EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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The Physician's PERSPECTIVE April 2012 Treading continued from page 66 come unnerved by the attending suddenly changing the surgical tech- nique that was planned. Changing from a block to a topical case or using unfamiliar instruments will prevent residents from being as comfortable as they would like to be. Residents need to trust their attend- ing, just as the attending needs to trust the residents. Trying to inter- pret what one is trying to say to the other intraoperatively can readily lead to problems, quickly worsening any apprehensions. Working in the wet lab is criti- cal, but often limited in some of its benefits, such as creation of the cap- sulorhexis. Its greatest help is simply getting residents comfortable with the microscope, gaining dexterity with the instruments, and suturing the wounds. I find residents who have these basic fundamentals may be timid initially, but they rapidly improve as they see the good out- comes and success in their prepara- tion. Some residents may not have faith in their hands, from lack of co- ordination, a tremor, or a variety of other possibilities. The following for- mula I came across in Malcolm Gladwell's Outliers says it best: Achievement = Talent + Preparation No matter your level of innate Richard L. Lindstrom, MD MINNESOTA EYE CONSULTANTS BLOOMINGTON, MN skills or talent, you will always im- prove your achievements by putting in extra preparation. Even the great ones will be greater with continued practice. expectations, that you can get them out of trouble, and that you will keep the patient safe. Timid resi- dents also need to know that you understand their fears. Some causes of excessive timid- ity include: 1. Not understanding the proce- dure: These residents appear overly passive as they wait for instructions. Ask them to watch more surgery and narrate each step in advance, includ- ing which instruments will be called for. 2. Feeling physically uncomfort- able or unable to see well: Spend as much time as necessary setting up the microscope, pedals, stretcher, and chair before the case. Check in often throughout surgery, making adjustments as needed. 3. Unrealistic expectations: When residents expect too little or too much from themselves, they can lose confidence and become hesitant to try new maneuvers. Honest, timely feedback and clear expecta- tions foster confidence and more re- alistic goals. 4. A bad experience: Almost every resident loses confidence after a complication. Residents must have opportunities to review the compli- cation in detail with non-judgmen- tal, experienced teacher-surgeons and peers, so they can understand what went wrong and how to pre- vent it from happening again. If the patient has suffered significant harm, the resident may need addi- tional assistance dealing with that. 5. A slow learning curve: Some In to day's ec onomic clim y's onomic climamate ... I trust my business to ASOA. The American Society of Ophthalmic Administrators— the fastest, most reliable, and accurate resource for ophthalmic practice staff. Sign your staff up for a free-trial membership! Call Susan at 703-591-2220 or email susan@asoa.org www.ASOA.org Susannah Rowe, M.D., M.P.H. Faculty, Department of Ophthalmology Boston University Teaching the overly timid resident can be as challenging as teaching the overly aggressive resident. Some residents are so tentative they can barely get through a case; others freeze suddenly at critical junctures. A few seem so worried about their abilities that they duck surgical op- portunities altogether. The key is to gently nudge the resident forward along the surgical learning curve at a pace that develops skills without endangering patients. Earning your timid resident's trust is essential. All residents need to know that you understand what they are ready for and have realistic residents are appropriately timid be- cause they have underdeveloped sur- gical skills. They should be directed to wet labs, surgical simulators, and suture practice sessions. Opportuni- ties in the OR should be tailored to their abilities and may need to be curtailed until their skills improve. As with all residents, small successes build confidence and should be celebrated. With appropriate mentoring, most residents can learn to over- come these challenges. A dedicated surgical instructor who is aware of these issues will help overly timid residents develop into skillful, confi- dent, independent surgeons. EW Editors' note: Drs. Afshari, Blackmon, and Rowe have no financial interests related to this article. Contact information Afshari: natalie.afshari@duke.edu Blackmon: dmblackmon@me.com Rowe: susannah.rowe@bmc.org