Dear Editor, Oh et al. provide a valuable snapshot of how Royal Australian and New Zealand College of Ophthalmologists Fellows acquire new operative skills, showing that nearly all respondents used YouTube and that younger surgeons, New Zealand Fellows, supervisors of more trainees, and self-described early adopters reported adopting more new procedures over 5 years.1 Despite the survey’s modest response rate, their findings underscore how surgical learning is increasingly shifting from traditional apprenticeship toward self-directed, video-based education. We suggest, however, that the central challenge is increasingly shifting from access to “how-to” content toward the governance of unsupervised adoption of new procedures. The primary outcome – number of techniques self-reported as newly adopted – implicitly treats all innovations as equivalent. However, a minor modification to a capsulorhexis and the introduction of a new minimally invasive glaucoma surgery device carry very different implications for patient safety, cost, and evidentiary support. Prior analyses of surgical learning curves emphasize that early patients may face avoidable risk if adoption is not structured and monitored.2 A future phase of this work could therefore classify listed techniques by complexity, indication, and level of supporting evidence, yielding a “risk-weighted innovation index” that more directly links learning patterns to patient-level outcomes. Oh et al. highlight the opportunity for colleges to curate high-quality videos and other online materials. We would extend this by proposing that such resources be embedded within competency-based pathways rather than offered as stand-alone viewing. Surgical simulation – recently reinforced by international ophthalmology survey data – can standardize skill acquisition and reduce intraoperative error, providing measurable benchmarks before live surgery.3-5 For ophthalmology, a similar model could combine college-endorsed videos with structured checklists, mandatory simulator or wet-lab milestones, and a brief period of proctored live surgery before independent practice of a new technique. Finally, the survey shows that “fear of adverse outcomes” and “already having a technique that gives good results” were almost universal barriers to adopting innovation. Rather than viewing these concerns as resistance, they could be reframed as signals that surgeons lack psychologically safe, institutionally supported pathways to climb the learning curve. Explicit local credentialing processes for new procedures – paired with transparent patient information that a surgeon is early in their experience – may help align innovation with the profession’s ethical obligation to minimize avoidable harm. By moving from counting innovations to characterizing their risk, and from ad hoc video learning to credentialing-ready digital curricula, future work can build on Oh et al.’s survey to ensure that modern modes of surgical learning translate into safer, more equitable care for patients.1 Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.
Henry Bair (Tue,) studied this question.