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Unlocking New Frontiers of Knowledge GenEye’s New Gen Surgical Training

Built on the concept of learning in new, different, and collaborative ways, GenEye 2023 presented a unique, immersive, and experiential conference. Dr Rogan Fraser explains.

In high school we read works by three of the great modern Latin American authors: Gabriel Garcia Marquez, Isabel Allende, and Jorge Luis Borges. My favourite story was The Library of Babel by Borges. With it, he creates a labyrinthine universe of knowledge: an enormous library housed in a sprawling expanse of interconnected hexagonal chambers within which all of the books that ever were – and ever will be – are contained. But to the untrained (unwilling?) mind, it exists as just a bewildering symphony of language. An alphabet soup of endless possibilities, with learning beyond the reach of those not utterly dedicated to parsing the incomprehensible, from the utterly vital.

The message, I believe, is that our world is full of infinite possibilities, and while our capacity for comprehension is not limitless, the best of the human condition urges us on to understand mysteries that seem to lie just beyond our grasp. A ‘growth’ mindset, if you will.

As health professionals we make a commitment to engage in continuous learning. Perhaps though, the guardrails of comfort keep us from challenging ourselves in important ways when it comes to this ‘lifelong’ education. Professor Carol Dweck coined the terms ‘fixed’ and ‘growth’ mindsets to describe how people view the acquisition of abilities. It is far beyond the scope of this article (and, indeed the expertise of this writer) to deep dive into this paradigm, but suffice to say that it definitely underpinned the aspirations of Dr Jacqueline Beltz when she created GenEye on behalf of Eye and Ear Education.

Simply, Prof Dweck describes those individuals with a growth mindset as seeing skills and abilities as being derived and honed through continuous deliberate practice. In the pursuit of these skills, individuals with a growth mindset readily embrace challenge, see failure as progress, and use critical feedback as a springboard for innovation and change.

While I was fortunate enough to be adopted into the GenEye faculty this year, the genesis and genius of both the concept and the conference, predates me by years. And so, though I come at this with some degree of inside knowledge, this is more a view from the ‘cheap seats’ than it is a peek behind the curtain. I give you: GenEye 2023 – the post-COVID redux.

A Unique Experience

GenEye 2023 was held across three days in Melbourne in May. As far as conferences go, GenEye is a unique experience. It is proudly immersive, energising, and interactive. There is no didactic component.

No lectures. Learning is peer-to-peer. This approach provides distinct advantages, including the pragmatic advantage of a years’ worth of interactive continuing professional development (CPD) points for optometrists, and category 2 CPD points for ophthalmologists. Each day’s attendees were new. Day one was dedicated to inspiring and leveraging the fervent minds of our colleagues so vital to surgery but removed from it by mere degrees. On this day medical students, junior doctors, orthoptists, and one optometrist embraced the various activities. On the second and third days, consultant ophthalmologists from Auckland, north Queensland, Sydney, and of course Melbourne, were joined by local trainees. The morning consisted of three stations: virtual reality surgical simulation on the EyeSi, a simulated patient consent station, and a ‘high performance’ station with experienced clinical and coaching psychologist, Dr Jo Mitchell.

Amid it all, I stood with my colleagues on the top floor around the EyeSi surgical simulators that buttressed my own introduction to intraocular surgery. The foundations of the technical skills of surgery that I now possess were honed on two of these very machines. But as well as those skills, the day was more about some of the non-technical skills or, as we like to say at GenEye, the “mind skills”: communication, collaboration, adaptability, and resilience. Consultants watched as their registrar colleagues created a virtual rhexis with some of its edges uncomfortably close to the equator.

Then, out of their comfort zones, they took those same virtual capsules and tore them right around the back. But universally they started again and fared better. Undeterred, many of these vastly experienced and expert surgeons spoke of what they saw as a creative and challenging tool and environment to enhance performance. In my favourite moments of the conference, the transaction of knowledge and learning was in equilibrium. Registrars bravely coached the consultants through some of the most difficult EyeSi scenarios, while consultants offered a deeper understanding of why certain things are often done in certain ways.

Next door, behind a wall of plants, Dr Mitchell, co-founder of The Mind Room, led small groups in discussing key management strategies for high performance: time, energy, and attention. Ideas were openly exchanged and in keeping with one of the core tenets of GenEye – education through collaboration – each group drove the conversation forward in unique directions. Overall, though, it underscored the notion that surgical excellence is a lifelong quest and to thrive in this difficult environment we need to look after our minds and our bodies. As my five-year-old says to me often: “No Daddy, practice makes progress.”

Of course, virtual reality is not the only form of simulation. Highly trained actors presented as patients in simulated clinic scenarios. In consenting these ‘patients’, learners received feedback from their peers and their ‘patients’ providing a unique and important perspective, and potent vehicle for knowledge transfer.

Shooting Hoops

The structure of the afternoon took the form of a ‘choose your own adventure’. While the EyeSi simulators remained available for customisable dedicated practice, access to a variety of other interactive stations was also on offer.

Another simulation of sorts was popular. With the help of a performance psychologist, attendees were asked to consider their preparation and performance routine by shooting hoops. A straight line can be drawn from a general ability to remain focussed under pressure, and performance in the operating theatre.

I speak with experience when I say that we profoundly undervalue the importance of ergonomics and personal health in our workplaces. And so, having Lisa Harman, an industrial physiotherapist and Director of Safe Work Practice, and occupational physiotherapist David Hall available to provide individualised recommendations on injury prevention at work, was invaluable.

Fujitsu brought in its Human Digital Twin: a markerless motion detection and analysis tool, that has already been used to analyse posture for elite level gymnasts in Japan, to once again highlight the future-thinking that permeates much of GenEye’s mission.

Downstairs, Alcon asked us to set our eyes beyond the horizon as it introduced its Fidelis virtual reality operating theatre – perhaps a glimpse into one arc of the future of surgical training – and demonstrated its Ngenuity 3D visualisation system.

There were also those keen to take a deep dive into fluidics and phacodynamics. And a personal favourite was the non-sleep deep rest (NSDR) station. Guided by one of The Mind Room’s psychologists, NSDR offered a much needed (caffeine-free) recharge, but also an insight into a novel and burgeoning area of meditation that is being applied in both clinical practice and research settings for a range of purposes from mental health management to unlocking neuroplasticity for memory consolidation.

In the end, I envision that attendees left with their minds swirling with visions of surgical grandeur, and forever hungry for the next frontier of exploration (though that may have just been the aftereffects of the virtual reality roller coaster). At the very least, aiming for this in the way that GenEye does, should be seen as a wonderful achievement.

GenEye 2024 will take place from 19–21 June. Further information is available at geneye.org.au.

Dr Rogan Fraser is the Chief Ophthalmology Registrar at the Royal Victorian Eye and Ear Hospital.