S01E01: GENEYE Philosophy

In our very first episode, Dr Jacqueline Beltz connects virtually with Drs Ivo Ferreira, Diane Webster and Rahul Chakrabarti to discuss the philosophy behind this community of ophthalmic surgeons as well as how and why we think we can all continue to improve.

Transcript

Dr Jacqueline Beltz :   0:10
Welcome to GENEYE a podcast where we get to have conversations that inspired you. Way set up Jenna in 2019 but we started planning it in 2017. Jen Ai has been a collaborative effort and forms part of idea education. This has been one of those projects that's been positive from the beginning, and it's brought together a diverse group of amazing and inspirational people. I look forward to introducing you to many of them during this podcast. Hi, I'm Jacqueline, Belts ophthalmologist, educator and enthusiast. I grew up with a huge respect for my dad, who was a GP and with the absolute knowledge that I could do whatever I wanted with my life. I'm thankful to my dad and to my mum, who has a feminist and an educator, taught me to always find a way. I wanted to be an ophthalmologist when I was in primary school. I'm lucky to be won on. I'm grateful every day to get to work in this amazing profession. I did med school in taxi, then moved to Melbourne to pursue my dream. After ophthalmology training, I did two fellowships in cornea, righted a revolutionary time for that sub specialty. I'm forever grateful to my mentors, professors Razek Veg P and Massimo Goossen, for teaching me the skills to do these surgeries back when they were still figuring them out for themselves. But more importantly for teaching me what it takes to be an excellent surgeon, they showed me that technical skills are important, but also that it's the decisions, the planning and the way that we think that leads to better outcomes. It's about who we are, what we believe, taking responsibility, the decisions we make, how we innovate and how we communicate. Those decisions and innovations, too. Our patients and colleagues, my professors taught me to never be satisfied with the status quo, to strive to improve, to never give up. Like my mum. They find a way whilst I continue to work hard in the field of corneal transplantation, and I continue to be mentored by those two professors as director of training for the Victorian branch of the Royal Australian and New Zealand College of Ophthalmologists. Ah, lot of my focus has shifted to teaching cataract surgery. We don't need to wait to learn these skills that I'm talking about. If we can encourage high performance from the beginning and train our future surgeons in all of these aspects of high performance. Then they innovations will astound us. Patients will benefit, and hopefully these young surgeons will have more satisfying and enriching careers. Three. Jenna We aim to encourage a new generation of ophthalmologists. It's not about age, level or experience or name, but more about mind set attitudes in performance. We want to collaborate in order to encourage excellence and high performance. We want to learn in new and innovative ways. Jenna is a philosophy, and we've realised that it's not just the trainees that are interested in this. Our conference in 2019 was super successful run in Melbourne. In collaboration with idea education, we delivered the first virtual reality based training programme to integrate mind and technical skills for experienced consultants and cataract surgeons that we know off. Our focus was on anteria the trek to me, an area that we all need toe up skill infrequently. We had a mind to love three, which participants explored what it takes to be an excellent surgeon. We had a fluid IX lab where we figured out and thought about modern florid IX of anterior. The trek to me. We had a dry lab to work on anterior. The trek to me for the experienced surgeons on Microscope uses suturing with own island for the inexperienced, excitingly consultants and trainees practised anteria the trick to me through virtual reality and pre vocational attendees, land microsurgical skills and inter ocular navigation of surgical instruments. We had strong learning objectives, peer to peer learning, briefing and debriefing and really tried to set this conference apart as a modern and progressive way to learn. We had small groups rotating through all of those stations all morning. In the afternoon of our 2019 conference, we shifted Focus. Jen is as much about health and well being as it is about surgical performance. We believe these factors cannot be separated. You can't have one without the other. We all know that well being is important, but notoriously we did not always practise it well. During the afternoon, we ran an expose style event where attendees could rotate through stations of their choice. We had dedicated practise in the dry lab in virtual reality or using a three D visualisation system. We had a tech station being virtual reality gaming with the intention being tohave fun but also to spark ideas and conversations relating to technology. We had clinical physiotherapists from fit wise physiotherapy with a reformer and other equipment to take just exercise is to look after our bodies. And we had an industrial physiotherapist from safe work practise teaching us about slit lamp and computer related ergonomics. One of the great successes of 2019 was out collaboration with Jo Mitchell and her team from the Mind Room. Joe is a clinical psychologist with significant interest in experience. In high performance. We've been able to adapt a lot of Joes knowledge from sports and other high performance areas to surgery, and her team has become an important part of our education programmes. The registrar's The Mind Room took us through to meditations at Jenna, one on Focus and one on mindfulness. It was interesting to see us all slowing down and taking time to consider these important aspects that were all quite good at applying during surgery but could probably apply better at other times. Jen I 2019 was so successful we were almost at capacity. People seem to have a good time and feedback was excellent. We were used much of that feedback to continue to improve and expand in the future. One unexpected outcome of Jenna, 2019 was the part of Jen Ai that we've become most proud ofthe. Thiss was development of a community. The faculty of Gen. I were chosen for their mindsets and skills rather than their level of experience or reputation. They put everything into this event. I can't thank them enough. Bernardo Suarez, Mohamed El Nor are we Daniel Buck, Evo Ferreira, Marshall Dial, Rahul Chakrabarty and Dianne Webster created Jen Ai. They are Jen Ai and saw you, Jen, I 2020 will not take place to do covert 19. The's are difficult times, and we are all by now accustomed to cancellations and interruptions. We had a great event planned, with the focus continuing to be on advancement of surgical practise as well as mindset in skills required to perform surgery at a high level. A major skill to be acquired prior tio Independent cataracts, Surgical practise is the ability to change a surgeon's own technique, try new things or innovate to advanced techniques and outcomes for outpatients, as surgery is an unforgiving environment and patient safety is at all times our main concern. It can become tempting for surgeons to stick with tried and true methods. Sometimes that's even the most appropriate approach. At Jenna 2020 we were going to explore issues relating to adoption of new and advanced techniques or technologies to figure out some solutions. We've created what we believe to be a safe, innovative and modern collaborative learning environment in which trainees and consultants Khun come to discuss challenges and to work on their techniques without risk of adverse reactions, judgement or regrets. Since we can't do it in person, we'll do it online adaptation is what we're about anyway. The surgical techniques that we were going to use to explore our concepts for 2020 were fake o Chop I'Il exchange insertion of a three piece I'll and operating under topical anaesthesia these air skills and techniques that we believe to be important and that attendees of Jenna, 2019 and others have raised his areas of interest. Whilst the actual training in these techniques will be important, we believe that the underlying psychology and training techniques are essential to help us expand our learning across many areas of our practise. This year we've decided to convey our messages through this podcast Siri's as well as some short videos. We're also developing a return to surgery programme for all of us that will now taken enforced break. From what we do, we're into short stackable content. So he promise you won't get bored. Please subscribe so that you don't miss our episodes and keep an eye on our Instagram at Jen Ai Surgical, Our website jen ai dot or got a You will also be updated. So have a look when you can. At Jenna, we believe that we need to take care of ourselves and of each other in order to take care of our patients. That is more important right now than it ever has been before. So please take care. Throughout the next episodes, we will explore some of the core values of Jenna and how these relate to the delivery of modern and excellent author Mick surgical practise. I look forward to introducing you to all of the most important members of our team You love wth um thank you for listening. Thanks for being Jen Ai. And please be careful I'm here now virtually with Dr Ivo Ferreira Evos a good friend of mine and an amazing educator. He was our international faculty member for Jenna, 2019. And he brought with him so much knowledge, experience and enthusiasm even has been with us from the start. We love having him as part of the team. Evo, Thank you so much for joining me on this podcast.

Dr Ivo Ferreira:   8:48
It's an honour to be here with you. Jackie.

Dr Jacqueline Beltz :   8:50
Could you tell me about yourself professionally and personally? Well, yeah.

Dr Ivo Ferreira:   8:55
I am 38 years old, married with one lovely girl and another girl coming in the way. I'm originally from a small country in South America way and now living in Mexico City. I had to come to this country to become, ah, cataracts surgeon on I have been living here for the last six years. I work in a very big institution called in where I have the honour to teach young residents and fellows twice a week. And also I'm involved in virtual simulation and they spend a lot of time with a virtual simulator in a private institution.

Dr Jacqueline Beltz :   9:42
Thanks, Eve. Oh, I love your Storey. Thanks for sharing it with us. you're such an experienced author make educator and what you do is amazing. Can you tell us a bit about off Tomic University, and especially about the virtual classroom that you have been running during the pandemic?

Dr Ivo Ferreira:   9:57
Well, Azad told you know in my storey I got to didn't teach me fake O in my country, I really was motivated to learn. So when I came to a fellowship, it was an amazing experience. He was in one year. I need about 1000 cataract surgeries. Maybe that's normal for you guys in Australia, but in the rest of the world, that's not very usual. So since I was older, I think it was more, you know, paying attention off the process I was getting and gathering information. So I was a little more mature. I really like the process off learning and I took it a zoo learning experience. So I was looking into the details into what was going on in my mind when I was, you know, and getting knowledge and experience. I was asking the questions that maybe nobody does. So I think that gave me, you know, the different perspective ofthe faker. So that's why I tried to When I When I finish, I tried to play that in everyday teaching. I tried to have these three pillars that I call every time I'm teaching. And I'm not only teaching fine motor skills but cognitive skills and mindset skills. I think surgeon needs to be very completing what they do. Andi, I also had the opportunity when it was doing my fellowship to have ah, virtual reality simulator one of the first in Latin America on always again, you know, with this different mindset trying to instead of saying if this is realistic or not, always with a question off, what can I learn from this machine on DH? I fall in love with with visual simulation not only because of the machine, but from the experience you know I love. I love to take away the our environment to take out the patient from the equation so you can communicate better with students. You can also be desk. You can have ah, also more cognitive approach off tasked about decision making, problem solving. So that's me. You know me, right, Jackie, you know, with this new perspective and I think we shared this perspective a lot.

Dr Jacqueline Beltz :   12:26
We certainly do, Evo, but the way you explain it is really inspiring. Thank you for that. And what about the website and the podcast on the virtual classroom? Can you touch on that? Oh, yeah.

Dr Ivo Ferreira:   12:39
Well, that's depression off my life. You know, sometimes people ask me, where did I get this energy, Tio? We are right now in quarantining Mexico, but in 14 16 hours a day. But I'm so happy to do it because it's my true passion on DH. Mostly I thinkit's is to build the community. I think we scatter insurgents and doctors. We spend our entire careers no competing from from from grades. And I want to get into this precision. And you were my company. You know, we're competing. But But when we when we become a surgeon, I think the best thing to do it is to be part of a community to share, to share, without expecting anything in return. So that became made the passion of my life. I started three years ago with a little website doing some cut, both gassed to people. And I am You know, I I understood that I was learning so much from people that will be open. They will share knowledge they will share their experiences on. That was the one who was learning the most. And I congratulate you, Jackie, for this mentioned idea of having your own focus with Agena Group that it's doing amazing things. And basically, this is connecting us. You know, I have I'm having such an amazing experience now connecting with people from all over the world. Like my, my concerns now are like, OK, what time is in Australia right now? Maybe Jackie, It's sleeping, you know, And I wanna text her and see if she wants to do a webinar with me next week. So I I think technology can be amazing tool for us. I'm all over doing a community, unopened community where people who really want they have something to share. They can share it with no politics. No economic issue's behind that, and no friendships. You know, I invite you because I want you to come to my meeting and I think we can really make a revolution in how medicine it's communicated. Unlearn. So I'm really happy that, you know this is working. People are understanding the here. The principle behind everything.

Dr Jacqueline Beltz :   15:09
Amazing, Eva and some really good points there on that point of community. You came halfway around the world for GENEYE last year, and it wouldn't have been the same without you. What did you think of it? And what do you think is different about Jenna compared to some of the other events that you've taken part in?

Dr Ivo Ferreira:   15:26
Well, Jenna waas was awesome, was completely a great idea. I was so happy to know that, you know, in the other side ofthe planet Earth, there is people with same much patient on the same knowledge and the same energy to share. I really liked the experience every like the structure. I really like the way you guys, you know, there was that the perfect set up we were with colleagues on. I'm going to talk about my my station. That was Oh, man, it was It was amazing. But everything had a point, right? Every station will be specifically done in a way that you will sure some skills. We will have virtuous simulation with specific task. We will have artificial eyes. We will have the gaming. And because it's related also too. To Morrow skills who have the mindfulness station about how to train the mind. Andi also, you know me and all about training the mind. I had the honour to have the fake of mind lab that I'm working for two years now on DH. Really? Dig deep ing how we can prepare mentally to be in this big performance level in the moment we are doing surgery. But also what happens with us when we finished surgery? When we prepare for the next day off surgery, right when we have complications. So I think Jenna Wass probably one off the best camera courses I have ever Bean

Dr Jacqueline Beltz :   17:13
Thanks so much for those comments and thanks especially for joining me on this podcast. Your perspectives are always amazing and your experience and enthusiasm for education is really unmatched. You're so far ahead in teaching thes skills. And it's always a pleasure to speak to you. You should know too. You can text me at any time. I have my notifications turned off and I don't mind waking up Tio lots of ideas about education.

Dr Ivo Ferreira:   17:42
Thanks. No, no, thank you, Jackie. We you know we share this passion. I know we do. On This is not. This is a journey I have times have so much to learn. I'm always with an open mind. I'm always learning. I mean, yesterday I was just learning from my gag man. Wrong. Yale from Singapore, Jean Germany, from Japan to cash Hiedeh from Brazil. We were in this talk with an open mind, trying to learn from each other. I think that's the real secret, you know, to be open minded, to be constantly learning, learning and always tried to, you know, to stay kind of. ITT's loved the quarter of Steve jobs. Maybe, you know, basically share, but it's stay hungry and stay foolish. You know, you just need to be constantly learned

Dr Jacqueline Beltz :   18:42
such a good one. Eva and I totally agree. And thie other aspect is it's fun, right? So I look forward to seeing you on the next part of this journey.

Dr Ivo Ferreira:   18:52
I will love Teo

Dr Jacqueline Beltz :   18:57
here with Dianne Webster. Thanks die so much for joining me on the pod today. Could you please describe yourself for our listeners both professionally and personally?

Dr Diane Webster:   19:07
Sure. So I started off them ology training at the Idea hospital back in 1982 and did my training at the idea and then following my completion of training, I went to Queensland to practise. So I practised in Brisbane for 10 years and during that time I was travelling up to Makai in Regional Queensland weekly Teo perform cataract surgery and and see patients, and I had very busy practises in both Brisbane and McKay. I built day surgeries there and did a lot of operating. I had of five other off some ologists working with me and together with perform about 5000 cataract surgeries a year. So over a 10 to 12 year period, I was very busy and then I was full time in a regional area in Makai for three years before returning to Melbourne. That was 18 years ago and I've been working at the irony a hospital over that time and very interested in teaching trainees cataract surgery on working with trainees in ophthalmology and also consultants are very interested in developing new techniques and what it takes to adopt new techniques and techniques that are more efficient and effective in our practise off cataract surgery. I also did refractive surgery for about 10 years, but then decided to go back to cataract surgeries. I found that was the most rewarding part of ophthalmology and also mother and three Children. So I've combined my ophthalmology career with my private life, sometimes successfully, sometimes not. I've had a lot of injury on my back and neck because of Split the abuse. May's mainly with laser and poor posture. And so I've had to cut back on the amount of practise that Aiken due now. But I love to devote my time to teaching, and I'm very excited about the whole concept of Jen Ai being a vehicle whereby we can propagate ideas about how we practise off them ology, particularly in relation to anterior segment surgery.

Dr Jacqueline Beltz :   21:36
Thanks so much die. That's what a lot of cataract experience that you have. I think that you would have done tens of thousands of cataract surgeries, right?

Dr Diane Webster:   21:45
That's right. Yes, definitely more than 30,000 cases.

Dr Jacqueline Beltz :   21:50
And to have your experience teaching the trainees thie idea is amazing. I know that we really value your experience there, but I was wondering, as such, an experienced cataract surgeon. What value do you see comes from Jenna and the format that we use?

Dr Diane Webster:   22:07
Well, I think what it tracks people to. The idea of Jen Ai is the one on one teaching because what I found throughout my career is that you can learn a lot from reading journals and going tio lectures and listening to lectures in meetings. But a lot of the really valuable tips that you get in ophthalmology are when you talk to people one on one at international meetings and national meetings. Find out what people are really doing and what actually works, because often you can hear a presenter presented technique, and it sounds like it would be very good. But then, when you do it in your own practise, you think, Well, I don't think it's really a CZ effective as that person has said, it is even when they've done clinical trials and so on regarding it, and also, unfortunately, and cataract surgery, clinical trials. We can't really do that, Teo prove whether our techniques going to be or don't not, It's very difficult to do that in real life. So I find the value of Jen Ai is It's all about one on one. Teaching off the heuristics off cataract surgery on these air. The tips that make surgeons really good at what they do. It's ways of doing things that are more efficient, more effective and that make us better surgeons. So it's that one on one team

Dr Jacqueline Beltz :   23:36
thinks. And do you think that that's why, well, part of the reason why so many experienced surgeons came to Jen Ai last year. We didn't just have trainees and junior consultants. We had, ah, lot of experienced cataracts. Surgeons there. Do you think that they appreciate that one on one teaching as well? I think

Dr Diane Webster:   23:55
they do. And that ability that time to talk with colleagues because sharing ideas is another way that we were really learn and progress.

Dr Jacqueline Beltz :   24:05
So true, isn't it? And that peer to peer learning has been really important for me throughout my career as well. And it's not just, of course, it's not just that educational events like Jenna, it's just in day to day practise on it can be why it's good to work in big institutions rather than solo private practise. Sometimes because you get to have those interactions and discussions all the time, but you're right. We can become stuck in our ways, can't we? And I think a big part of that is safety, because we don't want to try something that's new and outrageous if we're not sure how it's going to go, because we don't have that permission to fail in ophthalmology. So if we can have a safe environment like an educational formats such as Jenna, and have that 1 to 1 teaching or peer to peer learning between different attendees, it does give us that chance, doesn't it? Tio, try something new and see if we really want to pursue that for our patients.

Dr Diane Webster:   25:03
Yes, exactly. And I think that's why we found with the first Gen. I. Why There were quite a few surgeons that really enjoyed trying chopping with the simulator, for instance, because there was there was not going to be any consequences ofthe failure with the practising with a simulator. And I've got a lot of very good feedback that surgeons love Teo. Try it and they would be more willing to try it with patients if they could be assured that they weren't going tohave a complication. But it's the most dreaded thing for all of us to have a serious complication from our surgery on DH. It's very hard to recover from that and Tio, keep on going and keep on operating once you've had a major complication. And I think that has driven, ah, lot of my decision making with my surgery that I have always looked over the years to find a way to perform cataract surgery. So that is on absolutely minimal chance that there will be a complication from the surgery and that that is exactly what holds us back a lot of the time from trying new techniques because we don't want to cause an adverse event for our patients.

Dr Jacqueline Beltz :   26:24
So die You were going to lead a couple of great discussions at Jenna 2020. But of course, with cancelled the live version of that event on one of those stations was a community lab where peers would come together to discuss a problem, and the problem we were going to give them was a sub Luxton i'il. Then they were going Teo, get together to figure out a number of potential solutions, agree on a single motive action and then demonstrate and teach that technique to each other in a lab environment. So the technique would have bean some type of Iowa exchange. Why do you think it's important for us to discuss problems like that together rather than considering them alone?

Dr Diane Webster:   27:07
Well, I think that would have Bean a very interesting station, and hopefully we can still do it in general 2021 because Iowa Exchange is still a very topical on DH. Interesting dilemma for us because so many people do it so many different ways. And that's the interesting thing, because I think there's a lot of pros and cons off the different ways that people do it. But still many surgeons gettinto problems on. It's not uncommon that we see it that particularly for something like Iowa Exchange, because it's not only sub lex to Iowa LS When people are loading Iowa ALS or when they're injecting ia whales, they can be injected with a crack in the optic or the damage to the haptic, and they have to remove them at the time of the operation and they can be removed well or they can root removed quite badly, and it can either extend the operation by a five or 10 minutes or by 45 minutes, depending on what the surgeon does next. When this happens, so this is a very valuable lab to do, and we really welcome discussion from all different points of view of surgeons, of what has worked for them and what hasn't worked on. I think that that is so good if we can get together and discuss it because I think we'll learn so much. I know that this topic has been discussed in journals and people have put their point of view in journals. But it's getting the feedback from others. When you mention the way you would do something and whether, why they think that that doesn't work or if it does work, why it works, what particular instruments they use, exactly how they do it. All of these very important. They seem like very tiny differences, but they can make a huge difference in ophthalmology.

Dr Jacqueline Beltz :   29:13
They certainly can Thanks die and you're right. We should save that up for 2021 run that station or similar in the future. On the other station that you were going to run was about operating under topical anaesthesia, and we don't need to go into specifics off that decision. But it's another thing we can learn from each other, right? And a discussion based format is really good when we're talking about those big changes in our practise.

Dr Diane Webster:   29:40
Yes, yes, I totally agree with that because topical is another thing that I think quite a few surgeons would consider changing too topical because they can see the value that ends up that you don't have the complications off block and a seizure by doing topical. But again, surgeons want to be safe. And a lot of wth, um, have the perception or the view that topical anaesthesia is not a safe in their hands doing cataract surgery as it would be if they had a block. And they feel like they're more likely to have a complication if they did topical anaesthesia. So it is great to tease all of these aspects out and also to communicate the ideas because certainly in my hands, I feel I'm much safer doing topical anaesthesia than I am doing cataract surgery under a block. And because I've done tropical anaesthesia for many, many years and thousands of cases. But I know that when I was first starting topical anaesthesia, I was scared myself. I really thought or what if the eyes moving while I'm doing topical anaesthesia and I'll have a complication because of movement. So I thought the only way that I could do topical anaesthesia was to go and visit at least three other surgeons that were routinely doing cataracts, surge around a topical anaesthesia and actually sat in with them during their surgery So I could ask them specifically, what were the tips? What were the heuristics? What were the important points that they took on board to be able to do topical anaesthesia, cataract surgery totally safely and as safe, if not more safe, than under block anaesthesia? And when I found out those tips and there were just very simple things, but it was a change, a shift in my thinking, And so then I could go back to my own day surgery and start doing topical anaesthesia, and it was actually much easier than I thought. And it's not a matter of whether you're fantastic surgeon or whether you're just the average surgeon. Everyone can take these ideas on board and be a good on effective and safe off sonic surgeon doing topical anaesthesia. And so that's what I'm excited about with trying Teo teach these ideas and discuss these ideas and share them so that we can tease out the objections that people have two topical anaesthesia. And that happens from meetings like we are having with Jen Ai of being able to discuss this between peers. The peer to peer learning, as you said so important

Dr Jacqueline Beltz :   32:32
that brings up so many interesting and important points die. And one of them is that in my hands are in your hands discussion because that's a good example. We know that the evidence is clear in the literature that topical anaesthesia is a safe for cataract surgery as regional anaesthesia. We know that the complications have not increased. But many of us do have that perception and especially when we start out that it might not be as safe. And that's a risk that we don't want to take on a personal level for ourselves and our patients on DH. I love that you brought up the peer to peer learning in theatre because I think that's something that we really don't do enough off in surgery, and I know I've done it. I've gone into watch many cataract in corneal surgeons and vice versa had had them come into my theatre and tio even ask each other for feedback and encouragement and advice is a really good thing to do, no matter what level we're at of our careers. It would be done in every other industry, but I think that we under do that in surgery s. So I love that you brought that up. Thank you.

Dr Diane Webster:   33:47
I totally agree, Jackie, that I really think the concept off a coach is very important and that we shouldn't think that because we've been doing off Tomic surgery for many years that we don't need. We all need a coach because I think it's the mindset of always thinking that we can improve on how we're doing things at the moment. And that's the great love that we all have for ophthalmology because we know that we're always striving to improve and it sze always possible to Esso. We never get bored or with our surgery because there's always ways that we can do it better.

Dr Jacqueline Beltz :   34:30
Exactly what I love about it to die, and I'm sure that's why you have managed to do 35,000 cataract surgeries and still be this enthusiastic about it. So thank you very much for talking to me. I've really enjoyed that chat. And I look forward. Teo, working with you further on Jenna. Thanks very much, Jacki. Say I'm here with Rahul Chakrabarti, fellow ophthalmologist and education enthusiast. Rahul. Thanks a lot for joining me. Could you tell me a little about yourself both professionally and personally?

Dr Ivo Ferreira:   35:03
So my name's Rahul Chakrabarti. I'm an ophthalmologist based in Melbourne, Australia. I have on interest in paediatric ophthalmology in your ophthalmology on DH adult and paediatric strabismus. I'm also very much interested in surgical education which has led me along the path to being involved with Jenna. That's something that I find very enriching and rewarding. And I also outside of work, have a few hobbies, including astronomy at I have a passion for tennis and I also have two young Children who keep me on my toes.

Dr Jacqueline Beltz :   35:47
So, Rahul, you are a really important faculty member of Jenna. And you been there from the start. Can you tell me from your perspective what Jenna is

Dr Ivo Ferreira:   35:56
so very privileged to have been involved in general on DH? I thank you for all your hard work in establishing and diverting effort into establishing this. To me, going from a trainee toe consultant, Jenna, is a philosophy off thinking. Practising and teaching are not only surgery but approaching the hope, discipline, off ophthalmology and how we balance between being professionals as well as outside of work. It's a way off life, and also it's a way to to bring together like minded individuals within our discipline. Surgery has really evolved in the last, particularly the last 20 years. But we since the origins of surgery, which was the house tedium, concepts of approaching surgical trainings that the see one do one teach one and you have the grey haired professor on DH. That's the way you were to do your technique. I think now we've moved to amore in depth understanding of what it means to become a surgeon. What were our were aspiring to be on DH? Why is surgical being a surgeon or becoming expert so difficult to define? We've got bought. We've got analogies from corporate fields where people have coaches. We have competitions, but surgery eyes not like that, and something that really challenges asked both as doctors. But also it becomes very personal, and it's I'm fascinated by the work of Ericsson, who has devoted his life to the understanding of the expertise, theories. And he's understanding off what it is to be an expert and how somebody goes from being competent to being an expert. And just because you are competent with the years of experienced still doesn't make you an expert, and Ericsson implores us all to become better than what we are constantly try. It's aspire or strive to do better on this is a really interesting mindset, and to me that's what is at the core of Jenna is not to be or achieve a competent mediocrity for the rest of our careers. How do we constantly try and improve? It might be a mental component, maybe ergonomics. It might be your behaviour, but ultimately all of these factors, in addition to purely motor skill, of doing a technique of surgery. All of these factors contribute to improved outcomes, and so that's what to me, Jenna, the core of general is about talking about how to be better. And how can we strive to be better and putting little things in place every week, every operating list and having this concept of a community of practise, which is like minded individuals through a passionate about something with us. It's cataract surgery, but it could be any aspect ofthe a surgical or medical field or any particular aspect ofthe life, which involves a skill and being open to feedback being open Teo improvement on then seeing whether that's actually what your changes that you put in actually benefit.

Dr Jacqueline Beltz :   39:23
I agree, Rahul, and those sports analogies a really interesting. You don't see a high level sports person without a coach or who's not trying to improve every single day, their training and they're out there trying to get better and better, no matter how good they are already right? That's one of the things that we're trying to achieve through generate that level of high performance.

Dr Ivo Ferreira:   39:41
Yeah, and that's fascinating because, as I mentioned earlier, love my tennis. Ah, lot love my life sport. I think there's a lot of things we can learn from watching athletes do what they do, and what resonates with me is Roger Federer, who has a coach. Roger Federer is arguably the greatest men's tennis player of all time. He doesn't need somebody to teach him how to serve or to hit a forehand or elegant backhand down the light. What he's looking at is how can he make himself better? So he's not happy being the number one or two tennis player in the world. But he he's still trying to improve on DH. Achieve the absolute maximum out of himself. And so that's why he has a coach. He has a coach who can critique his his moves, who can look at feedback, look at footage and give him feedback on DH. That's the idea ofthe coaching is toe have somebody who is personal, who can give object of feedback and also suggestions for for improvement. And then you act on that and on the cycle continues, and there's no reason why we as autumn ologists Ondas off Tomic. Surgeons shouldn't all be having a coach irrespective of how experienced you are.

Dr Jacqueline Beltz :   41:03
Thanks a lot, Rob Hall. That was really great to talk to you, and I love your take on Jenna. I look forward to talking to you a bit more through this podcast. Siri's. I loved speaking to Rahul Die and evil about Jenna. As you can hear, we're all super into this concept that we've developed. I'm looking forward to also introducing you to the rest of the Jena 18 through this podcast. There are positive group there, thought provoking conversations always inspire me on. I hope they'll do the same for you over the next episodes. We hope to give you some tools to help you do better. As cataracts surgeons are as those associated with cataract surgery. We really believe that to perform at a high level in surgery, we need to look after ourselves and each other before we can even consider looking after our patients to the level that's required. Next week, I will talk more with Rachael as we delve into the important aspects of returning to surgery after a break. Roland I originally started planning a programme for this last year, thinking that it might be useful for some of our trainees or junior consultants. They returned to operating after a short break, maybe parental leave, holiday or conference. Little did we know that we would all be taking an enforced break in 2020 so we've stepped up the programme ready to implement post covert. I look forward to discussing some of the mind and technical skills worth considering on return. Please subscribe to this podcast so that we can continue to produce episodes that are actually quite a lot of fun. Also, if you have time cheque out our website jen ai dot or dot you