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 just like athletes, though their movements are much smaller (in the case of ophthalmology). In our residencies and fellowships we benefited from direct teaching and supervision by more senior attending physicians. However, that input 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 toward self-improvement of surgical technique as video technology has become more accessible. More than 3 decades, ago, Robert Osher, MD, began the Video Journal of Cataract & Refractive Surgery, which revolutionized ophthalmic surgical teaching because it captured the best ophthalmologists performing surgery. The journal was distributed on videotape and as a resident, I borrowed every issue that I could get and studied them in detail. With the new video technology, live surgery events were brought to the major meetings. Soon after, 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 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 because 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 without my personal biases. 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 position or to pivot within the incision, these steps are corrected instantly. 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.