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12. Overcome your fears: See numbers 1 and 2. 13. Remember, there's a pa- tient under there: R.P.E. (Respect, Protect, Experience) 14. Reinforce particularly challenging steps by working in the wet lab or on a surgical simu- lator. I hope these recommendations contribute to a better learning expe- rience. There is something to learn, both by the instructor and the trainee, in every case. Carolyn Kloek, M.D., Massachu- setts Eye and Ear Infirmary, Harvard Medical School Teaching cataract surgery is gratify- ing but challenging. A few basic steps that are summarized below can make the experience more successful and rewarding for both the attend- ing surgeon and the trainee. 1. Practice with trainees in the wet lab before the operating room: Spending time with a trainee in the wet lab prior to working with him or her in the operating room not only gives the attending surgeon a sense of the trainee's skill level, but also gets both the attending and trainee comfortable working and communi- cating with one another prior to the operating room. 2. Make sure the trainee is in a comfortable position at the oper- ating microscope before beginning the surgery: Appropriate position- ing at the operating microscope (making sure the trainee isn't hunched over, making sure the shoulders are relaxed, and ensuring appropriate hand position and stabi- lization) is essential prior to begin- ning a teaching case. Awkward positioning makes the surgery more arduous for the trainee and can po- tentiate a nervous tremor. Often the beginning resident doesn't have enough experience to recognize awkward positioning and needs to be instructed. 3. Switch seats frequently: The attending surgeon should have a low threshold to switch seats with the trainee if he or she appears to be struggling with a particular step of surgery, visualization is poor through the side scope, or if the at- tending gets that sinking feeling that a step of the surgery just doesn't look quite right. I switch frequently with trainees in any of the above sit- uations, and once I have moved the case beyond the point at which the trainee was struggling and/or en- sured there are no complications, I hand the case back over to the trainee. 4. Introduce cataract surgery in a stepwise manner: Performing an entire cataract surgery from start to finish can be overwhelming for residents early in their cataract sur- gery training. At the Harvard Oph- thalmology Residency we introduce cataract surgery to residents in a stepwise manner. This approach to teaching surgery allows the trainee to focus on one step of surgery for a series of cases before progressing to entire cases. 5. Take time after each case to discuss every step of the surgery with the trainee in detail: Ideally surgical videos of the trainee's cases are available for the attending and trainee to review together, but in the absence of this technology, simply talking through the steps of surgery after each case is helpful. There are often many teaching points that can be highlighted when reviewing the cases in this step-by-step manner, even when a case goes smoothly. EW Contact information Borboli: sheila_borboli-gerogiannis@ meei.harvard.edu Greenstein: Scott_greenstein@meei.harvard. edu Kloek: Carolyn_kloek@meei.harvard.edu September 2011 Visit EyeWorld Online Now.... EW Meetings

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