How does a beginner surgeon transform into an expert in the operating room? For young ophthalmologists, the journey from novice to skilled surgeon is a process filled with learning, adaptation and mastering the unexpected. In this month’s RWO Corner, we explore five key elements every young ophthalmologist should consider for a smooth transition from clinic to OR — gleaned from experienced surgeons who have been there.
1. Plan Your Surgery
Ahead
Preparation for each surgery will increase your confidence and allow the surgery to flow smoothly. This can be done through studying, watching surgical videos and running through the steps of each surgery. Also, know your patients well and review their medical histories and imaging beforehand. Finally, when creating your surgical schedule ahead of time, organize your day by laterality or by case type to help with your flow.
During
Arrive at the surgical suite early to ensure there are no equipment issues and that you are on time. Review each case prior to starting and the equipment needed for that individual case. For example, for cataract cases, ensure the lenses are in the room and are easily accessible. Also, due to the exact precision and small movements needed for intraocular and extraocular surgery, many surgeons choose not to drink coffee to prevent shaky hands.
After
Even once surgery is over, your surgical commitment has not ended. It is imperative to make sure your charting and notes are completed, PACU orders are in and ready, and the patient has appropriate follow-up. Therefore, prepping some of these things beforehand can help with surgical day flow.
2. Focus on Each Case
Ensure you have minimal distractions in the OR and have a game plan for your surgeries. Taking the time to learn ergonomics and making them part of your early practice is key. As a surgeon your comfort is essential — adjust the bed height, microscope and equipment to what you need so you can focus on the surgery you are doing rather than on your back hurting.
3. Surgery Is a Team Sport
No surgeon can complete any surgery alone. The anesthesiologists, circulators, nurses, techs and janitors are all important parts of the surgical team. It is imperative to create a rapport with your staff. Even as a young ophthalmologist, you are the leader of your surgical team and therefore can give positive feedback when things are going smoothly as well as constructive criticism when things could go better.
4. Complications Happen
Complications do not care if you are at the beginning or end of your day and occur no matter how surgically skilled you are. In these situations, remain calm at all costs. The old adage remains true — “when a posterior capsule tears, put some viscoelastic in. When an artery starts bleeding, hold some pressure. You have a moment after temporizing the situation, so take a deep breath and refocus yourself.” Importantly, after these complications, take a moment between cases to debrief with yourself before jumping into the next case.
5. Be Open to Learning and Growing
Surgery rarely follows the textbook. As one surgeon once told me, “No two patients are the same, and sometimes no two eyes on the same face are, either.” This saying is valuable because it reminds a surgeon that creativity and adaptivity are imperative to your approach to each surgical case.
From planning ahead to mastering the rhythm of a surgical day, every step contributes to success in the OR. OM
At Real World Ophthalmology, we focus on equipping young ophthalmologists with the practical tools and real-world insights that make this transition smoother. Sign up at www.realworldophthalmology.com.
Special thanks to Drs. Loka Thangamathesvaran, Frank Mei, Jacob Kanter and Anupam Garg for their surgical advice for this article.
