Bucks Montgomery Physician Winter 2021 - 4

FEATURE

Senior and Neophyte Surgeons
can be trained to the highest standards of outcome success with
the use of up-to-date neuroscience research and modern training
by Steven B. Siepser, MD, FACS

I

mproved safety in surgery has taken giant strides in
the last decade. A constellation of developments in
neuroscience, sociology, robotic surgery, simulators,
and risk management has led to improved outcomes.
This comes at a good time with the demand for
ophthalmic surgical procedures growing ever greater
as the population ages. With 68 being the average
age for cataract surgery and 10,000 Americans turning
65 every day, cataract surgery volumes are rising. In
addition, more medical services are required after
retirement at higher frequency and cost.1 As demand
increases, so does the need to have senior surgeons
continue practicing and emphasizes the need to rapidly
increase the competency of younger surgeons.
Studies have shown that low volumes of surgical
procedures performed by older surgeons lead to poorer
outcomes.2 However, there seems to be no direct
correlation between age and competency. 3 Approximately
46% percent of physicians are 55 or older and the average
age of active licensed doctors is 51. 4 This is climbing with
even higher numbers of senior doctors in ophthalmology.
Younger surgeons lack experience and are not equipped
to identify problems early. They are late to recognize
complications and have fewer backup tools at their
disposal than more experienced surgeons. It has been
shown these young surgeons use multiple inefficient
movements compared to those with more experience.5
Those physicians faced with handling surgical
complications often refer their patients to more senior
surgeons due to their lack of experience and expertise.
We know that a minor misstep in surgery, rarely a result of
surgical incompetence, can lead to hours of counseling,
reconstructive surgery, difficult surgical challenges and

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winter 2021

long-term patient disability. It can also evolve into
financially fruitless medical litigation where everyone
loses, except the Plaintiff 's attorney. That is the subject
of another essay. So, it is clear that " no complications "
is " not complicated " and we have the technology
available to us today, we just must fund and use it!
What makes senior surgeons confident, consistent, and
safe? Why do young surgeons seem to look bewildered
yet sometimes solve challenging cases with brilliant
diagnoses? What can be done to address the very real
shortage of skilled doctors looming on the horizon?
Simulator and cognitive training have been shown to be
effective tools in expertly training young surgeons. For
example, the Wills Eye Hospital Residency Training
Lab is equipped with virtual reality training, giving
doctors experience with treating many conditions that
may take years to see in an actual operative setting.
Training such as this is akin to the sophisticated
flight simulators that can present multiple complex
scenarios to pilots in training. Using modern
OR simulators, various types of surgery can be
reviewed repeatedly, efficiently, and safely.
On the other end of the spectrum are new ways to
extend the " service life " of senior surgeons by studying
how aging affects their surgical skills. Training our
senior surgeons with devices that boost neurosensory
processes, cognition, and dexterity will allow them to
remain agile, adroit, and productive while prolonging
these doctors' years of utility and efficacy.
Bucks Montgomery Physician Winter 2021

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