Teaching Strategies: The Voice of Experience

Nick Mamalis, MD, has spent more than 40 years as an ophthalmologist, intraocular lens researcher, and medical educator. We asked Mamalis, who recently retired from surgery, to share perspectives from 38 years of teaching residents in the operating room.

1. Residents can be very nervous, and it’s important for attendings to do whatever they can to calm them down.

I would always try to speak in a very even, monotone way, what is described as my “HAL” voice (referring to the HAL 9000 computer in the movie “2001: A Space Odyssey”). If a resident is getting too deep in the eye, you can’t say, “OH, don’t go so deep!!!” Instead, you calmly say, “OK, we’re not going to go quite so deep, we’re going to go a little more superficial.”

2. Consider the inside-out cataract teaching method.

Residents start with the parts they can do most easily that won’t affect the other parts of the surgery. For example, in a cataract surgery, I would make the incision, and I would make the capsulotomy (capsulorhexis). Then, I would have the resident start the procedure where they remove the hard part of the cataract, and the softer parts, and put in the lens implant. We started from the inside first and added more pieces to the surgery as they became more confident.

3. It’s important to let more senior residents with many cases under their belt work through the problem.

I talked to them a lot and told them, “OK, you need to do this technique, or that technique,” and worked with them to rescue what was happening. There were times when they got into trouble and they weren’t going to get out, so in that case, you would have to trade places with them.

• • •

Dr. Mamalis is a clinician-scientist who directs Moran’s Ophthalmic Pathology Laboratory and is co-director of the Intermountain Ocular Research Center. He holds the Calvin S. and JeNeal N. Hatch Presidential Endowed Chair.

More Online

Scan for more teaching advice from Dr. Mamalis.