The art of training up the next generations of ophthalmologists Glenn Strauss, M.D. Chief simulator subject matter expert, Help Me See Consultant Ophthalmologist, Mercy Ships Fellow of the American Academy of Ophthalmology

Changes in the world of medicine New technologies in care delivery New technologies in compliance and auditing New technologies in access to information

Very little change in the world of training 100 year old model Apprenticeship Increasing pressure to address cost and patient risk during training Availability of new technology for training is just starting to make an impact

My experience as a skills trainer: U.S. residency training programs: 30 years International cataract training: 10 years MSICS training changed my training paradigm This paper presents my experience in international, cross-cultural training since 2005.

Effective complex task training does not happen by accident It results from carefully orchestrated interactions.

Three essential components of complex task training Skills Knowledge Attitude

Delivering complex task training is a complex task It is a skill that can be taught to those who have an aptitude for teaching.

MSICS training delivered since 2005 One trainer, hands on, delivering 3 weeks or more of training To 49 trainees In 18 countries.

MSICS training delivered since 2005 The trainees consisted of: 16 phaco surgeons 23 ECCE surgeons 10 ophthalmology trainees or medical officers with no significant surgical experience.

Training Objectives Competency (the ability to operate efficiently with a 5% or lower complication rate) Confidence (a state of mind that is geared towards contextual problem solving) Mastery was not a goal.

Achievement of Competence and Confidence 65% achieved competence and confidence From which, 7 (22%) then became successful trainers (all were ophthalmologists) 35% required additional training On average, 106 supervised cases per trainee (minimum 35, maximum 320).

What I learned about the 3 essential components: Skills Knowledge Attitude

Unique SKILLS Being present in the moment Using Socratic methodology and facilitation techniques Being articulate, logical, and level headed Anticipating and participating while thinking out loud Observing – seeing and interpreting subtle actions Performing as a ‘transparent third hand’ from the assistant scope.

Specialized KNOWLEDGE Knowing what I was teaching at a cause and effect level Understanding training patterns, especially typical peaks and valleys in learning Anticipating the sources of trainee stress Recognizing the surgical cues that predict problems.

Mature training ATTITUDE Appreciating the sanctity of life — caring Living by a code of service — sacrificial Being an agent of training delivery Depending on wisdom not power Committed to the success of each trainee Committed to the well-being of the patient.

Proper skills, knowledge, and attitude combined enhance training effectiveness. 16

Over time, I learned to be proactive rather than reactive in my training. 17

Technology does not always meet the need

What does the older generation have to offer Not completely enamored with technology Not ready to abandon what has worked until it is clear which improvements are real Not that much really new under the sun

What does the older generation have to offer Wisdom- knowing the right questions Wit- getting the right balance Wonder- seeking the meaningful, not the mindless

CONCLUSIONS In some ways, each generation needs to figure it out on their own Generational distinctives are important Christian faith is relevant but must be skillfully applied The basics of learning have not changed- we just need to be more aware of them

Seeing it passed on makes it all worthwhile

What about you? Your Aptitude? Your Calling?

Thank You