Interview with Dr. John Loewenstein, of Mass. Eye and Ear
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Dr. John Loewenstein
Loewenstein, vice chairman for education in ophthalmology at Harvard Medical School and associate chief of ophthalmology for clinical affairs at Massachusetts Eye and Ear Infirmary, has recently developed a computer program to help teach medical students how to perform cataract surgery.
Q. Cataract surgery has gotten substantially safer during the course of your career.
A. No operation will ever have zero percent risk, but cataract surgery has like 97 percent success rates. Patients are tending to have surgery [while they have] better vision than when I was a resident. It's a good thing for the patients, [but] it puts more stress on the health care system because there's very high expectations by the patients. They expect to be seeing darn near 20-20 within a week after surgery.
Q. So, there's less room for error by trainees than there used to be?
A. The expectations are very, very high, not only in terms of the quality of care in the technical sense, but in building relationships to the physicians, access to the physician, teaching of patients by physicians.
Q. And less time for doctors to train them?
A. Because we're reimbursed generally less than we have been, you're expected to see more patients to keep your income or to keep the hospital bottom line looking good. A lot of physicians love to teach, and they used to be able to take half a day or day and donate their time for teaching. [But] even our full-time faculty now have pressures that reduce their teaching time.
Q. Proposed congressional budget cuts, you say, would also put more pressure on medical students.
A. Our trainees are coming out of medical school with six-figure debt. If we don't pay them for another three to five years [while they're residents, as has been proposed], they're going to be under a huge debt burden, which skews what they want to do with their careers.
Q. What specific problem were you trying to solve with your new computer training program?
A. I've always been struck by the fact that we get the smartest people around in ophthalmology — really talented people. They read about surgery, they watch surgery, they watch videos of surgery, they assist in surgery. When they sit down to do their first cases, they look at the [experienced doctor] and say: '”What do I do?'’
Q. You spent eight years getting funding and developing the program with the help of colleagues, and just completed a study of it. Did it work as well as you'd hoped?
A. We found that residents not only liked it better and would be more likely to use it again, but also learned more from it than they did from standard teaching.
Q. Do you have any concern that online training programs like this will encourage people to shortcut other parts of their training?
A. Ultimately surgery is learned in the operating room. This is not meant to replace operating room teaching by an experienced surgeon. It's a supplement, it's a way to bring people's skills up to a higher level.
Q. Have medical trainees changed since you first started practicing several decades ago?
A. If you look at the big picture, they're the same. These are smart people who want to do good and who like taking care of other people. They would much prefer to access learning content when they want, where they want, and how they want, as opposed to sitting at 8 o'clock on Thursday morning in lecture hall. Although they work really hard, they need more attention and more spoon-feeding I think than my generation did — probably the people who taught us felt the same way about us.
Interview has been edited and condensed. Karen Weintraub can be reached at Karen@KarenWeintraub.com.