Dr Jai Shankar
The vast majority of ophthalmic surgery is performed under local anaesthesia and patients may be acutely aware of conversations that take place in theatre. Therefore, if the patient knows that the operation is being performed by a trainee surgeon, it is understandable that they may feel additional stress. The success and ease of performing surgery requires both the trainee and the patient to feel relaxed. A key part of ensuring this is effective communication between the supervisor and trainee.
For example, during cataract surgery, my new trainees operate in a reverse modular fashion, starting with the last steps of surgery first. Performing each step repeatedly allows the trainee to build confidence in a particular step before proceeding to the next. Whilst I would have already discussed with the trainee which steps they would be expected to perform, it often becomes necessary to guide the trainee during surgery as well.
As such, it is desirable to have some form of coded communication between the supervisor and trainee. There is no one, absolute correct way, but it is imperative that both the supervisor and the trainee understand each other. It is also important that the supervisor’s statements or comments are not patronising or demoralising but at the same time clearly indicate when the trainee’s actions need modification.
LET ME HELP YOU
When I provide specific instructions, for example “hold the instrument horizontally”, it implies that I am happy for the trainee to proceed but keep in mind my suggestion. However, when I feel that the trainee is struggling or has had a complication which they may be unable to handle, I use the phrase “Let me help you” to indicate that I wish to take over. In using these words, I neither discourage the trainee nor alarm the patient under the drape, thus allowing for a smooth change of hands. I never say “stop”, nor use any expletives or unprofessional language.
Theatre personnel talking to each other with reference to matters unrelated to the surgery being performed must be avoided. One must also be particularly vigilant about discussing other patients and the resultant risk of breaching patient confidentiality.
Equally important is debrief at the end of surgery. Video recording of surgery and reviewing it at the end of the list gives the supervisor and trainee an opportunity for critical appraisal to discuss what went well and how things could be improved.
Dr Jai Shankar is Consultant Ophthalmologist at Wrexham Maelor Hospital, United Kingdom
Jai Shankar: shobitha_jai@yahoo.co.uk
