Approaches to Difficult Training Situations in MSICS: A Panel Discussion Glenn Strauss, M.D. Chief simulator subject matter expert, Help Me See Consultant Ophthalmologist, Mercy Ships Fellow of the American Academy of Ophthalmology

Distinguished panel of trainers: Dan Gradin Carlos Gomez Dan Siapco Jeff Rutgard

Cataract surgery training challenges We would all prefer a training setting where the only issue is the trainee

But this is not always the case

How does our panel approach the challenges when training in poor conditions Political challenges- key actors and how they relate, your role as a guest Equipment challenges- instruments, sterilization, consumables Surgical logistics challenges- when, where, and how to get things done Trainee challenges- background, aptitude, attitudes The challenges of managing expectations

How does our panel approach the challenges when training in poor conditions Political challenges Equipment challenges Surgical logistics challenges Trainee challenges The challenges of managing expectations

Use of assessment tools to prepare for training work For review with on-site coordinator approx. 6 weeks before event. Highlight areas of concern and follow up 2 weeks before event. 11 areas to assess Training set up Who will you be training specifically? What is their background? What are the expectations? Do you have enough time to meet the expectations? Preop What is the surgical selection criteria? How are patients checked in? What are they charged? Who does the IOL calculation? Which formula and where is it documented? Who does the preop exam and where is it documented? Where are patients prepared the day of surgery? Who is handling preop dilation, consent, toileting, education? Any info available to review? Who does the block and when? What is block routine? Orbital decompression? When are patients cleaned? Sterile prep occurs when?

Use of assessment tools to prepare for training work Theater set up Is it dedicated space? If shared, shared with which service and what days. Possibility of getting bumped? Size of space- approx. Are scrub clothes provided? Can you bring your own? Who escorts the patients in and out? How is this managed to ensure efficiency? What is meant by sterile technique? What type of drape is used? What type of cautery is available? Are the scrub nurse and circulator willing and able to handle extra training demands? Will we work with the same staff each day or do they rotate with others? Is there one surgical stretcher or 2 per microscope? What type of stretcher? Does the staff take regular or required breaks? When?

Use of assessment tools to prepare for training work Microscope Type Light source (LED, xenon, halogen) extra bulbs available? Any problems with fiber optic cable? Binocular teaching scope? Video capability? Format/storage capability/existing library? Emergency equipment Vitrectomy equipment available? What is it? Is acetycholine available? Miostat or Miochol? How are medical emergencies handled? Crash cart available? Any backup for medical management? Instruments Confirm at least 5 complete trays of standard instruments (use custom list of MSICS instruments) will be set up in good condition and ready. Do they have vannas, utrata, iris sweep? How is it sorted for easy access? Sterilization support? Adequacy of sterilization process- do they use markers? Back table set up, any re-use of instruments

Use of assessment tools to prepare for training work IOLs Confirm adequate range of IOL powers Confirm type of IOLs available AC and PC IOLs available in adequate numbers (assume 5% of cases need AC but usually less) Viscoelastic Adequate amount of viscoelastic available for training (5cc/case) Confirm type of viscoelastic- what other choices are available if any? Prefer cohesive Other Consumables What do they use for dilation? Do they have Cyclogyl? (loss of dilation is major cause of complications for trainees) What options for local anesthetics? Options for syringes and needles? Prefer 25 g 1.5inch. Also use 27 or peribulbar needle What type of surgical sponges are available? Weck? Cotton pleget? Foam? Intracameral antibiotic options- Cef or Vanc? who will prepare? Is subconj only better option? Powder free gloves? Size 8 available? Enough for both trainee and trainer?

Use of assessment tools to prepare for training work Postop Are patients held overnight? What is the postop routine? What data is collected and by whom? Will there be time set aside to review postop results with trainee? Plan for approx. 5 min per case total Hand held slit lamp available? What are the usual post op meds? When is second follow up? Reporting How are the results audited? What data is collected and by whom? Who will have access to this data

Thank You