Mastering phacoemulsification is not just about surgical technique—it’s about how you approach learning and improvement. Many residents and beginner surgeons struggle not because they lack technical ability, but because their mindset limits their growth.
If you’ve ever felt stuck, frustrated, or uncertain in phaco, the problem is likely not your hands but your mindset.
Here are five crucial mental shifts that separate struggling beginners from confident, in-control phaco surgeons.
1. Ditch the “I’ll Figure It Out During Surgery” Mentality
Many beginners believe that simply doing more cases will lead to mastery. They assume that if they just keep operating, things will eventually “click.” This is a huge mistake.
Why This Mentality is Dangerous
1. Mindless repetition does not guarantee improvement. If you keep making the same mistakes, you reinforce bad habits.
2. Limited exposure to surgery time means you can’t afford to waste OR hours on trial and error. Unlike experienced surgeons, you don’t have unlimited cases to refine your technique.
3. Surgery is unpredictable. If you rely only on “figuring it out” in real time, you will always feel behind.
The Shift: Train Outside the OR
The best phaco surgeons don’t just learn inside the operating room— they actively train before and after surgery.
Actionable Strategies:
I. Watch Your Own Surgeries– Record your cases and review them critically. Pause at each step and ask yourself:
- What went well?
- Where did I struggle?
- What can I do differently next time?
II. Use High-Yield Video Learning– Instead of passively watching experts, analyze why they do what they do. Pay attention to fluidics, hand movements, and step transitions.
III. Mental Rehearsal– Before your next case, visualize each step in detail. Imagine holding the probe, maneuvering the tip, and handling complications smoothly. Studies show mental practice improves surgical performance.
If you only “learn” during surgery, you’re wasting valuable time. Real progress happens outside the OR.
2. Stop Blaming the Machine, the Eye, or the Instruments
It’s easy to blame external factors when a case goes badly. You might think:
“The nucleus was too hard.”
“The fluidics were off.”
“The phaco settings weren’t right.”
While these factors do play a role, they are never the real reason you struggled.
The best surgeons operate well under all conditions because they adapt quickly and take full ownership.
The Shift: Own Your Results, No Excuses
Mastery starts when you stop blaming and start analyzing your own role in the outcome.
How to Apply This Mindset:
I. After every difficult case, ask yourself:
- Could I have adjusted my technique differently?
- Did I anticipate potential issues, or did I react too late?
- How would an experienced surgeon have handled this case?
II. Understand Phaco Machine Settings – Instead of blaming the settings, learn how to customize them to suit your style and case type. If you don’t know exactly why each setting is used, you’re operating blindly.
III. Develop a Systematic Approach – The best phaco surgeons don’t rely on trial and error. They have a methodical plan for every single case, from soft nuclei to hypermature cataracts.
The moment you take full responsibility for your surgical outcomes, your learning curve accelerates dramatically.
3. Embrace Slow, Deliberate Movements
One of the most common beginner mistakes is rushing through surgery. Many residents feel pressure to operate quickly, which leads to:
- Erratic probe movements that make fragmentation inefficient.
- Unnecessary ultrasound energy, increasing endothelial cell loss.
- Chamber instability, causing surge and complications.
The Shift: Move Like a Sniper, Not a Machine Gunner
Instead of making rapid, reactive movements, focus on precision and control.
How to Apply This:
I. Stabilize Your Hands– Avoid sudden jabs or large sweeps. Instead, move in small, calculated increments. Every motion should be intentional.
II. Predict What Happens Next– Don’t just react to the eye—think one step ahead. If you’re chasing fragments impulsively, you’re already losing control.
III. Use Efficient Energy– Instead of relying on brute force, use minimal phaco power with proper fluidics. This prevents unnecessary endothelial damage and improves followability.
Surgical speed comes not from moving faster but from moving with precision.
4. Get Comfortable with Discomfort
Many residents struggle because they avoid the difficult parts of surgery. They hesitate during nucleus cracking, feel unsure about chopping techniques, or stick to soft cases because they fear complications.
The Shift: Learn to Love the Struggle
Mastery is built by leaning into discomfort, not avoiding it.
How to Apply This:
I. Accept That Struggle is Normal– The first 50-100 cases will feel awkward. The difference between those who improve and those who plateau is who is willing to push through discomfort.
II. Deliberately Practice Your Weak Points– Instead of avoiding tough cases, actively seek them out under supervision. The cases that challenge you are the ones that make you better.
III. Use Failure as Data– Instead of fearing complications, treat every mistake as information. The best surgeons aren’t the ones who never struggle—they’re the ones who learn the fastest from their struggles.
Growth happens exactly where you feel the most discomfort.
5. Detach Your Ego from the Outcome
Phaco surgery exposes weaknesses brutally. If your technique is flawed, the eye will not cooperate. Many surgeons take this personally, feeling humiliated after a difficult case or trying to prove themselves by taking on cases they’re not ready for.
The Shift: See Every Case as Data, Not a Judgment
The best surgeons are hyper-objective about their results. They don’t let emotions cloud their learning.
How to Apply This:
I. Review Every Case Without Emotion– Whether you had a great case or a disaster, analyze it with curiosity, not self-judgment.
II. Separate Learning from Performance– Your current skill level does not define your potential. If you have a bad case, it doesn’t mean you’re a bad surgeon—it means there’s something valuable to learn.
III. Develop a Continuous Improvement Mentality– The best phaco surgeons never think they’ve “arrived.” They are always refining, adjusting, and evolving.
Detach your self-worth from your surgical performance, and you’ll improve much faster.
Final Thoughts
Mastering phacoemulsification is not just about technique— it’s also about mindset. If you’re struggling, your mental approach needs to change before your hands do.
The 5 Key Mental Shifts to Internalize:
- Train outside the OR—don’t rely on experience alone.
- Take full ownership—no blaming external factors.
- Slow down—precision beats speed.
- Push through discomfort—growth happens in struggle.
- Treat every case as data—detach ego from performance.
Make these shifts, and you’ll transition from struggling with phaco to mastering it with confidence.