Concerned

[amelie4i's]

I am in my second year of ophthalmology training and have done very little intraocular surgery and am growing a little nervous about my career outlook. My program is very weighted towards intraocular surgery during third year and the lower level residents don't get to do much at all. Today I loaded the lens and injected it into the eye (for the second time in my career!) and my attending stated concern about my depth perception. I missed the wound when putting an instrument in to manipulate the IOL and when first loading the lens placed in on top on the injector rather than in it. I tested my stereo after the case and could see everything but the 20 sec of arc with no difficulty and could concentrate to see that one. Also, sometimes I don't feel aggressive or confident enough. I wondered if anyone had suggestions? Do you see cause for concern or is this just the normal adjustment to starting out?

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[MR1]

Wouldn't necessarily worry from what you said, I am a second year as well but have done about 50 cataracts and 15 muscles so far. The first time under the scope actually doing something can be disorientating even with perfect depth perception. I have missed the wound numerous times early on. I would try and get some practive in a wet lab if possible just playing with the scope. If you can do anything else, ie suture a fake eye that helps to. The first time I sutured under a scope I felt like I had 2 left hands with no thumbs.

I have asked about aggressiveness in surgery to many attending and they all have said we residents are either too agressive or not even close enough and the trick is to either speed up or slow down. Don't worry about being not aggressive, confidence will come with more surgery.

So overall I wouldn't worry, I think this is normal adjustment. Just practice with the scope if you can.

 

[4424]

Wouldn't necessarily worry from what you said, I am a second year as well but have done about 50 cataracts and 15 muscles so far. The first time under the scope actually doing something can be disorientating even with perfect depth perception. I have missed the wound numerous times early on. I would try and get some practive in a wet lab if possible just playing with the scope. If you can do anything else, ie suture a fake eye that helps to. The first time I sutured under a scope I felt like I had 2 left hands with no thumbs.

I have asked about aggressiveness in surgery to many attending and they all have said we residents are either too agressive or not even close enough and the trick is to either speed up or slow down. Don't worry about being not aggressive, confidence will come with more surgery.

So overall I wouldn't worry, I think this is normal adjustment. Just practice with the scope if you can.

i agree. i think it's odd that your program has no intraocular surgery experience until third year but i would suggest going to the wet lab and practicing under the scope. if it was your first few times today i would hardly give it a second thought. it definitely takes a bit of practice to get used to depth perception with the scope...i also think it's odd that your attending was concerned about your depth perception with no experience but maybe they didn't realize that. my suggestion would be to go to your wet lab and practice suturing with the scope.

 

[Stark]

I did all my intraocular surgery as a third year. Broad experience and about a hundred cataracts and was well-trained.

My advice - learn something from each surgery by videoing as many cases as you can and going over them.

If you have a video - you see a mistake on the video and will correct it for the next case. If you have no video - you repeat the same mistakes over and over.

If you have a video and do something cool in the OR. You can remember how you did it and do it again.

Video and reviewing each video was one of the most valuable parts of my surgical training.

Best of Luck,

Stark

 

[Mirror Form]

It sounds like you just need to practice working under the microscope. Does your program have wet lab or any kind of practice microscope set up?

 

[Stark]

PS - fumbling around is "just a natural adjustment to starting out."

Use the microscope in the lab if you have one. If not - go to the OR on the weekend and use theirs. Practice throwing and tying sutures into a scrub towel.

Stark