climbing up the surgical skill bell curve

Learning surgery, particularly micro-surgery, is very difficult. No one is born knowing how to work within the 0.25 cubic centimeter space of the anterior chamber while using a microscope. The ability to learn the required surgical skills also varies from person to person. The same way that some people are better than others at playing tennis or video games, there is a spread of surgical ability among new ophthalmology residents. We should not deny that there is a bell curve of surgical ability and we must acknowledge that hard work and dedication can allow any surgeon to get better.

If there was a million dollar prize for mastering all levels of the Super Mario video games or for sinking twenty basketball free-throws in a row, then I would practice day in and day out. I would commit the time, energy, and dedication to ensure success. For the video games, it may take me double the number of hours to master all levels compared to my son, who seems to have a natural knack for this skill. But rest assured, that I am fiercely competitive (with myself) and I would work hard to maximize my skills.

A resident surgeon was in trouble, stuck at the bottom of the surgical skill bell curve. Suturing ability with 10-0 nylon was poor, there was confusion with using the foot pedals while operating, and the limited manual dexterity increase the complication rate. There was only one option: an intense program of practice to bring the skills up to par. This required a few hours every day in the wet lab and with the surgical simulator, and at least 100 sutures of 10-0 nylon per week.

Six months later, I was impressed with the large increase in the surgical skillset and I am confident that this young ophthalmologist will have a successful career in the future. If you are struggling with surgery, the first step is to acknowledge the problem and make a list of the issues. Then, a careful plan of practice must be devised with many hours per week dedicated to improving your skills. Think about how many thousands of patients you will be able to help over the course of your career. That is the true value of your hard work.

click below to learn this important lesson about the surgical skill bell curve:


  1. I thoroughly enjoy your videos, it has helped me a lot. I have been in practice for 20 years and use divide and conquer technique. Your videos has helped my skills. I am watching the phaco fundamentals vidoes but i use a B & L machine, how do i apply the parameters to that machine?

    1. Parameters for ultrasound power are the same. For fluidics, the Venturi pump allows instant vacuum without occlusion but flow rate cannot be independently set. Start with about 75% of the vacuum level values shown in the video and then work up from there.

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