Kerala Journal of Ophthalmology

GUEST EDITORIAL
Year
: 2020  |  Volume : 32  |  Issue : 3  |  Page : 221--223

Postgraduate surgical training in ophthalmology


Vivek Oommen Varghese, Thara R Nair, K Mahadevan 
 Department of Ophthalmology, Sree Gokulam Medical College, Thiruvananthapuram, Kerala, India

Correspondence Address:
Dr. K Mahadevan
Department of Ophthalmology, Sree Gokulam Medical College, Thiruvananthapuram, Kerala
India




How to cite this article:
Varghese VO, Nair TR, Mahadevan K. Postgraduate surgical training in ophthalmology.Kerala J Ophthalmol 2020;32:221-223


How to cite this URL:
Varghese VO, Nair TR, Mahadevan K. Postgraduate surgical training in ophthalmology. Kerala J Ophthalmol [serial online] 2020 [cited 2021 Apr 21 ];32:221-223
Available from: http://www.kjophthal.com/text.asp?2020/32/3/221/304540


Full Text



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“Fill the cup of joy with the nectar of pleasure and enjoy life, before you too into the dust descend”

- DR. K. Mahadevan

Although it probably takes more than a decade of excruciating hard work and a highly precise skill-set to get there, the evolving prospects in Ophthalmic surgery are still the most exciting and rewarding area of the subject for most practicing Ophthalmologists. Whether it is the prospect of granting the gift of clear vision to the masses or the enviable high obtained by working on the cutting edge developments such as the latest Lasers or Corneal transplants, surgery is for many, the pinnacle of ophthalmology. It always attracts the best and brightest doctors in training, almost all of whom have a certain level of assertiveness and confidence as hallmarks. A surgeon has to be constantly up to date in this ever-changing field, regularly unlearning outdated methods and absorbing newer techniques that develop alongside every recent innovation.

 The Learning Curve



From the beginning of PG training to the acquisition of the much coveted degree, it makes for around 3 years of theoretical study coupled with core surgical training. These surgically formative years are his years of self-discovery. Opportunity to learn from the very best hands, who rose within their surgical specialties entirely on the basis of their dexterity and finer skills, is often the main highlight of this training period. The interactions with such high caliber surgeons often rub off on a trainee kindling a newly discovered love for the surgery. The niche area of surgery one wants to further specialize in is something that an aspiring ophthalmic surgeon only zeroes in during his PG years.

 Gleaning the Basics



Many top tier colleges in the country have, since many years now, resorted to teaching their postgraduate students the functional structure and mechanism of human eyes on the samples of goats' eyes. Goat eyes [Figure 1] and [Figure 2] that are economically sourced from slaughter houses have evolved as a relatively simple and inexpensive technique to train budding ophthalmology surgeons, preparing them to get over their initial awe in doing surgical procedures on a human eye. It provides the opportunities to hone their surgical dexterity, depth perception, handling of the operating microscope and phacomachine by hands-on training [Figure 3]. Postgraduates are encouraged to use the Head-Loupe for better clarity and more magnified view, even during minor op-based surgical procedures so that their eventual transition to the Operating Microscope is made much easier.{Figure 1}{Figure 2}{Figure 3}

 Age of Simulators



Simulation is becoming hugely popular in every surgical field, with Ophthalmology being no exception. Technology-enhanced simulation training[1],[2] has been shown to have positive knowledge, skills, and behavior-related outcomes in budding surgeons which reflect positively on the patient-related prognosis. Although bed-side teaching using real patients is the more traditionally acceptable norm, especially in the medical specialties, this method is being increasingly replaced by simulator training. Without taking away from the true learning experience from real patients in the clinical setting [Figure 4], this change in the teaching paradigm has been largely made possible by the enviable technological innovations happening in this regard, factoring in the patients' comfort or time constraint in a busy OPD. The simulations [Figure 5] are good platforms for the surgical residents to practise and refine their surgical techniques without jeopardizing patient care and inviting unnecessary litigations. It is a dress rehearsal where mistakes can be made and lessons learned without compromising on the quality of care that can be ultimately delivered.{Figure 4}{Figure 5}

Various other forms of medical simulation such as wet laboratories [Figure 6], mannequins, cadavers, simulated patients, simulated hospital environments, simulated laser or surgical models, and virtual reality[3] are also being designed to enhance the postgraduate resident's learning experience.{Figure 6}

 The Japanese Influence



A novel and revolutionary eye surgery training system has been developed by a major Japanese Enterprise for teaching, practicing and mastering phacoemulsification, and other ophthalmic surgeries. They aim to replace animal eyes in surgical learning and comprises of three types of realistic simulation training kits. This includes the “Dry Lab” for learning instrument manipulation, and “Wet Lab” for learning phacomachine operations, before attempting to perform the actual surgeries. The recently developed “Multi Lab” seeks to improve surgical skills for difficult and complicated cases in phacoemulsification in addition to various other ophthalmic surgical techniques.

 The Proactive Initiative



A leading Indian Pharmaceutical company in joint effort with the Vitreo-Retinal Developmental Program hosts and houses many major training initiatives in the Ophthalmic “Centers for Excellence” pan India. This undertaking came into the fore for the first time as early as 2014, in the premier institution of Susrut Eye Hospital and Research Center, West Bengal. The continuing program provides a common platform to trained eye surgeons from all over India and even neighboring countries such as Bangladesh and Nepal for finessing their surgical skills and learning newer emerging techniques in the treatment of ocular morbidities. The key agenda of this 2 week long Skill-enhancement initiative is to render formal training to VR surgeons intending to shift from 20-gauge vitrectomy to micro-incision vitrectomy surgery, especially in the surgical management of the Diabetic Retinopathy cases that are currently on the rise. Such companies that serve as the prime resource of the vitrectomy surgical system and consumables for the learning also plays a key role financing these training programs, as does other nongovernmental organizations that support the surgery cost. By 2016, the initial Susrut program expanded their scope to other select Institutions such as Aravind Eye Hospitals at Coimbatore, Madurai, and Pondicherry.

Similar training programs are also being undertaken in Specialist Training Institutes, targeted toward enhancement of cataract surgical capabilities among practicing surgeons from the various parts of the world. The Phaco Development Program is one such initiative aimed at building up expertise in phaco-based procedures at the community level.

 The Aura of a Surgeon



The strength of all these educational training initiatives stems from the commitment and dedication shown by practicing eye surgeons to continue their learning curve, sharpening and further strengthening their surgical capabilities to ensure enhanced positive eye surgery outcomes for their patients.

If the prospect of such long years of study, unending training and re-training, with grueling hours of work and the onus of making split-second life-saving decisions fills you with excitement rather than the customary response of dread, you are definitely born to be a surgeon. The modern day surgeon is, therefore, without question an extreme machine, with life in it.

Acknowledgments

India's Vitreo Retinal Development Project : Providing Advanced Training to Retina Surgeons, Pravin U. Dugel, MD, American Society of Retina Specialists”Kitaro Surgical Training System” – Junsuke Akura, Kiran PokharelAlcon Laboratories, Karnataka, IndiaSree Gokulam Medical College, Venjaramoode, Thiruvananthapuram, Kerala.

References

1Alwadani S. Cataract surgery training using surgical simulators and wet-labs: Course description and literature review. Saudi J Ophthalmol 2018;32:324-9.
2Saleh GM, Lamparter J, Sullivan PM, O'sullivan F, Hussain B, Athanasiadis I, et al. The international forum of ophthalmic simulation: developing a virtual reality training curriculum for ophthalmology. Br J Ophthalmol 2013;97:789-92.
3Solverson DJ, Mazzoli RA, Raymond WR, Nelson ML, Hansen EA, Torres MF, et al. Virtual reality simulation in acquiring and differentiating basic ophthalmic microsurgical skills. Simul Healthc 2009;4:98-103.