Residents' perspective on phaco

Cataract surgery using phacoemulsification is perhaps the most important surgical procedure that ophthalmology residents learn during their 3 years of training and is the "bread-and-butter" procedure for practicing ophthalmologists. It goes without saying, therefore, that the entire ophthalmologic community should do its best to ensure outstanding training for the next generation-this usually requires both adequate surgical volume and excellent supervision by the attending surgeon.

Balancing this, of course, is patient safety and the risks of complications, as Dr. Hu's study emphasized. No patient wants to be some young surgeon's "first" patient. As Dr. Aravind points out, formal instruction in the wet lab is a vital and effective way to teach new techniques to trainees. Furthermore, structured feedback from the attending is a constructive way for a resident to improve what he/she is already doing well, and learn from and change technique for the steps done incorrectly. We would further offer that assisting skilled attendings in the operating room is an important, and often under-utilized, ingredient to any successful surgical training program.

In the coming years, we suspect the use of technology will play an increasingly important role in resident training. For example, a virtual reality type of simulation, with life-like tactile feedback, would certainly be a wonderful teaching tool. These technologies will be important not only as teaching tools, but also for the documentation of competency required by the Accreditation Council of Graduate Medical Education and the American Board of Ophthalmology. Until these types of technologies are widely available at low cost, the wet lab, assisting in the operating room, and careful feedback from the attending are excellent ways to strengthen resident surgical training.