Journal of Academic Ophthalmology
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Implementing a “Surgery Olympics” in Ophthalmology Residency: A Pilot Study
No full textBackground/Purpose: Surgical residency programs seek innovative ways to teach and assess resident surgical skills. Significant barriers include motivating residents to practice given the time commitment of residency and limited availability of attending faculty outside of clinic time to lead teaching sessions. A Surgery Olympics program was implemented within the Northwestern Ophthalmology Residency program to promote mentorship between the senior and junior classes, resident camaraderie, and excitement for surgical training. This program was modeled after a similar program for medical students at the University of Michigan’s general surgery department. Methods: We divided residents into four families, with each family having one resident per post-graduate year (PGY) class. Two Surgery Olympics events were held, one in the summer and one in winter in which residents were given 10 minutes to complete surgical tasks specific to their PGY class. The resident’s performance was graded by an attending ophthalmologist based on various parameters, including the time taken to complete the task. Residents were surveyed prior to and after the Surgery Olympics program\u27s initiation to gauge the effect on surgical training and motivation to practice in the microsurgical laboratory. Results: Questionnaires prior to the Olympics indicated that 4 in 10 residents practiced \u3c 2 hours a month with an average practice time of 4.65 hours per month. Questionnaires following the Olympics indicated an increase in practice to 8.80 hours per month, with only 1/11 residents practicing less than 2 hours a month. Before the Olympics, residents cited confidence in the OR and having attendings turn over more surgical cases as motivating factors to practice. They cited a lack of a defined surgical curriculum, mentorship, and protected time outside their busy residency schedules as barriers to practicing. Following the Olympics, residents felt improved motivation, quality, and efficiency in performing surgical training skills and felt the Olympics program increased class camaraderie. Conclusion: Adoption of a surgical Olympics program may help increase microsurgical practice time, identify residents with potential issues through a formal grading process, excite residents about surgical training, improve camaraderie, and create strong mentorship bonds between classes
The relationship between open access article publishing and short-term citations in ophthalmology
No full textPurpose: In recent years academic journals have increasingly transitioned to a paid open access (OA) model. The present study aims to identify whether OA or subscription access (SA) influences short-term citations of articles in ophthalmology. Methods: The Dimensions database was queried in October 2022 for articles published in 2019 in the following journals with both open and subscription access options: Ophthalmology, American Journal of Ophthalmology, JAMA Ophthalmology, Graefe\u27s Archive for Clinical and Experimental Ophthalmology, and British Journal of Ophthalmology. Article access, citations, country, article type (review, letter/viewpoint/comment, original investigation), study type (basic science/animal model, case report/series, clinical trial, NA, observational) and subspecialty topic were recorded. Articles with a minimum of 5 citations were included. Results: 509 OA and 602 SA publications were included. The majority of articles were US-based (37.6%), observational (57.9%) original investigations (88.8%) that were focused on retina/uveitis (40.4%). There was a significant difference between the mean number of SA citations versus OA publications between original investigations (15.86 vs 25.3 respectively, P \u3c .001) and all articles (16.29 vs 25.04 respectively, P \u3c .001). According to multivariate Poisson modeling, SA status is significantly associated with a lesser number of citations compared to OA articles after adjusting for journal, article type, and subspecialty topic (β=-.284, 95% CI= -.313, -.254, P\u3c .001). Conclusions: Our results indicate a significant association between SA and decreased short-term citations compared to OA articles. Increasing article accessibility and decreasing financial barriers to publishing with OA may facilitate enhanced diffusion and impact of information in ophthalmology
Pilot and One-year Follow-up of a Novel Hybrid Ophthalmology Elective Course for Preclinical Students
No full textBackground: Preclinical elective courses, particularly in a hybrid format, may facilitate ease of access, increase exposure, and build interest in ophthalmology.
Purpose: To evaluate knowledge acquisition and interest in ophthalmology immediately after and 1 year after implementing a novel elective course.
Methods: We developed an optional, 8-session, hybrid elective course based on the American Academy of Ophthalmology objectives for medical students. The course included virtual didactics and in-person skills sessions. Each virtual session focused on an ophthalmic subspecialty and consisted of a facilitated case review followed by an interactive career-related discussion with a faculty member practicing that subspecialty. Cases were drawn from 20/20 SIM (2020sim.com), a free, online ophthalmology educational tool modeled after NephSIM. In-person teaching sessions covered the ophthalmic physical examination and basic microsurgical skills in a wet lab format. Participants were invited to complete anonymous pre-, post-, and 1 year post-course surveys assessing foundational ophthalmic knowledge and interest in the field. Survey score differences were analyzed using the Wilcoxon signed-rank test.
Results: Of 21 participants, 14 (67%) completed both pre- and post-course tests and surveys, of whom 10 were first-year (MS1) and 4 were second-year (MS2) medical students. Twelve (57%, 8 MS1, 4 MS2) completed the 1-year follow-up survey. Respondents attended on average 6.5 ± 1.33 of 8 sessions. Participant scores on knowledge questions increased from 79% to 94% from pre- to post-test (p = 0.003). Eleven of 14 participants (79%) found the skills sessions to be the most useful part of this course. Interest in ophthalmology following the course was 3.67 ± 0.94 of 5. Six students (6/14 [43%]) reported increased interest citing reasons related to “diverse subspecialty and career possibilities,” “surgical procedures,” and “more knowledge and understanding” of ophthalmology and physical examination techniques. In contrast, 3 students (21%) reported decreased interest, citing reasons related to the field being “too specialized.”
Conclusion: In our pilot course, participants demonstrated increased knowledge and interest in ophthalmology. Further studies should explore the long-term impacts of such an elective on ophthalmology interest
Analyzing the Role of AI in Resident Education: An Evaluation of ChatGPT on Ophthalmology Trainee Examination Questions by Subtopic
No full textBackground: ChatGPT is a large-scale language model trained on various datasets to learn, analyze, and generate human-like answers to user’s questions. To assess its applicability to medical education, more information is required to understand whether its analyses can provide accurate and coherent responses to questions. The aim of this study was to characterize ChatGPT responses to ophthalmology questions according to subtopic to determine where the system might be used reliably in resident education and where its performance remains weak.
Methods: Ophthalmology questions were obtained from a widely utilized study resource, OphthoQuestions. Thirteen sections, each with a differing ophthalmic subtopic, were sampled, and questions were collected from each section. Questions containing images or tables were excluded. Of 163 questions and their respective answer choices, 131 were input into ChatGPT-3.5. The accuracy of ChatGPT by subtopic was analyzed using Excel. ChatGPT responses were evaluated via the properties of natural coherence. Incorrect responses were categorized as logical fallacy, informational fallacy, or explicit fallacy. Statistical significance of categorical variables were analyzed using the χ2 test.
Results: ChatGPT answered 71 of 131 questions correctly (54.2%). Accuracy in each subtopic was as follows: general medicine (90%), oculoplastics (70%), retina and vitreous (70%) cornea (30%), fundamentals (40%), optics (40%), pediatrics (40%), glaucoma (50%), lens and cataract (50%), neuro-ophthalmology (60%), pathology and tumors (60%), refractive surgery (55), and uveitis (50%). Logical reasoning, internal information, and external information were identified in 82.4%, 100%, and 83.2% of the responses, respectively. The use of logical reasoning (P = 0.003) and external information (P = 0.02) was found to be statistically significant when stratified by correct and incorrect responses.
Conclusion: ChatGPT scored higher in general medicine, oculoplastics, and retina and vitreous than in cornea, fundamentals, optics, and pediatrics. Identifying subtopics in which ChatGPT performs less well allows learners to acquire appropriate supplemental resources in these areas
Michigan Ophthalmology Pathway Program: Five Years of Aiming to Increase Diversity in Ophthalmology
No full textIntroduction: Ophthalmology is one of the least diverse medical subspecialties. The Michigan Ophthalmology Pathway (MOP) Program was created at the University of Michigan Medical School in 2017 to promote diversity in ophthalmology through early exposure and longitudinal mentorship for medical students from underrepresented backgrounds (URiM). This innovative institution-level model aimed to increase URiM student interest in ophthalmology and help URiM students develop competitive residency applications. Methods: Each year, first-year medical students (M1) and residents (PGY2) were invited to apply to MOP. MOP mentees were matched one-to-one with an ophthalmology resident mentor whom they shadowed for six days in the clinic and the operating room. Additionally, medical students participated in educational and social events and received guidance and financial support to pursue research in ophthalmology. At the completion of the mentees’ M1 year, both students and residents were surveyed on their satisfaction with the program and changes in their skills and knowledge. The number of graduating MOP mentees who successfully matched at an ophthalmology residency program was also examined. Results: Over five years, 31 M1 mentees and 29 PGY-2 residents participated in MOP. Surveys were completed by 74.2% of mentees and 79.3% of mentors. Feedback regarding the program was nearly entirely positive: 95.7% of mentee respondents felt “very satisfied” or “satisfied” with MOP overall. Mentees agreed that MOP provided educational value (4.04/5 [1 being strongly disagree, 3 neutral, and 5 strongly agree]), increased their ophthalmology knowledge (4.48/5), and increased their interest in ophthalmology (4.04/5). Residents also found the program valuable: 81.8% of respondents would recommend MOP to others. Of the six graduated mentees, one applied and matched into ophthalmology residency while another intends to pursue neuro-ophthalmology. The remaining four mentees chose other medical specialties. Conclusion: The Michigan Ophthalmology Pathway Program successfully increased ophthalmology exposure, interest, and knowledge among URiM participants. Although only one of six graduated mentees pursued ophthalmology, six mentees currently in their third and fourth years of medical school are applying or planning to apply into ophthalmology. As MOP continues, additional student outcomes data will contribute to evaluating its impact
Analyzing the Feedback Trends and Perceived Benefits to Residents of an Ophthalmology Overnight Consultation Review System
No full textPurpose
To review all weeknight consults seen since the implementation of the review system to assess how often our night float (NF) residents are making appropriate clinical decisions and receiving educational points.
Methods
This was a retrospective, comparative chart review of all patients that received an ophthalmology consult resident on call from April 2022 to December 2022. The Experienced Group included 5 residents at the end of their PGY-2 year (April-July). The Inexperienced Group included 5 residents beginning their PGY-2 year (July-December). The spreadsheet of consults seen was reviewed for how often the plan was changed and how often educational points were made by the program director (PD). A survey was also conducted to determine how supported they felt and how beneficial they felt the review process was for patient care and resident education.
Results
A total of 586 consults were reviewed by the PD. As compared to the Experienced Group, the Inexperienced Group had a significantly higher rate of patient management plans changed (p=0.001) and a higher rate of changes to a plan a senior resident was involved in (p=0.001). The two groups had a similar frequency of learning opportunities: 45% of the cases in the Inexperienced Group and 32% in the Experienced Group (p=0.136). 60% of the residents in the participating class reported feeling much more supported and 75% of the responding residents felt it was very beneficial for patient care and their education.
Conclusion
The night float oversight system has increased the safety of patients, while also providing critical learning opportunities for PGY-2 residents. Other residency programs who use NF may find these results helpful in developing their own review systems
Quantifying Research Productivity among Matched Ophthalmology Applicants: Insights from the 2024 Residency Cycle
No full textBackground: Matching into ophthalmology has become increasingly competitive, with the overall match rate declining from 78% in 2020 to 66% in 2024. With the transition of USMLE Step 1 to pass/fail, residency selection committees may place greater emphasis on other objective metrics, including research productivity, which appears to be growing in significance.
Purpose: To quantify the research output of matched ophthalmology applicants in 2024 and to correlate descriptive statistics for research productivity with matching into top programs.
Methods: A publicly available medical student–maintained spreadsheet was used to identify matched applicants in 2024. Data was cross-verified using SF Match records, residency websites, and social media. Research output was assessed through PubMed searches, and publications were categorized as pre-application, post-application, or excluded. Ophthalmology-specific publications and authorship positions were recorded. Subgroup comparisons were analyzed by t testing, and multivariate logistic regression was used to determine predictors of matching into a top 25 residency program.
Results: A total of 502 matched applicants were analyzed. The average applicant had 4.00 ± 6.51 total publications prior to application submission and 1.58 ± 1.14 additional publications afterward. Applicants from medical schools with home ophthalmology programs had significantly greater pre-application total and first-author publications than those without home programs (p \u3c 0.001). International applicants had significantly higher research output than US MD/DO applicants (p \u3c 0.01). Compared with previous cohorts, the 2024 class demonstrated a notable increase in research output. Multivariate regression analysis found that attending a top 10 medical school was the strongest predictor of matching into a top 25 residency program (p \u3c 0.001). Number of first-author publications was also significant (p \u3c 0.05).
Conclusion: Research productivity among matched ophthalmology applicants has increased in recent years. International applicants and those from institutions with home programs tend to have higher research output. Additionally, attending a top 10 medical school and having first-author publications are significant predictors of matching into a top 25 residency. Future studies should explore additional factors to further refine the key predictors of matching success
Characterizing core journals in ophthalmology literature using Bradford’s law: a bibliometric analysis
No full textPurpose: The exponential growth of ophthalmology research can be challenging to keep up with for trainees, researchers and clinicians and little has been done to identify core ophthalmology journals. We thus applied Bradford’s law to characterize core journals in ophthalmology.
Design: Cross-sectional bibliometric analysis
Methods: Two sets of top 10 National Library of Medicine indexed ophthalmology journals based on h-index and impact factor (IF) were combined to create top 14 journals used for analysis. The references from all articles published in these journals in one randomized quarter were compiled into a citation database. Bradford’s law was applied to identify zonal distribution of journals.
Results: A total of 3093 journals containing 34633 articles were cited in ophthalmology literature from July-Sept 2022. Under linear regression, IF was significantly associated with h-index for the top 20 journals (P2=0.996), validating Bradford’s law.
Conclusions: Six core ophthalmology journals were identified: American Journal of Ophthalmology, Investigative Ophthalmology & Visual Science, Ophthalmology, JAMA Ophthalmology, British Journal of Ophthalmology, Journal of Cataract & Refractive Surgery. These highly cited core journals may serve as high-yield resources for describing the latest advances in ophthalmology research and may guide ophthalmology trainees and educators with their learning and teaching
Evaluating Ergonomics Education in United States Ophthalmology Residency Programs
No full textBackground: Musculoskeletal disorders are prevalent among ophthalmologists because of occupational risks that include repetitive movements and uncomfortable postures. Teaching proper ergonomic practices early in an ophthalmologist’s career may help avoid outcomes such as chronic pain and early retirement.
Purpose: To investigate the level of formal ergonomics education in U.S. ophthalmology residencies.
Methods: An Association of University Professors of Ophthalmology (AUPO) approved survey was distributed to program directors and coordinators of 113 residency programs via the AUPO email listserv.
Results: The survey had a response rate of 33.6%. Of the 38 programs that responded, only 13 (34.2%) had a formal ergonomics curriculum. The average instruction time was 2.25 hours per year, with didactic sessions being the primary mode of education. Although 80% of respondents from programs with ergonomics curricula considered ergonomic education “very important,” only 60% of those without formal curricula did.
Conclusion: Despite sporadic teaching in some programs, there is a significant gap in standardized ergonomics education across residencies
A Cross-Specialty Approach: Implementation and Evaluation of a Pilot Medical Student Ophthalmology Curriculum Integrated in an Emergency Medicine Rotation
No full textProblem
Exposure to clinical ophthalmology among medical students has been declining, leading to a lack in confidence in ophthalmic knowledge and skills among physicians. Innovative curricular strategies are needed to increase exposure to ophthalmology. We aimed to evaluate a novel integrated emergency ophthalmology curriculum developed and implemented by both ophthalmology and emergency medicine (EM) departments.
Methods
A novel ophthalmology curriculum combining didactic and clinical components was integrated into an EM elective. Medical students received a 1-hour didactic lecture focused on ocular emergencies and the bedside eye examination. During their rotation, students were assigned to independently evaluate patients with ocular chief complaints. They then received direct feedback by evaluating the patient alongside an ophthalmology resident. Pre-intervention and post-intervention surveys were developed to assess gains in medical student knowledge and self-assessed confidence in physical examination skills and independence in evaluating patients with eye complaints.
Results
67 students received the intervention from November 2022 to October 2023. 14 (20.9%) completed the pre-assessment and 15 (22.4%) completed the post-assessment. Comparing grouped pre- and post-intervention scores, there were significant gains in knowledge (pre mean score 7.14/10, post mean score 8.27/10; p=0.03). Using a 1-5 Likert scale, students felt more confident to independently evaluate patients with ocular chief complaints (pre mean 1.5, post mean 2.93; p= 0.001). There were significant gains in confidence in physical examination skills and history taking. Confidence improved in the ability to identify vision threatening diseases (pre mean 2.50, post 3.53; p=0.002), and knowing when to call for an ophthalmology consultation (pre mean 2.50, post 3.60; p=0.003).
Conclusion
This study of a novel ophthalmology curriculum for medical students integrated in an emergency medicine rotation demonstrated feasibility and improvement in both knowledge and self-reported independence in evaluating patients with ocular complaints in the emergency department. The curriculum could be enhanced by incorporating clinical exams skills sessions and implementing higher measures of outcomes