Journal of Academic Ophthalmology
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Integrating internship into ophthalmology residency: Assessment of a national survey and structured microsurgical curriculum
No full textObjective: To report the results of a national survey soliciting residency programs’ microsurgical curricula for ophthalmology interns, and the efficacy of a single institution’s intern microsurgical wet lab curriculum.
Design: Mixed methods study including a national survey and a prospective trial.
Setting: Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA. Tertiary care institution.
Participants: In this two-part study, an electronic survey soliciting intern microsurgical curricula was distributed to all accredited ophthalmology residency programs nationwide. Additionally, interns at the study institution (n = 10) were evaluated on speed and quality of a corneal suturing task prior to and following completion of an eight-session microsurgical curriculum. Post-curriculum intern performance was also compared to the performance of first-year ophthalmology residents (n = 5) without an internship microsurgical curriculum.
Results: Twenty-four percent of programs responded (n = 27). All programs had a microsurgical wet lab but only five (19%) had a structured curriculum for interns. Most programs described little emphasis on intern microsurgical training and a need for increased guidance on incorporating intern instruction. Interns (n = 10) showed significant improvement in time to task completion (P=0.002, 95% CI: 0.76 to 1.51) and technical performance (P= 0.02, 95% CI: 0.44 to 3.21) after curriculum completion. Compared to PGY-2 (curriculum-naïve) residents, interns were faster and performed better, but these differences were not statistically significant.
Conclusion: Few ophthalmology residency programs offer microsurgical training during internship. Our structured microsurgical curriculum significantly improved intern microsurgical skills. Nationwide integration of the internship year into ophthalmology residency provides a valuable opportunity to commence microsurgical training
Specialty Distribution and Treatment Methods of Eyelid Lacerations in a Tertiary Care Center: Implications for Resident Education in Ophthalmology
No full textBackground
While eyelid laceration repairs can be performed by many different specialties, literature investigating the incidence of such repairs is limited. If the majority of these repairs are performed by other, non-ophthalmology specialties, there may be limited opportunities for ophthalmology residents to gain the necessary skills and meet Accreditation Council for Graduate Medical Education (ACGME) case log requirements. The purpose of this study was to determine the frequency of eyelid lacerations and respective treatment methods performed by different specialties within a tertiary care center.
Methods
A retrospective chart analysis was performed. The electronic health record was queried to identify cases of eyelid laceration between 2011 and 2020 at Rush University Medical Center, a tertiary care center in Chicago, Illinois, USA. The treating physician medical specialty and treatment method were recorded.
Results
Of the 468 total cases of eyelid laceration identified, 303 (64.74%) were treated by emergency medicine, 98 (20.94%) by ophthalmology, 27 (5.77%) by plastic surgery, 20 (4.27%) by primary care, 11 (2.35%) by pediatrics, and 9 (1.92%) by otolaryngology. Of the total number of cases, 310 (66.24%) were treated using sutures. Suture-treatment occurred during 181 (59.74%) of emergency medicine’s total cases, 86 (87.76%) of ophthalmology’s total cases, 26 (96.30%) of plastic surgery’s cases, 6 (30%) of primary care’s cases, 3 (27.27%) of pediatrics’ cases, and 8 (88.89%) of otolaryngology’s cases. Year of presentation significantly affected the number of cases that ophthalmology treated, with ophthalmology cases increasing over time (p=0.032).
Conclusions
Although ophthalmology-involvement has increased throughout the years, ophthalmology was only involved in a minority of total eyelid laceration cases while emergency medicine was involved in most cases. The findings of this study highlight the importance of supporting ophthalmology residents to gain exposure completing eyelid laceration repair to meet ACGME case log requirements. Collaborations with other specialties may be necessary to ensure that residents have sufficient opportunities to gain these required skills. Additionally, targeted programs for ophthalmology residents to be involved with the diagnosis and management of eyelid lacerations may help to improve this involvement and provide residents with the opportunity to meet ACGME requirements
Evaluating the Effectiveness of Personalized Wet Lab Training on Phacoemulsification Surgery Learning Curve
No full textPurpose To assess the impact of individualized one-on-one wet lab training on the learning curve of phacoemulsification cataract surgery among ophthalmology residents. Methods This prospective study involved 15 ophthalmology residents at a single institution between 2016 and 2019. Each resident participated in tailored training sessions focusing on phacoemulsification surgical steps, guided by an experienced cataract surgeon. Proficiency across 11 procedural steps was evaluated using a 5-level ordinal scale, and data on complications, case times, and proficiency scores were collected and analyzed using multiple regression models. Competency was defined as resident trainee performance of a surgical case without complication and level 3 proficiency for all steps, all within 1 standard deviation (SD) of the average attending surgical time. Univariate logistic regression modeling was used to model outcomes of complication and competency with difficulty as the independent variables, each performed separately. All models utilized general estimating equations with an exchangeable correlation to account for multiple records from residents. A p-value
disassembly and removal. A marked decrease in complications in later cases (beyond 100 surgeries) was noted. Complication rates were much higher when case was scored as difficult (2.3% among cases that were not difficult, 14.6% among difficulty score of 1, and 21.0% among difficulty score of 2). Full proficiency in all 11 surgical steps rose from 5.0% in the first quintile to 90.7% in the final quintile of surgical cases. Conclusions Personalized wet lab training allowed for expedient and efficient resident mastery of phacoemulsification cataract surgery. This training method was associated with a short time to achieve proficiency in some of the most challenging steps reported by residents, such as cortex removal, wound integrity, and capsulorrhexis. The number of prior cases and the degree of difficulty remained the most significant predictors of surgical competency. Offering more tailored training sessions with progressively challenging models, particularly in the later years of ophthalmology residency, could further improve educational outcomes and patient safety
A Bibliometric Analysis of Social Perception and Academic Trends on Gender and Race in Ophthalmology
No full textBackground: Gender and race disparities in ophthalmology have gained increased attention in recent years due to their clinical and societal significance. This study aimed to assess the number of publications related to gender and race in ophthalmology, factors associated with increased scholarly impact, determine journals with the greatest output, and identify leading institutions and countries contributing to this literature.
Methods: This bibliometric analyzed published literature from January 2000 to June 2022. Article publication year, authors, journal, citations, institution, and country were collected. Focuses included history/biographies, career analysis, pay gap, recruitment/retention, scholarly productivity, training, and disparities. Citations per year, total citations, and article age were compared using Pearson’s correlation and Spearman’s test. PubMed, Scopus, and Web of Science databases were queried using custom terms, including “woman,” ophthalmology,” and “race.” Articles in English discussing the perception of race and gender within ophthalmology.
Results: Ninety-seven articles were analyzed, including 67 articles on gender and 30 articles on race. Research on gender and race in ophthalmology has increased from 2000 to 2022. Citations per year were associated with total citations (r=0.814; p
Conclusions and Relevance:
Trends in literature addressing gender and racial disparities in ophthalmology show a recent and growing field. Further work should evaluate factors that can overcome barriers in race and gender within ophthalmology
OphthoPods: An Analysis of the Educational Content and Changes of Ophthalmology Podcasts
No full textObjective
Podcasts are a novel modality for digitally disseminating ophthalmic knowledge, yet minimal information exists on their offerings. This study sought to describe the growth of ophthalmology podcasts, characterize their features, and analyze clinically pertinent content trends.
Materials and Methods
Apple Podcasts, Spotify, Google Podcasts, and Google Search were queried for English-language shows relating primarily to ophthalmology. Ninety-six podcasts and 3,594 episodes were analyzed.
Results
Of the 48 currently active shows, most cover general ophthalmology topics (n = 25, 52.1%) and are run by multiple hosts (n = 29, 60.4%) in both academics and private practice. The majority of podcasts released episodes monthly (n = 21, 21.9%) or less frequently than monthly (n = 36, 37.5%). Among all episodes, procedural topics (n = 951 episodes, 26.4%) and clinical education (n = 1385, 38.5%) were the most prevalent categories. Retina was the most represented subspecialty in podcast production, while oculoplastics and neuro-ophthalmology had the fewest podcasts. Episodes on disease pathophysiology (p = 0.04) and published research (p \u3c 0.001) each declined over time. The proportion of episodes released from 2020 to 2022 that discussed digital technologies was 33.3% greater versus 2005 to 2019 (p = 0.005). Personal retrospective episodes doubled, career guidance and patient perspectives tripled, and wellness and social justice topics increased fivefold (all p \u3c 0.001).
Conclusion
In summary, the coronavirus disease 2019 pandemic coincided with a rise in ophthalmology podcasts and shifts in content. Podcasts have trended toward practical advice and technologies, reflecting their value in sharing modern, peer-to-peer pearls. Emphases on storytelling and social justice offer unique, clinically relevant perspectives compared with traditional modalities
The Big Data Gap: Asymmetric Information in the Ophthalmology Residency Match Process and the Argument for Transparent Residency Data
No full textBackground
The ophthalmology match is an important step for graduating medical students that defines their future career. Residency programs demonstrate significant variability due to differences in size, location, research output, subspecialty exposure, surgical case load, and alumni fellowship/practice placement. Despite the importance of informed decision-making, applicants often find limited, inconsistent information about potential programs.
Purpose
The purpose of this study was to characterize and identify gaps in the information available to residents in the 2022 to 2023 Match.
Methods
The SFMatch Web site was reviewed to identify programs included as well as characteristics cited on each program\u27s webpage. Program webpages were used to evaluate availability and consistency of data on site surgical caseload, fellowship slots, and teaching staff.
Results
Of the 121 programs included on SFMatch, 23 (19%) provided no data on August 15, 2022 (15 days prior to application submission deadline) and 9 (7%) lacked program data on October 15, 2022. Though most programs provided mean cataract volume, data on volume of other procedures for graduating residents was highly variable and occasionally misleading. Programs did not provide information on several academic and social considerations that may influence match ranking choice.
Conclusion
Applicants often must read “between the lines” to identify residency program strengths and weaknesses. Data crucial to informing the application process remain sparse, unavailable, or spread across resources. Limited data increases applicant dependence on word-of-mouth knowledge to inform decision-making. This might reduce diversity by limiting successful applicants to those with existing connections within the field
Gender representation of presenters at American Academy of Ophthalmology conferences from 2004-2019
No full textImportance: Gender equity is an important topic in medicine and accurate trends are essential to evaluate historical, current, and future trends.
Objective: To describe changes in gender representation at American Academy of Ophthalmology (AAO) meetings from 2004 to 2019.
Participants: Presenters at the American Academy of Ophthalmology meetings from 2004 to 2019.
Design & Setting: This is a retrospective cross-sectional study. Data was extracted using AAO annual and subspecialty meeting archives for every third year between 2004 and 2019. Sessions were stratified by category and subspecialty. Poster sessions were excluded. Gender was considered binary and determined using pronouns or photographs from professional websites when available and the gender-api name tool when individual information was not available.
Main outcome measures: Proportion of gender of the presenters at the American Academy of Ophthalmology within respective specialties with a focus on surgical vs clinical sessions.
Results: The proportion of female presenters at AAO meetings increased between 2004 and 2019 from 13% to 29%. The largest changes were observed for oncology (net +28%, 1.85%/year increase, OR 1.09) and oculoplastics (+25%, 1.66%/year increase, OR 1.106). For surgical sessions, the increase in proportion of female speakers fell short of the overall increase in representation in comprehensive (+16% overall vs. +13% for surgical sessions), glaucoma (11% vs. 7%), and pediatrics (+17% vs. -1%). The increase in female representation among surgical session presenters did not exceed the overall increase for any subspecialty. For clinical sessions, the proportion of female leaders exceeded the overall increase in cornea (20% cornea vs. 13% overall), neuro-ophthalmology (15% vs. 9%), and pediatrics (35% vs. 17%).
Conclusions: Female representation among presenters at the AAO annual and subspecialty meetings increased between 2004 and 2019 for all subspecialties. For many subspecialties, there was a proportionally slower rate of increase in female representation among surgical session presenters and faster rate of increase for clinical sessions
Representation of Women at Select Academic Ophthalmology Institutions in the United States
No full textPurpose: To investigate the representation of women among ophthalmology faculty members at select academic institutions in the United States (US).
Design: Cross-sectional study
Subjects: Clinical faculty members at the top 20 academic ophthalmology institutions in the U.S. according to US News and World Report ranking
Methods: Gender as reported on institutional websites either directly or via pronouns, academic rank, medical school graduation year, and subspecialty were collected about clinical faculty members with MD, MD/PhD, MBBS or DO from their respective institutional websites. The number of publications for each faculty member was collected using Scopus ® (Elsevier, Netherlands). One way z-test was used to compare proportions, and an independent t-test was used to compare means.
Main Outcome Measures: Gender proportions across data points described in the Methods.
Results: Women comprised 416 (38%) of the 1099 ophthalmology faculty members reviewed (z-statistic: -0.43, p
Conclusion: There remain more men than women at some of the top academic ophthalmology institutions in the US and significantly fewer women at the full professor rank. This gap in representation appears to be narrowing over time. Additional efforts to reduce the challenges faced by women in academic ophthalmology may narrow this gap further
Accuracy and Utility of Internet Image Search as a Learning Tool for Retinal Pathology
No full textAbstract
Purpose Ophthalmology residency training heavily relies on visual and pattern recognition-based learning. In parallel with traditional reference texts, online internet search via Google Image Search (GIS) is commonly used and offers an accessible fund of reference images for ophthalmology trainees seeking rapid exposure to images of retinal pathology. However, the accuracy and quality of this tool within this context is unknown. We aim to evaluate the accuracy and quality of GIS images of selected retinal pathologies.
Methods A cross-sectional study was performed of GIS of 15 common and 15 rare retinal diseases drawn from the American Academy of Ophthalmology residency textbook series. A total of 300 evaluable image results were assessed for accuracy of images and image source accountability in consultation with a vitreoretinal surgeon.
Results A total of 377 images were reviewed with 77 excluded prior to final analysis. A total of 288 (96%) search results accurately portrayed the retinal disease being searched, whereas 12 (4%) were of an erroneous diagnosis. More images of common retinal diseases were from patient education Web sites than were images of rare diseases (p \u3c 0.01). Significantly more images of rare retinal diseases were found in peer-reviewed sources (p = 0.01).
Conclusions GIS search results yielded a modest level of accuracy for the purposes of ophthalmic education. Despite the ease and rapidity of accessing multimodal retinal imaging examples, this tool may best be suited as a supplementary resource for learning among residents due to limited accuracy, lack of sufficient supporting information, and the source Web site\u27s focus on patient education
Virtual Ophthalmology Rotation for Visiting Medical Students: An Opportunity to Enhance Diversity in the Workforce
No full textAbstract
Introduction We created a virtual rotation to facilitate the exposure of ophthalmology to medical students and serve as a pilot program to help attract students from under-represented in medicine (URM) backgrounds. In addition to the rotation eliminating the financial burdens associated with in-person away rotations, we offered a not-for-credit (i.e., drop-in) option that included sessions outside the typical clinic hours. This option reduced scheduling conflicts as a barrier to enrollment and allowed junior medical students and postgraduates to participate and hopefully further develop an interest in ophthalmology.
Methods Before the rotation, participants completed a pre-test and a survey to collect data on learners\u27 backgrounds and interest in applying for ophthalmology residency. The rotation included live lectures, case-based discussions, chart reviews, and guided self-study. Following the rotation, participants completed a post-test and a survey to query applicants on the online rotation\u27s utility and delivery.
Results Eleven learners enrolled in the course and completed the prerotation survey and test. Approximately one-third (4/11; 36%) were URM students and two-thirds (7/11; 64%) were female. All responded they were planning to apply for ophthalmology residency. All responded they strongly agreed that the rotation increased their general knowledge in ophthalmology, and 89% (9/11) strongly agreed that it improved their ability to diagnose and manage actual patients. Nearly all (7/8; 87.5%) strongly agreed the rotation provided the opportunity to seek support for the residency application process, and all found the online platform reliable and easy to access. Exam scores improved significantly from pre- to post-tests (60 vs. 79%; p \u3c 0.01).
Conclusions The rotation attracted a substantial proportion of URM students. Learners reported that the virtual rotation effectively taught and supported their endeavors to become ophthalmologists. Virtual rotations for visiting students can reduce barriers such as travel, financial costs, and time constraints that might otherwise hinder exposure to specialty training that is not offered or is underrepresented at students\u27 home institutions. Increasing exposure and offering mentorship through this novel platform deserves further study to enhance diversity and inclusion in medicine