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Main Themes and Key Ideas:
1. The Need for Innovation and Continuing Medical Education:
- Ivo stresses that the traditional paradigm of a training stage followed by a purely executing stage is no longer sustainable in a constantly changing world. “We've realized, and it may sound like a cliché, but in such a changing world, I mean, whoever isn't learning day by day and taking the time to learn day by day is lost.”
- He highlights the importance of adopting new technologies to improve learning and adapt to advances in medical practice. “Using new technologies, uh, definitely with you we don't have that resistance to adopting, um, new things, right, and maybe living a bit in the future, even if there's criticism and, and maybe there's, um, well, that existence there is, right, toward new things.”
2. Resistance to Change in Medical Education:
- Resistance to change is acknowledged as a natural phenomenon, both on a personal level (leaving one's comfort zone) and at the level of one's environment. “Resistance, I think first we have to see it as something natural; resistance happens to 100% of us, I mean, you resist stepping a little out of your comfort zone because literally the comfort zone is designed so that we as human beings are comfortable, calm, without so much stress.”
- Ivo points out that this resistance shows up in the persistence of outdated training methods. “In most countries, yes, except, um, countries like Australia, the United Kingdom, some areas of Denmark and some areas of Canada, uh, we're still training the way someone was trained 50 years ago, which is: we go to the OR, you watch what I do, and then you come and copy what I did, and that's it.”
3. The Transformative Power of Simulation in Ophthalmic Education:
- Simulation is presented as a key tool for revolutionizing surgical training. “I think the key here is to talk a little about my absolute passion, which is simulation, simulation itself, and if you add technology to it, it's even better.”
- It allows learning through error in a safe, controlled environment. “Here I like them to make mistakes. I want them to break capsules, I want them to cause a zonular dialysis, yes, I want them to touch a retina and make it bleed, yes, I want them to do a completely incorrect SLT and have the machine give them a low score saying, look, you weren't focused on the trabecular meshwork when you fired that. Why? Because, look, no, I'm not discovering anything new; we already know that adults learn from error, not from getting it right.”
- Simulation, combined with mentoring, accelerates the learning curve and makes it possible to acquire complex skills more efficiently. “That's where I think technology comes in today, yes, virtual reality really comes in. Look, let me give you an example: behind this wall we have two colleagues facing a complex cataract scenario… Imagine what that is: they make an attempt, they get an objective score, and they have a mentor beside them telling them, look, this happened, this happened, this happened, back button, no, now this happened and this happened, again. I mean, really think about what it means in a human being's learning process to have that.”
- It draws inspiration from high-safety training models such as the aviation industry. “Basically, imagine, if you think about it, I looked at one that does things perfectly and I try to model myself on them whenever I can, which is the aviation industry. Exactly, period. Exactly, period, period. And, and think about it, uh, it's the safest thing we human beings do to get around. Why? Because that pilot, I know he has specific training, that he keeps advancing in his training, and every so often he has to go back 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'd tell you that, being Latino and proud to be Latino, with roots in South America and now in Mexico for more than 10 years, uh, I'd say the factors are going to be fairly general and shared; no, I don't see a factor that is more decisive in Latin America than elsewhere. But I can tell you one that is maybe a little local: it's the issue of price, access to technology because of price. That is always a very limiting factor for a, no, for Latin America.”
- Educators' lack of time, driven by productivity models based on clinical practice, is a “blind spot.” “The biggest factor is time, it's always a balancing act. I always tell, I call it the blind spot. Why? Because it's a matter of time. Who are you going to be able to bring into an educational environment who will devote time to another person? Because the educator, and this happens even in the United States, which is a very structured university environment, even the teachers don't have time to give 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'm going 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 put forward. “What we've tried to do here, in the most humble, authentic and transparent way, is to put a business model behind education… We need a mentor who is here, happy, eager to teach, and whose time is valued. Therefore, there has to be a business model behind it.”
- Making simulation mandatory could be a way to drive its adoption, similar to what is seen in Australia. “In Australia today a resident does approximately 600, 600 to 700 cataracts during residency. But that doesn't mean he has to do the full simulation course to touch the first eye, period. There's no discussion.”
5. The Impact of Artificial Intelligence (AI) and Robotics on Ophthalmology:
- AI has the potential to completely restructure the ophthalmologist's role, especially in diagnosis. “What's coming with artificial intelligence absolutely restructures what it means to be an ophthalmologist today… I have a device that does, it's called an eight-in-one… and guess what, it has an artificial intelligence tool that looks at that retina and makes a better diagnosis than I do; it has suprahuman capability about the patient, something I'll never in my life know from looking at a fundus. So for the whole diagnostic and therapeutic side, we're going to have, um, a tool that does things better than we do, period.”
- Robotic eye surgery is advancing rapidly and could become a reality in the short term. “Horizon Surgical will soon be placing its first robots in different centers around the world to perform human surgery. A lot of people see it as, no, within 5 or 10 years I'll still have work. That is happening as we speak, period. I mean, they're being installed soon, uh, the, uh, it's the robot that is most, you can see it on YouTube, I can send you the link to what the Horizon robot that performs cataract surgery looks like. Okay, so that's already happening.”
- While robotics offers precision and the potential to increase efficiency, there are challenges in implementation, costs and liability in the event of complications. “You're going to tell me that a 1-million-dollar robotic surgery is coming with a consumable of 00 per procedure and it's going to leave us without work, and that's very difficult, very difficult, because the problem isn't only having good outcomes and all the perfection and being faster, it's a whole implementation problem… What happens if a surgery doesn't go the way you want? There's an abort button, and who is going to go do that surgery? Who is going to be responsible for that complication? I ask myself that.”
- AI and robotics set a new standard of excellence, forcing surgeons to keep improving. “It actually motivates me, you know, it motivates me that we surgeons have a, uh, and I won't call it an enemy, but let's call it someone who is going to set a gold standard for us and force us to be better.”
6. The Importance of Developing “Human” Skills in the Age of Technology:
- As technology advances, the surgeon's psychomotor and cognitive skills (decision-making and problem-solving), and especially the surgeon's mental and emotional skills, will remain crucial. “We talk about a surgeon, no matter what specialty, and we, we divide it artificially into three, into three areas, right: we talk about the psychomotor part… we talk about the cognitive part… but what we really should learn from robotics… is the mental part of what being a surgeon involves, really, that is the emotional and mental component and how we must master that component.”
- The need for cyclical retraining to maintain and improve skills is emphasized, similar to models used in other fields such as defense forces. “Nor would it be something undemonstrable to do retraining every so often. For example, in the Israeli Defense Forces, even if you're no longer in official service, one month a year until you turn 45, 47, you go train again, and, and you stay up to date with the skills you need, because, well, there, you see, the 9 million are, are soldiers, but they have to keep their skills up to date. So how do they do that? Cyclical, cyclical retraining.”
7. The Scientific Method as a Driver of Medical Progress:
- It is argued that evidence-based medicine and the scientific method are fundamental to progress, allowing new techniques and technologies to be evaluated and adopted in an informed way. “I think that's where the, the issue lies; I think it's the other way around: I think evidence-based medicine and the scientific method are the most powerful thing for moving forward, not the other way around, as in saying 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 phone, okay, and let's look at this app here called… iol evidence… which means 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 and what isn't valid.”
Ivo's Final Reflection for His Past Self (R1):
- He would focus on developing critical thinking, the ability to collaborate, creative thinking and communication skills as fundamental pillars in an era of rapid technological transformation. “If I saw myself at another stage, I'd tell myself, first, what we just discussed: pay more attention to critical thinking. Where is the quality information, how do I access it and how do I apply it, I mean, the scientific method. I'd put more emphasis on the collaborative side of medicine, how to collaborate… creative thinking… and, um, this one that also fascinates me, which is communication: the skill of how to communicate with your patients, with your colleagues, but also how to, um, communicate, I'd even say at a general or social level, what you do.”
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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