August 2020


YES Connect
Residents back in the OR

by Liz Hillman Editorial Co-Director

Residents practice in the wet lab prior to the COVID-19 pandemic.
Source: Jeffrey Goshe, MD


Studies have already started to be published on how the pandemic is affecting surgical training and education for the next generation of doctors. Its effect on the medical profession and trainees will no doubt continue to be researched.
Jeffrey Goshe, MD, said the Cleveland Clinic is looking at outcomes before and after the pandemic among all of its ophthalmologists, including residents. Anecdotally, he has found that it’s like riding a bike for residents coming back into the OR.
Elective surgery at the Cleveland Clinic was halted for approximately 8 weeks between March and May. During that time, when urgent surgeries were taking place, Dr. Goshe said personnel in the OR was limited, which prevented some residents and fellows from participating or even observing.
“For the second and third years, they missed out on 15–20% of their volume,” he said.
When elective surgeries returned, Dr. Goshe said, “The residents barely missed a beat. They came back in and were performing anterior segment surgery with minimal or no regression. They were impressively good.”
If anything, Dr. Goshe said residents might have been a tad slower than usual. He noted that most of his residents had already performed at least 200 cataract surgeries when COVID-19 hit. He speculated that if this had happened earlier in their training, they might not have picked surgery back up so easily.
When all surgery was stopped, Dr. Goshe said the onsite wet lab was opened up for extra days to allow residents to book more time to practice surgical maneuvers using animal eyes, synthetic eyes, and virtual simulation technology (Eyesi, VRmagic) the clinic instituted several years ago.
“I think surgical simulation as a training tool is valuable as a part of training preparation. It does a good job at replicating certain elements of surgery, things like the depth of the anterior chamber and giving immediate feedback about whether you’re going too high or too low, training that depth perception. It also gives an objective assessment of quantitative variables such as capsulorhexis uniformity and surgical efficiency.”
What virtual simulation doesn’t do is totally recreate the tactile, hands-on feeling of working in an eye with fluidics.
“It’s a different experience when you have an actual human or animal eye,” Dr. Goshe said.
Virtual simulation also doesn’t address the nuances of different surgical equipment made by different companies, such as the different phacoemulsification platforms, he said.
There have been improvements in surgical simulation in the last decade, Dr. Goshe continued. But to get to something that would replace non-virtual, all-hands-on equipment, actual ophthalmic surgery itself would have to become more automated or virtual. Dr. Goshe mentioned doing surgery off of a 3-D display vs. looking through microscope oculars as an example.
“I have no doubt it will keep getting better, and I would not be shocked if within a decade most ophthalmic surgery is ‘virtual,’ with surgeons relying on external displays or augmented reality rather than traditional operating microscopes. … The further we get away from microscopes, the more natural it will be to have training virtually,” Dr. Goshe said.
Overall, Dr. Goshe said the pandemic has shown that residents were able to handle the situation better than he thought.
“We haven’t seen the full effect—there is still a full class of residents and fellows who are likely to be more impacted by this—but I think that with using these platforms (surgical simulation and wet laboratories) as a way to maintain skills, early experience has been that residents have adapted well, and I think time will bear that out. From what I’ve seen, they’ve handled it beautifully.”

About the doctor

Jeffrey Goshe, MD

Residency program director
Cole Eye Institute
Cleveland Clinic
Cleveland, Ohio



Relevant disclosures

Goshe: Dompe

Residents back in the OR Residents back in the OR
Ophthalmology News - EyeWorld Magazine
283 110
220 137
True, 8