Did anyone find it difficult first starting out? I'm a few months into private practice and I don't know if its getting use to the new asc (I'm using a new machine) or what, but I'm just not comfortable. I had one broken capsule in my residency training, and I've already had two since I started. Please tell me this gets better. Any tips on how to get over this hump would be appreciated.
always more stressful when you are out on your own, that goes for the OR and in clinic. This is because you've loss your safety net. For the OR, you want to start with easier cases and build your skill set. To do this however, you have to know what is easy and what would present challenges. Identifying your limits is not an easy thing sometimes.
As one of the above post mentions, common challenges for the beginning surgeon are 4+brunescent NSC, white fluffy diabetic cataracts prone to the argentinian flat sign, high hyperopes with shallow AC, high myopes with hyperdeep AC and reverse pupillary block, floppy iris, pseudoexfolation syndrome, post vitrectomy eyes where they can have thick leathery posterior plate, posterior polar cataracts, mostly psc cataract with otherwise soft lens....etc.
How well you deal with these challenging cases will improve with experience. Watching videos on youtube, eyetube and the complications sessions at aao/ascrs are helpful to learn from others.
if you have a helpful colleague/mentor, it is helpful to analyze and debrief with them on challenging cases. Talking it through with someone can help you identify what critical steps you may be missing. it could be as simple as patient positioning, adequate anesthesia, not hydrodissecting as much as possible, phaco settings that are too fast for you.
If you are comfortable, you can discuss the details of your challenging cases here and get some pearls on managment.
maybe get your partner to shadow you in the OR one day.
record all your surgery and go through them.
have the rep for the phaco machine come out and optimize your settings.