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Main Themes and Key Ideas:
1. The Need for Innovation and Continuing Medical Education:
- Ivo emphasizes that the traditional paradigm of a formative stage followed by a purely executive stage is no longer sustainable in a constantly changing world. "We've realized, and it may seem like a cliché, but in such a changing world, anyone who isn't learning every day and taking the time to learn every day is lost."
- It highlights the importance of adopting new technologies to improve learning and adapt to advances in medical practice. «Using new technologies, eh, definitely with you we don't have that resistance to adapting to new things, no, and maybe we live a little in the future. Even though there are criticisms and maybe there is this, well, that existence that there are, really, new things.»
2. Resistance to Change in Medical Education:
- It is recognized that resistance to change is a natural phenomenon, both at a personal level (leaving one's comfort zone) and at an environmental level. «I think that resistance first we have to see it as something natural. Resistance happens to us 100%. In other words, we resist leaving our comfort zone a little because the comfort zone is literally designed so that as human beings we are in comfort, we are calm, there is not so much stress.»
- Ivo points out that this resistance manifests itself in the persistence of obsolete training methods. «In most countries, yes, except for these countries like Australia, the United Kingdom, some areas of Denmark, and some areas of Canada, we are still training. Someone trained 50 years ago, what is it? Let's go to the operating room, you see what I do, and then you come and copy what I did, that's it.»
3. The Transformative Power of Simulation in Ophthalmologic Education:
- Simulation is presented as a key tool to revolutionize surgical training. "I think the key here is to talk a little about my absolute passion, which is simulation—simulation itself, to which, if you add technology, it becomes even better."
- It allows learning through error in a safe and controlled environment. «Here I like them to make mistakes. I want them to break capsules. I want dialysis in a zonule. Yes, I want them to touch a retina and bleed. Yes, I want them to do a completely incorrect SLT and for the device to give them a low score saying, "Look, you weren't focused on the travé when shooting that." Why? Because let's see, no, I'm not going. I'm not discovering. Nothing new is this. We already know that adults learn from mistakes, not from success."
- Simulation, combined with mentoring, accelerates the learning curve and enables complex skills to be acquired more efficiently. «That's where I think technology comes in today, yes, virtual reality comes in, really, let me give you an example. Behind this wall we have two colleagues who are facing a complex cataract scenario... Imagine what it's like, they make an attempt, they have an objective score and they have a mentor next to them who is telling them, look, this happened, this happened, I passed this, back button. No, now this happened and this happened again, I mean, really think about what it's like in the learning process of a human being to have that.»
- It is inspired by high-security training models such as the aeronautical industry. «Basically, imagine if you think about it, I saw one that does things perfectly and I try to base myself on them every time I can, which is the aeronautical industry. Exactly, point. Exactly, point. point. And think about it, eh, it is the safest thing that we human beings do to transport ourselves. Why? Because that pilot, I know that he has a specific training, that he is advancing in his training, and every so often he has to go back and forth to a simulator and demonstrate competence to me.»
4. Challenges and Opportunities for Technology Adoption:
- Cost and access to technology are limiting factors, especially in Latin America. «I would tell you that being Latino and proud to be Latino with an origin in South America and now currently in Mexico for more than 10 years, I would tell you that the factors are going to be quite general and they are going to be shared. No, I don't see a factor that is more determining in Latin America than in others. But I can tell you one. Maybe it is a little local, it is a question of price, the issue of access to technology due to price, that is always a very limiting factor for one, not for Latin America.»
- Educators' lack of time due to clinical practice-based productivity models is a "blind spot." «The maximum factor is time, it's always a game, I always tell it, I call it the blind spot, why? Because it's a matter of time. Who are you going to be able to put in an educational environment that dedicates time to another person because the educator, and this happens even in the United States, which is a very structured university environment, even teachers don't have the time to give to their students, why because they earn based on productivity, so they have to produce to earn, and if I don't produce, I don't earn, so if I go to train someone, I stop producing. Therefore, the equation doesn't work, it doesn't work.»
- The need for a business model that values mentors' time in education is proposed. "What we've tried here in the most humble, authentic, and transparent way is to put a business model on education... We have to have a mentor who is happy here, eager to teach, and whose time is worth it. Therefore, there has to be a business model behind it."
- Mandatory simulation could be a way to boost its adoption, similar to what is being seen in Australia. «In Australia today a resident does approximately 600 to 700 cataracts during his residency. But that does not imply that he has to do the full simulation course to touch the first eye point. There is no discussion.»
5. The Impact of Artificial Intelligence (AI) and Robotics in Ophthalmology:
- AI has the potential to completely restructure the role of the ophthalmologist, especially in diagnosis. «What is coming from Artificial Intelligence absolutely restructures what it means to be an ophthalmologist today... I have a team that does what is called an eight in one... and guess what? It has an Artificial Intelligence tool that sees that retina and makes a better diagnosis than I do. It has superhuman capacity for the patient, something that I will never know in my life by looking at the fundus of the eye. So the entire diagnostic and therapeutic part, we will have this tool that does things better than we do, period.»
- Robotic eye surgery is advancing rapidly and could become a reality soon. «Horizon Surgical will soon be putting its first robots in different centers around the world to perform human surgery. No, many people see it as not being able to do so. In 5 or 10 years, I'll still have a job. That's happening, as we speak, period. In other words, they will be putting it in soon. eh, the eh, it's the robot that's already there. You can see it on YouTube. I can send you the link to what the Horizon robot that performs cataract surgery is like. Okay, so that's already happening.»
- While robotics offers precision and potential for increased efficiency, there are challenges in implementation, cost, and liability in the event of complications. «Are you going to tell me that a $1 million robotic surgery is coming with a $0 consumable for each procedure and it's going to leave us without work and it's going to be very difficult, very difficult because the problem is not only having good outcomes and having all the perfection and being faster but it's also a problem of implementation... What happens if a surgery doesn't go the way you want there's an abort button And who's going to do that surgery Who's going to be responsible for that complication I ask myself that.»
- AI and robotics set a new standard of excellence, forcing surgeons to continually improve. «I am also motivated by this, you know what motivates me is that we surgeons have an eh And I'm not going to call him an enemy But let's call him someone who is going to score a standard goal against us and is going to force us to be better.»
6. The Importance of Developing "Human" Skills in the Age of Technology:
- In the face of technological advancement, the surgeon's psychomotor, cognitive (decision-making and problem-solving), and especially mental and emotional skills will continue to be crucial. «We talk about a surgeon, no matter what specialty, and we artificially divide it into three areas, we don't talk about the psychomotor part... we talk about the cognitive part... but what we do have to learn about robotics... is the mental part of what it means to be a surgeon, not really, that is the emotional and mental component and how we should master that component.»
- The need for cyclical retraining to maintain and improve skills is emphasized, similar to models used in other fields such as the defense forces. «It wouldn't be something that couldn't be demonstrated either, that you would be doing retraining every so often, for example in the Israeli Defense Forces. Although you are no longer in official service for one month a year until you turn 45 or 47, you go to train again and you keep up to date with the skills they need because, well, you see that the 9 million are soldiers but they have to keep their skills up to date. So how do they do that, cyclical retraining?»
7. The Scientific Method as a Driving Force of Medical Advancement:
- It is argued that evidence-based medicine and the scientific method are fundamental to progress, allowing for the informed evaluation and adoption of new techniques and technologies. «I think that's where the issue lies. I think it's the other way around. I think evidence-based medicine and the scientific method are the most powerful things to move forward, not the other way around, to say this was published 20 years ago, let me give you another example, sorry, but these things are very practical, fantastic. I mean, you take my cell phone, okay, and we're going to look at this application here called... iol evidence... it means that it's telling you that the paper has this validity based on what science is. I mean, we're living in the best time in history, we're seeing what is valid, what is not valid.»
Ivo's Final Reflection for his Past Self (R1):
- It would focus on developing critical thinking, collaborative skills, creative thinking, and communication skills as fundamental pillars in an era of rapid technological transformation. «If I saw myself in another stage, I would first tell myself what we have just discussed: pay more attention to critical thinking. Where is the quality information? How do I access it and how do I apply it? In other words, the scientific method would put more emphasis on the collaborative part of medicine? How to collaborate… creative thinking… and this one that fascinates me too, which is communication, the skill of how to communicate with your patients, with your colleagues, but also how this communication works. This would even tell you about the general or social level of what one does.»
This document provides an overview of the challenges and exciting opportunities that technology presents for the future of ophthalmology medical education, with "Oftalmo University" as an example of an innovative initiative in this field. End of form
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