EVRS EDITORIAL

The EVRS: Surgeons Coming Together to Learn

It takes a village to teach vitrectomy.

GIAMPAOLO GINI, MD

Those of you who, like me, started practicing vitreoretinal surgery back in the late '80s and early '90s will probably remember the mixed feelings of excitement and apprehension that we experienced whenever we performed a vitrectomy.

We moved in largely uncharted territory then, with few basic rules to guide us. There were many elements of the procedure that we needed to understand more fully before we could even attempt to master the art of consistently performing successful vitrectomy.

Soon after facing your first proliferative vitreoretinopathy case — or a deceptively "simple" vitreous hemorrhage — you knew whether you would grow to love vitrectomy or hate it.

But, if you did think you would love it, it would be love without compromise — the sort of love that compels you to overcome the mental and physical hardships of long hours spent at the operating microscope, well after your cataract or glaucoma colleagues have gone home for the night.

The excitement of this pioneering spirit led us to search for new approaches and techniques. There were mistakes to be made and lessons to be learned, but few true experts available with whom to share your thoughts. In most hospitals, there was generally no more than 1 retina specialist and, as a result, not much support could be expected in times of doubt. At most, you might receive a few sympathetic comments for your efforts. There were, of course, professional meetings, attended by those of us who had immersed ourselves in the nuances of vitrectomy.

Depending on which country you lived in, you might have had the marginal advantage of having 1 of the few existing "masters" of the procedure geographically closer to you than others did. Yet few of us were actually fortunate enough to work with one of the masters.

And then the day came when we could start developing procedures with our own store of knowledge, even if this meant not following the "official" approach to the problem. I remember performing vitrectomy on all endophthalmitis cases well before the Early Vitrectomy Study was published and continuing to do so ever afterwards, simply because to me it was the sensible thing to do.

CREATING A FORUM FOR LEARNING

Maybe it was this particular set of experiences and hard-learned knowledge that stirred me into action when the idea of creating a vitreoretinal teaching society was first proposed to me.

As Darwin postulated, diversity is the key to evolution. The experiences of many surgeons in greatly diverse work settings represent a huge asset for growth in our specialty. But ideas have to circulate, and it is not easy to get people to express their thoughts. Many surgeons do not believe strongly enough in their own experiences to widely disseminate their insights. Others are simply wary of criticism. What better idea than to create a "peer-to-peer" society to overcome this problem: a society in which each and every member could express doubts and contribute ideas, no matter how apparently insignificant.

This is the spirit of the European VitreoRetinal Society (EVRS). At its core is a teaching philosophy based on the idea that knowledge does not travel in a 1-way vertical direction, but rather in a horizontal plane having many links.

Such is the spirit that pervades the Society's Training School, a 2-week full-immersion course held annually in Bremen, Germany. Attendees are not given a single set of fixed rules. Instead, information on each topic is provided by several different lecturers, each proposing his or her personal approach to a given problem. And because there are many ways to climb a mountain, it is hoped that when the time comes for decision-making with actual patients, our students will be able to make those decisions, having a wide variety of options from which to choose.

This is the philosophy that informs the EVRS Web site, where members can share their experiences, either through videos or short papers or by simply participating in the open forum, where problems can be submitted and solutions proposed.

No particular status is required. All that is necessary is a bit of time, enthusiasm, and the sincere desire to exchange knowledge that can help patients throughout the world receive better care.

Is this what our members want? It would seem so if we are to judge from the response we have had, even at meetings where presenting one's experiences could have led to some uncomfortable moments. For example, last year's EVRS Congress in Venice was titled "Errare Humanum Est." At this meeting, surgeons' errors rather than their accomplishments were presented. Because we learn more from our mistakes than from our achievements, this meeting provided powerful teaching content.

In September, EVRS will meet again for its annual symposium, this time in Prague. Once again, this will not be a "once-a-year" moment of information but, rather, the highlight of a mutually beneficial educational project among members that is intended to continue throughout the year. The title of this year's meeting is "My Way" — not reminiscent of some old Sinatra song, but an open invitation to share ideas and techniques.

AN INVITATION TO JOIN US

We certainly have come a long way in overcoming the sense of isolation that was present during the early days in vitreoretinal surgery, yet much more remains to be done. Join us in this effort, either through the options that I have explained here or by simply e-mailing me about your experiences or specific problems, whether related to technical aspects in the operating room or to your overall professional experiences. I will sift through your e-mails, selecting, organizing, and disseminating information that is of general interest.

I look forward to hearing about "your way" of doing things. RP