Residents & Fellows Corner | Mar/Apr '15

Surgical Online Learning: A Trainee’s Perspective

There is a plethora of online resources available to ophthalmologists today.

There is a plethora of online resources available to ophthalmologists today. For those in training, these sites serves as excellent platforms for learning and for acquiring surgical pearls. Ophthalmology-specific YouTube channels, Eyetube, Eyeworld rePlay, the American Academy of Ophthalmology (AAO) ONE Network, the ASCRS MediaCenter, and ESCRS On Demand are just a few that come to mind. Where does the trainee stand in line of this impetuous flow of virtual surgical knowledge?

A surgeon must keep learning incessantly and updating his or her skills. But the meaning of the term learning for a resident, a fellow, an assistant professor, and a professor would obviously be different. An experienced surgeon must fine-tune his or her surgical skills and results by practicing complex procedures in a variety of ways; in contrast, the trainee must first build a strong foundation before learning the intricacies of advanced surgeries.

As a second-year resident, I once attended a live surgery session in which I was mesmerized by a glued IOL implantation by the talented Soosan Jacob, MD. Over the next 2 days, I spent my free time watching videos of scleral fixation and reading about glued IOLs. My next day in the OR, I made a foreseeable mistake in incision construction. I then realized that a more prudent use of my time would have been to watch videos of incision construction and revise the basic steps of surgery—or, at least, to have devoted 70% of my free time to learning basic surgical maneuvers and maybe 20% to 30% on advanced surgery.

A trainee ought to know the basics in great detail and a have a general understanding of the advanced procedures. This article focuses on the online resources that are tailored to the needs of a surgeon in training, while recognizing, of course, that trainees may be of various levels with differing needs.

ONLINE RESOURCES

There is a wealth of surgical knowledge available online today. However, many of the videos we see are edited and fail to show to a trainee any difficulty the surgeon faced in reaching that superior outcome. As we all know, complications and less-than-optimal results do occur. Young surgeons must keep in mind that a skilled surgeon’s 5-minute video demonstrating a new technique may not always give the viewer the full picture.

Below are some online resources that I have found especially valuable
in my training thus far.

ASCRS Phaco Fundamentals Classroom

The ASCRS Phaco Fundamentals Classroom provides a wealth of data for the phaco learner in form of courses, podcasts, videos, textbooks, lectures, an instrument gallery, papers, meeting content, academic grand rounds, steps for improving your phaco skills, and more. All information is labeled advanced and basic, and a small symbol next to the resource indicates its format (audio, video, PDF, PowerPoint, etc.).

With cataracts representing a major chunk of remediable blindness in the developing world, I feel making this resource free is highly appreciable. The site serves as a quick way for residents all over the world to learn from great surgeons and see what other mentors may be teaching their trainees—almost like an international educational exposure and exchange of ideas without travelling!

The phaco FAQ section is especially helpful, as the questions are meant for learners and the answers do not digress into personalized replies, as in other discussion forums. At times, running videos can be a tad bit slow, but if a trainee has some spare time, spending it here may be wise.

iLearn

A sterling example of a trainee-centric website is iLearn by the European Society of Cataract & Refractive Surgeons (ESCRS), which I have been using for quite some time and find valuable. The cataract and cornea-related courses are designed by a panel of experts and include a presentation with videos at appropriate places. At the very end, the questions and score keeping is a superb advantage to the viewer. All of the courses are prepared under the guidance of leading surgeons from around the world and often include a wide range of perspectives on a topic, instead of just one point of view.

At the end of a hard day in residency, if I do not have the energy to study with textbooks or ebooks, I can still review some topics via iLearn. Most of the courses have UEMS-EACCME for CME accreditation too. The didactic course suites include topics like refractive surgery, cataract surgery, a workshop on visual optics, and cornea. Instructional courses include IOL calculations after refractive surgery, penetrating and lamellar keratoplasty, basic phaco, surface ablation techniques, and endophthalmitis. The iLearn site also includes some animations that are helpful for trainees.

The only pertinent shortcoming perhaps is that iLearn focuses entirely on anterior segment because it was developed by the ESCRS. Hopefully a website initiative in the near future will yield a similar platform that covers all branches of ophthalmology.

Eyetube

In my experience, the most mobile-friendly and trusted resource for ophthalmic videos is Eyetube. The site features dedicated channels for specific topics, making navigation of the site quick and easy. Eyetube contains a vast library of videos for all ophthalmologists, with content from a variety of ophthalmic subspecialties.

ONE Network

Creating a ONE Network membership is immensely useful at the beginning of a young ophthalmologist’s career. It is an excellent resource for accessing publications and interesting cases that serve to further stimulate interest in learning.

SUMMARY

Online learning is not comparable to actual classroom teaching or patient experience. However, the Internet is a platform increasingly sought after today by sentient minds in the learning phase. Even social media is no longer purely social; professional updates and personal platforms are merging imperceptibly. Quite commonly, the younger the person, the more Internet-savvy he or she is, so whether by design or unwittingly, trainees are exposed to a lot of “online ophthalmology.” This article merely highlights a few surgical online resources that may be worth a trainee’s time.

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