we thought it might be useful to start by sharing our faculty's tips and pearls for new cataract instructors. Residents rely on their teachers to take them successfully through a case. These teaching skills are unique from those we learn in training, and most instruc- tors don't receive formal training as educators. For those of you who have taught residents for some time, these themes may resonate with you. We have asked Drs. Borboli, Greenstein, and Kloek to share their insights into "at the microscope" cataract training for new teachers. Sherleen Chen, M.D., and Roberto Pineda, M.D. continued on page 72 T he Harvard Intensive Cataract Surgi- cal Training Course was founded in 2005 by Bonnie Henderson, M.D., at the Massachusetts Eye and Ear Infirmary (MEEI). This annual weekend course draws second year residents from across the coun- try and features lectures and wet lab training in basic cataract surgical techniques. What is unique is that the faculty consists of surgical instructors from residency programs across the country who voluntarily travel to Boston to teach in the course. All of the faculty mem- bers are selected by their respective depart- ment chairs as the best resident surgical attending from that program. Because many of us teach residents and because many readers are in (or are not that far removed from) their own residencies, I thought that EyeWorld should have a regular column deal- ing with tips for helping less experienced cataract surgeons. Our trade journals and meeting programs tend to highlight cataract experts discussing the most complex cases and techniques (e.g., Rich Hoffman's Tips and techniques column). In contrast, this column will focus on more basic surgical pearls and problems. To lead this effort, I have tapped two talented MEEI faculty members, Sherleen Chen, M.D., and Roberto Pineda, M.D., who along with Bonnie are co-directors of the Har- vard cataract surgery course. In this ongoing column, they will feature the talent and ad- vice from these Harvard course faculty mem- bers who have been designated as the "best of the best" at training residents. This new EyeWorld column—Cataract tips from the teachers—debuts this month. David F. Chang, M.D., chief medical editor Sherleen Chen, M.D. Instructor in Ophthalmology, Harvard Medical School and Director of Cataract and Comprehensive Ophthalmology Massachusetts Eye and Ear Infirmary Roberto Pineda, M.D. Assistant Professor of Ophthalmology Harvard Medical School and Director of Refractive Surgery Massachusetts Eye and Ear Infirmary

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