We have performance coaches for athletes, so why not for surgeons?
Athletes of all skill ranges benefit from coaching even when they are already performing at world-record level. Having the independent perspective of the coach helps to pinpoint areas where improvement is possible. Surgeons are performing a physical activity in the same regard as athletes, though involving much smaller movements in the case of ophthalmology. In our residencies and fellowships we benefited from direct teaching and supervision by more senior attending physicians, but that tends to stop after board certification.
In cataract surgery, some ophthalmologists tend to stagnate, performing surgery the same way they learned it during training decades earlier; others evolve their techniques and learn new approaches for the rest of their careers. Both of these groups of surgeons could benefit from having a cataract coach. Even surgeons who are world-class and leaders in the field could enhance their performance, which of course would benefit their patients. Surgery could become more efficient, less traumatic, and safer for patients – that’s a win for all parties involved.
Our profession has moved towards self-improvement of surgical technique as video technology has become more accessible. More than three decades ago, one of my idols, Robert Osher MD began the Video Journal of Cataract & Refractive Surgery which revolutionized ophthalmic surgical teaching because it captured the best ophthalmologists performing surgery. These videos were distributed on video cassette tape and as a resident, I borrowed every issue that I could get a hold of and studied them in detail. With the new video technology, live surgery events were brought to the major meetings. And then video recording through the operating microscope came to operating rooms across the country and around the world.
The residents whom I train are now able to stream videos in full HD quality on their phones at any time. YouTube channels for cataract surgery garner countless views from surgeons across the world. When a technique is pioneered, such as newer methods of corneal lamellar transplantation, teaching videos can be made and distributed instantly and surgeons everywhere can learn. That’s a great first step: learning from the videos of others.
The next phase is learning by watching your own surgical videos. Athletes review game-day video footage to judge their own performances in order to find areas where improvement would be beneficial. As surgeons, we can do the same. Even after tens of thousands of surgeries under my belt, I still record surgeries and review them, asking myself if I could do something differently. I highly recommend doing this and the costs are very low since the same storage drive can be written over countless times.
I’ve now moved to forwarding videos of complex cases that I’ve completed to colleagues for an independent analysis and point of view. And it has proved useful since they have a different perspective and may see things that I would be biased toward. Even better would be to have a live commentary from a cataract coach while performing cataract surgery. When I tell residents to keep the eye in primary or pivot within the incision, these steps are corrected instantly and as the surgeon progresses along the learning curve, these are no longer issues. A cataract coach is useful to novice surgeons during training but even more helpful for experienced surgeons who truly wish to master their craft.
I truly enjoy teaching ocular surgery to the next generation of ophthalmologists. The energy and enthusiasm of these bright, young doctors keeps me motivated to stay at the cutting edge of the latest advances in our field. Seeing these surgeons blossom into experts in their own right is a pleasure.
Uday Devgan, MD is in private practice at Devgan Eye Surgery in Los Angeles, partner at Specialty Surgical Center in Beverly Hills, Chief of Ophthalmology at Olive View-UCLA Medical Center, and award-winning Clinical Professor of Ophthalmology at the Jules Stein Eye Institute, UCLA School of Medicine.