In March, I had the pleasure of speaking at YMDC Live in Austin, Texas. The purpose of my talk was to encourage medical students and residents to pursue a glaucoma fellowship, and I am confident my words inspired a mass of trainees ready to save the optic nerve.

After my presentation, a trainee asked me, “How do you master new surgical techniques or devices in practice without your mentors right beside you?” Unfortunately, I had only a few minutes to respond. This article gives the question the consideration it deserves.

STEP NO. 1: ASSESS CLINICAL EFFICACY

Ask the opinions of your coresidents or cofellows in your specialty.

Once I have determined that a procedure or technique is efficacious and will fit well in my practice, I find out whether my colleagues and mentors have experience with it. I also reach out to mentors across the country to request their firsthand impressions of the procedure or technique.

This information is invaluable. Mentors and colleagues can advise on common operative pitfalls and provide tips on patient selection that otherwise might not be obvious.

STEP NO. 3: HANDS-ON TRAINING

If the procedure in question involves a new device, do a wet lab with your local industry representative well before your first case. Ask whether the device you are using is the latest model or if changes will be made by your surgery date.

When learning techniques not included in my fellowship training, I often take advantage of wet labs offered at large ophthalmology meetings such as those of the AAO and ASCRS.

STEP NO. 4: PATIENT SELECTION

Your literature search will have indicated the best candidates for the procedure. Select a patient who has the greatest chance of success.

For example, for a new MIGS procedure, I would choose a patient with an open, moderately pigmented angle and no neck or back issues that could cause them intraoperative discomfort.

STEP NO. 5: PRACTICE INTEGRATION

Share your growing confidence with your team. I like my technicians and surgical counselor to have a basic knowledge of every procedure my practice offers. Whether by sending an email, gathering for a lunch discussion, or using a phone tree—somehow take a moment to educate your staff on a new procedure, potential billing codes, and what to expect postoperatively. Your staff members need to know how to counsel patients when they call the office and when they ask questions during the pre- and postoperative periods.

STEP NO. 6: WRITE IT DOWN

Before you perform a procedure for the first time, write down your surgical plan.

If there are multiple steps, I write down every one. I even include where and when I place the paracenteses. I print out the information and hang the paper on the microscope where I can see it and refer to it during surgery as needed. This is also helpful for surgical technicians to follow along and best assist the surgeon during the procedure.

STEP NO. 7: GO FOR IT

Go nail that new procedure! You have prepared, and you are ready. Do all the things necessary to have a great surgery day. Get a good night’s sleep, eat a balanced breakfast, strike a power pose, wear your favorite scrub cap, and blast your favorite tunes (or operate in silence if you prefer).

STEP NO. 8: TRACK YOUR OUTCOMES

Monitor all your patients’ outcomes but particularly the results of those who have undergone a new procedure. Stay humble. If something is not working, do not be afraid to make a change or pivot to an existing or alternative procedure in your practice.