Journal of Academic Ophthalmology
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Antibiotic Protocols for Endophthalmitis Prophylaxis Following Open-Globe Repair: A Survey of U.S. Residency Programs
No full textAbstract
Purpose To assess the various approaches to endophthalmitis prevention following traumatic open-globe injury (OGI) repair.
Methods A research electronic data capture (REDCap) questionnaire evaluating the usage of antibiotics and steroids in patients with OGI was distributed to program directors of all U.S. ophthalmology residency programs using the Association of University Professors of Ophthalmology program directors\u27 listserv. Completed questionnaires were analyzed for treatment patterns.
Results The REDCap questionnaire was distributed to 111 programs, with 32 residency programs responding. Two responses were excluded. Ninety percent (27/30) of included programs used perioperative intravenous (IV) antibiotics, with 78% (21/27) of those giving one dose only. At the time of surgery, 27% (8/30) of programs gave intravitreal antibiotics and 60% (18/30) gave subconjunctival antibiotics. Postoperatively, 100% (30/30) gave topical antibiotics and 97% (29/30) gave topical steroids. Only 53% of responders discharged patients on oral antibiotics. Of the three programs who did not use IV antibiotics, all three gave intravitreal therapy and one also discharged patients on oral antibiotics.
Conclusion There is a large variation in practice patterns for endophthalmitis prophylaxis among residency programs. Further investigation is needed to compare rates of endophthalmitis between these protocols and establish a safe and minimally burdensome standard of care
A Bibliometric Analysis of Ophthalmology Resident Research Productivity in the United States
No full textAbstract
Background The extent and impact of ophthalmology resident scholarly output is not well known. The authors aim to quantify scholarly activity of ophthalmology residents during residency and assess what factors may be associated with greater research productivity of these residents.
Material and Methods Ophthalmology residents who graduated in 2021 were identified from their respective program Web sites. Bibliometric data published by these residents between the beginning of their postgraduate year 2 (July 1, 2018) until 3 months after graduation (September 30, 2021) were captured through searches via PubMed, Scopus, and Google Scholar. The association of the following factors with greater research productivity numbers was analyzed: residency tier, medical school rank, sex, doctorate degree, type of medical degree, and international medical graduate status.
Results We found 418 ophthalmology residents from 98 residency programs. These residents published a mean (±standard deviation [SD]) number of 2.68 ± 3.81 peer-reviewed publications, 2.39 ± 3.40 ophthalmology-related publications, and 1.18 ± 1.96 first-author publications each. The mean (±SD) Hirsch index (h-index) for this cohort was 0.79 ± 1.17. Upon multivariate analysis, we discovered significant correlations between both residency tier and medical school rank and all bibliometric variables assessed. Pairwise comparisons revealed that residents from higher tier programs had greater research productivity numbers than those from lower tier programs.
Conclusion We obtained bibliometric standards for ophthalmology residents on a national scale. Residents who graduated from higher-ranked residency programs and medical schools possessed higher h-indices and published more peer-reviewed publications, ophthalmology-related articles, and first-author publications
Exploring Potential Schedule-Related and Gender Biases in Ophthalmology Residency Interview Scores
No full textAbstract
Purpose Prior studies have revealed grading discrepancies in evaluation of personal statements and letters of recommendation based on candidate\u27s race and gender. Fatigue and the end-of-day phenomenon can negatively impact task performance but have not been studied in the residency selection process. Our primary objective is to determine whether factors related to interview time and day as well as candidate\u27s and interviewer\u27s gender have a significant effect on residency interview scores.
Methods Seven years of ophthalmology residency candidate evaluation scores from 2013 to 2019 were collected at a single academic institution, standardized by interviewer into relative percentiles (0–100 point grading scale), and grouped into the following categories for comparisons: different interview days (Day 1 vs. Day 2), morning versus afternoon (AM vs. PM), interview session (Day 1 AM/PM vs. Day 2 AM/PM), before and after breaks (morning break, lunch break, and afternoon break), residency candidate\u27s gender, and interviewer\u27s gender.
Results Candidates in the morning sessions were found to have higher scores than afternoon sessions (52.75 vs. 49.28, p \u3c 0.001). Interview scores in the early morning, late morning, and early afternoon were higher than late afternoon scores (54.47, 53.01, 52.15 vs. 46.74, p \u3c 0.001). Across all interview years, there were no differences in scores received before and after morning breaks (51.71 vs. 52.83, p = 0.49), lunch breaks (53.01 vs. 52.15, p = 0.58), and afternoon breaks (50.35 vs. 48.30, p = 0.21). No differences were found in scores received by female versus male candidates (51.55 vs. 50.49, p = 0.21) or scores given by female versus male interviewers (51.31 vs. 50.84, p = 0.58).
Conclusion Afternoon residency candidate interview scores, especially late afternoon, were significantly lower than morning scores, suggesting the need to further study the effects of interviewer\u27s fatigue in the residency interview process. The interview day, presence of break times, candidate\u27s gender, and interviewer\u27s gender had no significant effects on interview score
Adoption and Use of Social Media Platforms by Ophthalmology Programs during the COVID-19 Pandemic
No full textAbstract
Purpose The aim of this study was to determine whether the coronavirus disease 2019 (COVID-19) pandemic influenced the presence of ophthalmology residency programs on social media platforms.
Methods The presence of all accredited ophthalmology residency programs on Twitter and Instagram was assessed for January 2020 and August through March 2021 through an online search. The number of followers and posts per month during these periods was collected for each program. The presence of programs on social media was compared between the two time periods.
Results The percentage of programs on Instagram rose from 18% in January of 2020 to 57% in March of 2021 (p \u3c 0.001). On Twitter, the percentage of programs rose from 24 to 37% (p \u3c 0.001). From January 2020 to March 2021, the mean number of Instagram followers increased from 265 to 649 (p \u3c 0.0001), while the mean number of Twitter followers increased from 421 to 532 (p \u3c 0.0001). The top ten ophthalmology residency programs in 2021 according to Doximity all had Instagram pages, while 57 (53%) of remaining programs had pages (p = 0.005). Meanwhile, 7 top ten programs (70%) were on Twitter compared with 36 (34%) of the remaining programs (p = 0.036).
Conclusions The presence of ophthalmology residency programs on Instagram and Twitter increased significantly after the onset of the COVID-19 pandemic. Social media represents an evolving platform through which programs can connect with prospective residents
Relative Importance of Applicant Characteristics in Ophthalmology Residency Interview Selection: A Survey of Program Directors
No full textAbstract
Introduction Ophthalmology residency positions remain competitive. A lack of clarity regarding which residency selection criteria are prioritized by program directors can heighten the stress associated with the match process. While surveys of program directors in several other medical specialties have been conducted to identify the most important residency selection criteria, there is limited data on selection criteria used by ophthalmology residency program directors. The purpose of our study was to survey ophthalmology residency program directors to identify the current state of interview selection decisions—the factors currently considered most important in determining whether to extend an interview invitation to residency applicants.
Methods We developed and distributed a Web-based questionnaire to all U.S. ophthalmology residency program directors. Questions evaluated program demographics and the relative importance of 23 different selection criteria used by ophthalmology residency program directors when evaluating applicants for residency interviews (Likert scale 1–5, with 1 being “not important” and 5 being “very important”). Program directors were also asked to identify the one factor they felt was most important.
Results The overall residency program director response rate was 56.5% (70/124). The selection criteria with the highest average importance scores were core clinical clerkship grades (4.26/5) followed by letters of recommendation (4.06/5), and United States Medical Licensing Examination (USMLE) Step 1 score (4.03/5). The most frequently cited single most important factor for interview selection was core clinical clerkship grades (18/70, 25.7%), with USMLE Step 1 score (9/70, 12.9%) and rotations at the program director\u27s department (6/70, 8.6%) also commonly reported.
Conclusion Our results suggest that core clinical clerkship grades, letters of recommendation, and USMLE Step 1 scores are deemed the most important selection criteria by ophthalmology residency program directors as of a 2021 survey. With changes in clerkship grading for many medical schools and changes in national USMLE Step 1 score reporting, programs will face challenges in evaluating applicants and the relative importance of other selection criteria will likely increase
Perceptions of a Virtual Visiting Ophthalmology Elective in the COVID-19 Era
No full textAbstract
Background The coronavirus disease 2019 (COVID-19) pandemic was a disruption for all aspects of medical education, especially for clinical students preparing for residency applications. Clinical rotations are essential for a student\u27s specialty choice, especially for subspecialties such as ophthalmology where students may not get significant exposure during preclinical years. The cancellation of home and visiting ophthalmology electives due to the pandemic brought a need for newer, innovative ideas of instruction.
Methods A 4-week not-for-credit virtual elective was developed at the Department of Ophthalmology for visiting medical students and was offered from August to October 2020. Visiting fourth-year medical students were paired with faculty and resident mentors for one-on-one virtual mentoring, in addition to participation in departmental conferences and research opportunities. Surveys were distributed to students and mentors, and results were analyzed using Microsoft Excel and GraphPad Prism 9.
Results A total of 12 visiting fourth-year medical students participated in the virtual elective, 67% of whom did not have a home ophthalmology program. There was a significant increase in students\u27 perception of their ophthalmology knowledge, with all of students reporting that the elective contributed to this. Students (100%) were “very satisfied” with their faculty mentors on a five-point Likert scale, with high satisfaction from faculty and resident mentors toward students also. The two required events in the elective, the journal club and case virtual conferences, were highly rated from students and mentors.
Conclusion The virtual ophthalmology elective, which was developed to address medical education gaps due to the COVID-19 pandemic, was favorably viewed by all who participated. As dedicated ophthalmology instruction time has decreased over the years, it may become increasingly more important to turn to virtual resources for ophthalmology instruction and mentorship
Characteristics of First-Year Residents in Top-Ranked United States Ophthalmology Residency Programs
No full textAbstract
Objective The aim of the study is to investigate the characteristics of first-year residents associated with attending a top-ranked United States (U.S.) ophthalmology residency program over the past decade.
Methods First-year ophthalmology residents in 2009, 2013, 2016, and 2019 were identified from institutional websites, Doximity, LinkedIn and the Wayback Machine. Publications were obtained from Scopus and Google Scholar; research productivity was measured using the h-index, and medical school region based on U.S. Census Bureau designations. Medical school and ophthalmology training program rankings were based on U.S. News & World Report (U.S. News) rankings and National Institutes of Health (NIH) funding. One-way ANOVA, Wilcoxon rank sum, χ 2, and t-tests were used to analyze trends, and odds ratios (ORs) were calculated using logistic regression.
Results Data were obtained on 81% (1,496/1,850) of the residents; 43% were female; 5% were international medical graduates (IMGs); and 10% had other graduate degrees. Over the decade, the mean h-index increased (0.87–1.26; p \u3c0.05) and the proportion of residents who attended a top 20 medical school decreased (28–18%; p \u3c0.05). In a multivariate logistic regression model, characteristics associated with being a first-year resident in a top 20 program ranked by U.S. News were female gender [OR: 1.32, 95% CI: 1.02–1.72], having a Master\u27s degree [OR: 2.28, 95% CI: 1.29–4.01] or PhD [OR: 2.23, 95% CI: 1.32–3.79], attending a top 20 [OR: 5.26, 95% CI: 3.66–7.55] or a top 40 medical school by NIH funding [OR: 2.45, 95% CI: 1.70–3.54], attending a medical school with a mean USMLE Step 2 score above 243 [OR: 1.64, 95% CI: 1.01–2.67] or located in the Northeast [OR: 2.00, 95% CI: 1.38–2.89] and having an h-index of one or more [OR: 1.92, 95% CI: 1.47–2.51]. Except for gender, these characteristics were also significantly associated with matching to a top 20 ophthalmology program by NIH funding.
Conclusion Female gender, graduate degrees, research productivity, and attending a medical school with high research productivity, high mean USMLE Step 2 score or in the Northeast were key characteristics of first-year residents in top-ranked U.S. ophthalmology residency programs
Accuracy Assessment of Outpatient Telemedicine Encounters at an Academic Ophthalmology Department
No full textAbstract
Purpose We assess the clinical accuracy of direct-to-patient real-time outpatient video visit encounters at our eye center.
Design This was a retrospective longitudinal study.
Subjects and Methods Patients who completed a video visit over a 3-week period between March and April 2020 were included. Accuracy assessment was determined by comparing diagnosis and management from the video visit with subsequent in-person follow-up over the next year.
Results A total of 210 patients (mean age 55±18 years) were included, of whom 172 (82%) were recommended a scheduled in-person follow-up encounter after their video visit. Among the 141 total patients who completed in-person follow-up, 137 (97%) had a diagnostic agreement between telemedicine and in-person evaluation. Management plan agreed for 116 (82%), with the remainder of visits either escalating or deescalating treatment upon in-person follow-up with little substantive change. Compared with established patients, new patients had higher diagnostic disagreement following video visits (12 vs. 1%, p=0.014). Acute visits trended toward more diagnostic disagreement compared with routine visits (6 vs. 1%, p=0.28) but had a similar rate of management change on follow-up (21 vs. 16%, p=0.48). New patients were more likely to have early unplanned follow-up than established patients (17 vs. 5%, p=0.029), and acute video visits were associated with unplanned early in-person assessments compared with routine video visits (13 vs. 3%, p=0.027). There were no serious adverse events associated with the use of our telemedicine program in the outpatient setting.
Conclusions Video visits had high diagnostic and management agreement with subsequent in-person follow-up encounters
Impact of Social Media on Applicant Perspectives of Ophthalmology Residency Programs
No full textAbstract
Purpose This article evaluates the relevance of social media to ophthalmology residency applicants in the setting of virtual interviews, the types of information sought by applicants, and the impact of rebranding of an institutional and departmental social media account.
Design Cross-sectional survey.
Participants Ophthalmology residency applicants from the 2020 to 2021 cycle.
Methods A voluntary survey was emailed to 481 applicants to the University of Louisville Department of Ophthalmology residency during the 2020 to 2021 application cycle to gauge the impact of social media on their perspectives of residency programs, especially with regards to a new departmental social media account.
Main Outcome Measures Applicants\u27 use of social media platforms and specific components of departmental social media accounts found most useful.
Results The 13-question survey was completed by 84/481 applicants (17.5% response rate). Social media was used by 93% of respondents. Of those respondents reporting social media use, the most common platforms utilized included Instagram (85%), Facebook (83%), Twitter (41%), and LinkedIn (29%). Sixty-nine percent of respondents specifically used Instagram to learn more about residency programs. With regards to the rebranded Instagram account at the University of Louisville, 58% of respondents reported being influenced, with all asserting that the account positively encouraged them to apply to the program. The most informative elements of the account related to current resident profiles, resident life, and living in Louisville.
Conclusion A majority of responding ophthalmology residency applicants utilized social media to search for program information. A newly developed social media profile at a single institution positively influenced applicant impressions of the program, with the most importance assigned to information provided about current residents and typical resident life. These findings suggest key areas where programs should continue to dedicate online resources with targeted information to better recruit applicants
Rate of Posterior Capsule Rupture in Phacoemulsification Cataract Surgery by Residents with Institution of a Wet Laboratory Course
No full textAbstract
Purpose To determine if a structured surgical wet laboratory curriculum for ophthalmology residents reduced the rate of posterior capsule rupture (PCR) in phacoemulsification cataract surgery.
Setting James A. Haley Veterans\u27 Hospital, Tampa, FL.
Design Retrospective cohort study.
Methods The study assessed resident-performed phacoemulsification cataract cases from 2011 to 2017, after the creation of a wet laboratory course. Primary outcome measure was PCR. If present, timing of complication, dropped lens fragments, and the need for anterior vitrectomies were noted. Self-reported rates of PCR prior to institution of a wet laboratory course (2010–2011) were compared with cases done by residents who completed the course (2011–2017).
Results A total of 3,445 cases were reviewed of which 2.44% (84 cases) noted PCR. Of these, 19% (16) had dropped lens fragments, and 60.7% (51) required anterior vitrectomy. Sixty-nine cases documented timing of PCR with the majority, 58%, occurring during phacoemulsification. When comparing rates of PCR in cases done prior to the presence of a wet laboratory course versus after, there was a significant reduction observed (5.20% before vs. 2.44% after).
Conclusion In the presence of a wet laboratory curriculum, the rate of PCR decreased dramatically. The average rate was lower than those reported at other training programs (2.6–9.9%). Most PCR occurred during phacoemulsification, suggesting need for further focused instruction in this step