Advancements in cataract surgical technique and instrumentation have led to excellent outcomes for most patients. These improved outcomes have led to higher patient expectations, which have grown exponentially over the years. The majority of patients expect to achieve 20/20 vision without correction and without complications. These high expectations also apply to residents performing cataract surgery. Most training programs are now developing more rigorous surgical curriculums to meet these higher demands and expectations.
After performing numerous cataract surgeries year after year, it is often hard to remember how difficult it is to learn cataract surgery. Because every step builds upon the previous one, each step must be performed meticulously with very high precision. In our teaching program, we have recently adopted the Dreyfus model of skill acquisition to better prepare residents for performing surgery. In this new curriculum, we define stages of learning, set expectations, provide resources, and finally, measure and document progress. We require residents to review surgical videos, watch cataract surgery performed by attending surgeons, read books about cataract surgical techniques and principles, and practice in supervised wet labs.
At our institution, the majority of cataract surgery is performed during the students third year of residency. In an effort to better understand how they best learn cataract surgery, I asked our third-year residents the following questions:
What most helped you prepare for performing cataract surgery?
What surprised you most about cataract surgery?
What was the hardest step to learn/master?
What steps/strategies most help you improve (ie, feedback, returning to the wet lab, simulators, watching and critiquing videos)?
Learning to perform high-quality cataract surgery requires practice, patience, and good mentors. Structured surgical curriculums are becoming increasingly important with recent emphasis on quality outcomes. In my experience, practicing with residents in wet labs is very important. Having a resident become comfortable with the surgical setup, positioning, and foot pedals allows him or her to more easily focus on the technique. With the availability of newer, more realistic wet labs and simulators, the transition to the operating room will be even easier for residents. I also favor the “backing in” technique, where residents start with surgical steps at the conclusion of the case and then slowly work their way toward the beginning steps.
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Finally, immediate feedback is crucial after each case. Although summative feedback can be helpful, I find immediate feedback and the deconstruction of each case in real time allows residents to learn and fix potential problems in a timely fashion.
