1. 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

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

3. 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

4. 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.

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

6. Three essential components of complex task training
Skills
Knowledge
Attitude

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

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

9. 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.

10. 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.

11. 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).

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

13. 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.

14. 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.

15. 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.

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

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

18. Technology does not always meet the need

19. 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

20. 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

21. 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

22. Seeing it passed on makes it all worthwhile

23. What about you?
Your Aptitude?
Your Calling?

24. Thank You