Lecture: Pearls on Giving Wonderful Training to Residents

In this presentation, Dr. Brian Leonard explains the general rules that need to be followed while mentoring young colleagues.  He shares examples from his experience and sheds light on the practices he followed while working with younger doctors.

Lecturer: Dr. Brian Leonard


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DR LEONARD: So good morning, everybody. So this is a talk that Orbis has asked me to do in the past, and some people think it’s a silly talk. But I think it’s a strong talk. And I wish when I was young somebody had given me this talk. So it’s really a talk about how to have a career in ophthalmology that is most effective and most enjoyable. Now, many of us will be in ophthalmology with a salary, and many of us will be in ophthalmology where we’re compensated for the number of patients we see and the things we do. So I’m in a situation where I’m not salaried. I’m paid for the work that I do. With each patient. So in my clinics, if they get too busy, it’s not the residents’ fault. Not the fellows’ problem. It’s my problem. So this is where I work, at the University of Ottawa Eye Institute. And every morning, we go in, we can’t wait to get there. We go marching into work. Because it’s fun. And we work with amazing colleagues. Amazing teams of special people. And we work with incredible technology. And every day, we restore sight to blind human eyes. And we research ways to do it better. And we mentor others to do it. So other people we know in our lives — if they had an opportunity once in their life to restore sight to a blind eye, it would be a highlight of their life. And we have the pleasure of doing this every day. How do I advance it? So this is a person that you’ve met in the last couple days. And this is my wife of 52 years. And my profession is very important to me, but not as important as her. I have balance in my life. And my work is very important, but not as important as these people. So we have five children and eight grandchildren. So you balance the life. You love your profession. You love your family. I’ve done many things with Orbis. For 35 years, I’ve been involved with Orbis. And so I have a commitment to Orbis. I’m committed. It’s in my heart. So I’m a member of the International Board of Directors. I was the founder of the Medical Advisory Committee. And I founded and chaired an affiliate board in Canada. What does an affiliate mean? Good question. It’s a junior board. Yeah. A local board in Canada. For Orbis Canada. And along the way, I’ve had many, many interesting experiences, because of Orbis, that I would never have done in my life. So this is just an example. This is ringing the opening bell at the New York Stock Exchange. You see this on CNN. And I’m there with Richard Branson, the Prime Minister of Ethiopia, the head of FedEx, people like that. And it’s fun. But this is where I have lots of fun, in the Eye Institute. And one of the most — that gives me the most pleasure is mentoring the young doctors. And we mentor them in the clinic. We mentor them in the operating room. We mentor them with lectures and teaching and presentations. And here on the right we mentor them in our research labs. And this doctor here on the right — we’ve just finished an operation on a little cat. Kitty. Kitten. Yeah. On the cat. Yes. Yeah. Yes. But not a therapeutic operation. A research operation. And I’ll show you some more of the research later. How vital and important it can be to having a happy and balanced career. And this is a resident here who’s very interested in it. Who’s got his arm around me. He likes me. He’s got his arm around me. And he respects me, and I respect him. And that morning, I had asked him five times to pull his mask up over his nose. And his mask is still down. And we mentor another interesting thing — is mentoring young people, mentoring the careers and the experiences of young people around the world. In India, in Pakistan. In Danang. Danang, Vietnam. In Paraguay. In China. So when I get home, people ask me: How many operations did you do? And that’s not the correct question. The question is: How many young doctors did you mentor? And here this picture in China — this was a couple years ago. We mentored a lot of people. And that’s the magic of Orbis. The magic of international development. Now, here are some pearls. Pearl number one, or suggestion number one. Okay. Honor the trust of your patient. The patient is not two eyes that walked in your clinic. The patient is a fellow human. With a sickness. And they trust you. Now, this man trusts me. He’s in the operating room. And he’s awake. He’s in a strange situation. He has a blind eye. So he trusts me. But even in the clinic, this is a woman who’s come to get a needle in her eye. An anti-VEGF needle in her eye. So she’s sitting in the clinic. She’s not sedated. She’s wide awake. And I’m gonna tilt her back in the chair and stick a needle inside her eye. So she trusts you. And there’s the needle going in her eye. She’s awake and not sedated. So… She trusts me. So… Honor that trust. She trusts me. It’s an honor that she trusts me. It’s an honor. So I honor her. And every time I know this is a person. Not an eyeball. It’s a person. Who is displaying an enormous amount of trust. The second pearl is: Always be nice. And don’t forget this. Yeah. It’s very important. You heal people. You treat people. They trust you. Be nice to them. And be nice to them even if they’re not nice to you. She’s not nice to me. But I’m nice to her. And sometimes there are patients who treat you so mean, or so rude to you, and I just… I smile and I’m nice to them. And before too long, they respond. And then your practice is much happier. There’s harmony. I mean, this little girl — you just wanna smack her. But, of course, you don’t. You be nice and kind and gentle. And that is… We all took the Hippocratic Oath. And we’re nice to them in the way we treat them. The surgical safety checklist is very important. The informed consent is very important. Surgical safety checklist. It’s vital. So when I entered the practice as a vitreoretinal surgeon in 1976, I made a pledge to myself. I pledged that I would treat my patients with dignity. That I would not cheat with my billing. That I would never, ever operate the wrong operation on the wrong body part on the wrong person. So from the day I entered practice, I had my own surgical safety checklist. And part of this is because I’m also a pilot. And pilots are very big on checklists. Yeah. There are a lot of similarities between aviation and medicine. And one of those is harmony in the team. And everyone in the cockpit and everyone in the operating room has a responsibility to question any decision that’s made by anybody else. So another pearl is: Always be careful. So every time I see a patient — when I was seeing patients in your hospital the other day, every time a patient comes, I say to myself: Be careful. So this is a patient that I saw in the clinic. And it was seen by a retina fellow. And the fellow wanted to see many, many patients. See one patient, quick. See another patient, quick. See another patient, quick. So I said to him — this is a Valsalva hemorrhage. So I said — is there any other pathology in the eye? And he said no. And so I said… Well, what’s this? That chorioretinal scar. It’s right next to what he was focusing on. He was so focused on that, that he didn’t see that or pay attention to it. And another fellow — we were doing a case together in the clinic, and I said — is the patient phakic or pseudophakic? And he said — one or the other. So we went into the chart, and the patient had had cataract surgery three months before. And his name was on the surgical report. And there was also vitreous. So… And he didn’t even know that when he presented the patient to me. He was in a hurry. So I said… Look. If the clinic gets busy, that’s my fault. You just take your time with every patient. Do your best. And here’s another. This was a colleague in another city. Was doing an Ozurdex implant. And the patient came to me. And there’s the Ozurdex. Is the Ozurdex supposed to be there? So from right here, onto the right, that Ozurdex is in the lens. In the crystalline lens of a young woman with uveitis. So there were two things. The colleague who did this was not careful. It should not go anywhere near the lens. And then… And then the colleague inspected it with the slit lamp and did not — just quick look — did not notice it was in the lens. So… This patient had trusted my colleague to do a good job. Yeah. Yeah. There was lots of trust. But the trust was not honored. So the people that I’m mentoring — I encourage them to take a case, to take a chart, and open it like a birthday gift. And enjoy the chart. Enjoy talking to the patient. Enjoy talking to the family. Because it’s not a pair of eyes. It’s a person. It’s a human. And everybody loves a birthday gift. And that’s what I look like, every time I see a new patient. And we have fun with the patients. They know we’re very, very serious, but they know that we enjoy seeing them. Pearl number three: Honor the trust of your colleagues. This is a young man who’s a graduate from a very good university, a very good medical school, who chose to do his four years of eye surgical training with us. And he had a lot of opportunities. But he chose us. So he trusted us. And we honor that trust. We treat him with dignity and respect. And some humor. And that’s in the operating room also. We honor our colleagues in the operating room. So in the operating room, everybody knows that I am the surgeon. I am the surgeon. I’m the leader of the team. They know that. But they also know of my respect for the team and harmony of the team. I involve them in advance in the case. I show the photos. I show the images. The OCTs. The fluorescein. I tell them a bit about the patient themselves. What they do. What job they do. So, you know, the nurses and the anesthetists, they just want to get the job done. Just another eyeball came in. But it’s not another eyeball. It’s another human. So… For example, on the scrub nurse’s setup, the scrub nurse’s tray… I would never ever reach and take something off their tray. I would never do that. That’s their job. Their responsibility. And I honor their responsibility. And I would never be mean or say something mean to them or get mad at them. Never get mad at them. If there’s something you want to say to them, say it really nicely or talk to them later in private. And I involve them in decisions. If a patient comes in, and there’s a latex allergy, so we talk to each other — do you think this is a real latex allergy? And we discuss it. And then make a decision together. To cancel a case or take special precautions. This is — you remember Brad Pitt? You recognize him now? This is an ophthalmologist from Palestine. In Israel. Yeah. And he spent two years doing retina surgical training with us. And this was taken on his last day, at the end of the last operation. So at this point, it was very sweet. So he knew that I knew… And I knew that he knew… That in his two years, he had become a better surgeon than me. And that is the greatest honor that a mentor can have. To mentor someone to be better than them. We stay in touch with each other. We text. We email. As we will. So this is in Hanoi, in November, 2004. Do you recognize anybody here? Yeah. And so there have been a group from San Francisco that had come to Hanoi, to the National Institute of Pediatrics. And they started a NICU, a neonatal intensive care unit. So at this point, they were saving children up to 1200 grams. And this was new in this country. Before that, everyone who was premature, they either survived or did not survive. So what happened here is that suddenly, at this time, there was ROP in Vietnam. And there had never been ROP. And the people from San Francisco had not accounted for that. So Orbis got involved right away. And we took ophthalmologists from your center, at the National Institute of Ophthalmology, and we brought them to America, to Canada, and to Carolina. And we gave them training in the diagnosis and management of ROP. And we found that the hardest part was not getting the ophthalmologists on board. It was getting anesthesia on board. Because you come with a little baby, a little person this big, for an anesthetic, and the anesthetists hide behind doors, hide under beds, run away. So we brought six anesthetists from Hanoi to Canada. And we gave them each a six-month course in neonatal anesthesia, and Canada donated two neonatal anesthesia machines. So you know I haven’t changed at all since 2004. Right? But he has. He is a little bit older now. But this guy still looks young and still has all his hair. And they’re friends, and we’re in touch. And now these are some of your colleagues here. This is on the Flying Eye Hospital in 2015, in Hanoi. And they’re amazing people. They call me “Grandfather”. And they’re very focused. And they’re very good. Yeah. So, of the people in the picture, which one of these people is the most precise, most gifted ROP surgeon? Not him. Her. Yeah. So respect your colleagues. Okay. And my colleagues. The nurses in the operating room. Every year, I take them out for a dinner. And we have a slideshow. A slideshow from work, slideshow of baby pictures when they were small, that I got. Slides. Like this. A slideshow. And we have fun. Lots of fun. My wife says too much fun. You recognize all those people. Yeah. And this was the International Board of Directors, 15 years ago, of Orbis. And this was the founder of Orbis. So there’s always room for fun. So he’s dead. He’s dead. He’s dead. He’s dead. He’s retired. He’s retired. I’m the last soldier standing. And this is the board later on. Much more serious. And some of the most wealthy and powerful and influential people in the world are on this board. For example, this man here is the Chief Executive Officer of Boeing Aircraft. 68% of all the airplanes flying in the world he makes. So embrace advancing technology. Very important. This is your life’s work. Your life’s work. And there’s lots of different ways to do this. Do you use the BCSC American Academy books? 15 volumes? Yes. Okay. Yeah. Well, I’m involved with that. It’s the most popular textbook in ophthalmology and vision in the world. And I’m on the committee. And it’s hard work. And there’s no pay. But I do it. As a responsibility to my profession. Don’t say it. Don’t say it. Don’t say it’s too expensive. It’s a bargain. It’s a real bargain. And if anybody needs it and they can’t afford it, I give them a digital copy. So the Ophthalmology Journals. You have to read the journals. You have to get them digitally or get hard copies. Get them to your university. Get them wherever you can get them. And I read a lot of journals. But these are ones I look at. I look at the journal every month. The American Journal. Ophthalmology. The Archives. The Canadian Journal. And Retina. And now the American Society of Retina Specialists has a new journal also. So read your journals and discuss with each other. Try to be better than the other one is. And talk about it. And the American Academy of Ophthalmology has lots of opportunities for mentoring. The ONE Network is awesome. And the OKAP exams we take every year. Do you do the OKAP exams? You should consider it. Because you get a bargain if you live in Vietnam. And it’s not expensive. And it measures your level of achievement and compares it to your colleagues. Worldwide. So now I’ve created a monster. They’re gonna curse me doing the OKAPs. And the American Academy of Ophthalmology has these preferred practice pattern manuals. And the American Society of Retina Surgeons has lots of really interesting things, including their new journal. I understand. I understand Vietnamese. Yes, yes. Cybersight is a very useful tool for you. Very useful. Yes. It’s unique and it’s useful. And it’s free. The wet lab. Do you have a wet lab here? You do have a wet lab? So this is our wet lab. And it was organized by Dr. Burmann, who’s an IOP specialist. Glaucoma specialist. A glaucoma specialist. And it’s very well organized. And it’s structured. And there’s a curriculum. And not only him, but the cornea people come in. The other people come in. And it’s very well equipped. And you can do it digitally as well. There’s a digital mentoring device there. And these are some of our colleagues. And here’s a colleague you may recognize right there. He’s sitting right there. So she’s the chief resident. She’s mentoring a younger resident. They’re all part of the team. So you need hands-on training on human eyes. That’s necessary. You cannot be an ophthalmologist if you don’t have that. But it is so valuable if part of your learning curve is just with electrons or on non-real or animal eyes. And it’s structured. And they’re graded on it. And it’s competitive. And we have one on Orbis as well. Another thing with developing technology is things — interesting things like 3D printing. And with 3D printing, you can use anything for paper and anything for ink. You know, ink on paper. For printing. So with 3D printing, you don’t need paper and ink. Your paper can be any material, and your ink can be any material. And you can make interesting things. Like this gentleman made an image of his own funny-looking face. Or you can make very intricate things. And you can also make human tissues. Body parts. And another thing. Optogenetics. A very fascinating subject. You should all know about it. You should all know about it. As part of your development, part of your growth, as somebody who’s gonna spend their life doing ophthalmology. So embrace innovation and scientific inquiry. Get involved in research. And this is our animal lab. And we have an operating room at our university next door, connected by tunnel. Because when it’s freezing and white in the wintertime, it’s nice to have the tunnel. And we have it set up to do vitreous surgery. And we have a cat model for retinal detachment, where we purposefully detach the retina with a gas bubble. And we inject a genetic cocktail under the retina, for neuroprotection. A special mixture. Yes. A special mixture of genetic material. Under the retina. To preserve… Yeah. And we treat these animals with dignity and respect. They’re carefully monitored. And they’re comfortable. This is for your balance in your career. You’ve got your whole life in front of you. And we all know people who just go in to work and work, work, work, work, work. Make as much money as they can, see as much patients as they can, and that’s good, but the happy people, the really content people, balance it. With their work, their family, with research, with teaching, mentoring. So I pass the challenge to you. Yeah.

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May 16, 2017

Last Updated: October 31, 2022

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