Journal of Academic Ophthalmology
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Applicant Perceptions Regarding the 2020 to 2021 Virtual Ophthalmology Residency Interview and Match Season
No full textAbstract
Background The coronavirus disease 2019 pandemic has significantly impacted medical education, notably the mandate for all residency programs to implement virtual (rather than in-person) residency interviews. Understanding residency applicants\u27 perceptions and approach to this novel virtual interview season will be beneficial as potential future interview formats are considered.
Objective The aim of this study was to examine perceptions of the 2020 to 2021 ophthalmology residency match applicants regarding the virtual interview season prior to the start of the interview season.
Patients and Methods Ophthalmology residency applicants during the 2020 to 2021 cycle were invited to complete the survey between October 20 and 29, 2020. Respondent demographic information, perceived importance of various application details in a normal versus virtual interview season, strengths and limitations of virtual interviews, and preferences for optimal virtual interview format were obtained.
Results There were 337 survey respondents, with at least 50% of the survey completed by 190 applicants (56%). Of these, 73% of respondents applied to more than 60 ophthalmology residency programs, and 78% felt that the evaluation of candidates would be impacted by the virtual interview format. Regardless of interview format, United States Medical Licensing Examination Step 1 score and letters of recommendation were perceived to be the two most important factors related to matching at an applicant\u27s top ranked programs. The primary limitation of a virtual interview season was the inability to experience a program\u27s culture in person, while largest strength was cost savings.
Conclusion The ophthalmology residency match is a competitive process made potentially more complex by a novel virtual interview format. A detailed postcycle analysis will be important to optimize future interview seasons
The Impact of Virtual Interviews on the Geographic Distribution of Ophthalmology Match Results in the 2020–2021 Cycle
No full textAbstract
Background Instead of the traditional in-person interviews, the 2020 to 2021 ophthalmology application cycle was conducted with virtual interviews due to coronavirus disease 2019 (COVID-2019). Little is known about differences between the results of this application cycle with previous years.
Objectives The aim of this study was to determine the effect of virtual interviews on the geographic distribution of matched ophthalmology residency applicants.
Methods Information was collected on the medical school location and matched residency program location for 2020 to 2021 applicants as well as applicants during the 2016 to 2017, 2017 to 2018, and 2018 to 2019 cycles from publicly available Web sites. Pearson chi-squared tests were conducted to determine whether there was a significant difference in the proportion of applicants matching in the same region, state, and institution as their medical schools in the 2020 to 2021 interview cycle when compared with past cycles.
Results Three-hundred seventy-five applicants from 2020 to 2021 and 1,190 applicants from 2016 to 2019 application cycles were analyzed. There was no difference in the type of medical school attended (allopathic vs. osteopathic vs. international medical graduate) (p = 0.069), the likelihood of attending a residency program in the same region as the home medical school (54% for 2020–2021 vs. 57% for 2016–2019 applicants, p = 0.3), and the likelihood of attending a residency program in the same state as the home medical school (31 vs. 28%, p = 0.2). There was a higher likelihood of applicants during the 2020 to 2021 cycle matching at a residency program affiliated with their home medical school than previous cycles (23 vs. 18%, p = 0.03).
Conclusions Virtual interviews did not increase the likelihood of medical students staying in the same region or state as their medical school, while there was a higher likelihood of applicants matching at residency programs at institutions affiliated with their medical schools. A hybrid approach to maintain geographic diversity of applicants\u27 final residency programs involving virtual interviews with the addition of in-person away rotations is suggested
Smartphone Compatible versus Conventional Ophthalmoscope: A Randomized Crossover Educational Trial
No full textAbstract
Objective The aim of the study is to compare performance and ease-of-use (EOU) of optic disk assessment using a smartphone direct ophthalmoscope attachment (D-EYE) to the gold standard direct ophthalmoscope (DO).
Design The type of study involved is prospective, randomized, crossover, and educational trial.
Participants The participants involved were first year medical students inexperienced in ophthalmoscopy.
Methods Optic disks of standardized and volunteer patients were examined using the D-EYE and a conventional DO. Optic disk identification, EOU ratings of the devices, self-reported confidence level in their examination with the devices, and estimation of vertical cup-to-disk ratio (VCDR) were compared. Analyses included Chi-square tests, independent samples t-tests, correlations, and multivariable linear regression.
Results Forty-four medical students voluntarily participated in the study. Students using the DO required more attempts (3.57 vs. 2.69, p = 0.010) and time (197.00 vs. 168.02 seconds, p = 0.043) to match the patient\u27s fundus to the correct photograph. Overall EOU between the devices (6.40 vs. 4.79, p \u3c 0.001) and overall confidence in examination (5.65 vs. 4.49, p = 0.003) were greater when using the D-EYE. There were no statistically significant differences in accuracy of VCDR estimations between the two ophthalmoscopes.
Conclusion Smartphone ophthalmoscopy could offer additional learning opportunities in medical education and may be considered in clinical practice by non-specialist physicians given its greater EOU and increased success in visualizing the optic disk
Impact of Resident-Led Small-Group Learning Sessions on Preclinical Students\u27 Perceptions of Ophthalmology
No full textAbstract
Introduction Resident physicians have a significant role in the education of medical students, and limited research has demonstrated that positive interactions with residents are linked with enhanced students’ perceptions of a specialty. Minimal research on residents as teachers has been done in ophthalmology, and no research has examined the impact of residents as teachers on the perceptions of preclinical students. This is an important area of interest because ophthalmology conducts an early match. The competitiveness of the field increases the importance of early involvement in research and clinical activities. This study aimed to assess the role of a resident-led workshops as a vehicle for exposing preclinical students to ophthalmology.
Methods A 2-hour workshop on the Ophthalmology Clinical Skills was held at the University of Cincinnati College of Medicine in November 2018. The workshop was conducted by seven ophthalmology residents, and the learners were 15 first-year and 11 second-year medical students. The workshop format consisted of a 30-minute introductory lecture on the field of ophthalmology, followed by a 60-minute small-group clinical skills’ session focusing on direct ophthalmoscopy and slit lamp examination. Preworkshop and postworkshop surveys were administered to the medical students, and Student’s paired sample t-test was used to assess the differences in responses before and after the workshop.
Results Students’ average interest in ophthalmology rose (p = 0.049) as did their likeliness to approach a resident for career advice (p = 4.65 × 10−6) and their likeliness to attend the Secrets of the Match Lunch talk, a yearly talk held by a student matched into ophthalmology (p = 0.002).
Conclusion These results suggest that resident intervention can have a positive impact on preclinical students’ perceptions of ophthalmology and may be a good educational strategy to foster their positive attitudes toward the field
A Comparative Analysis of Ophthalmology Resident Physician Performance Based on Use of Parental Leave
No full textAbstract
Background Taking parental leave during ophthalmology residency may be perceived to negatively affect resident surgical volume and educational outcomes. However, limited data exist on whether taking parental leave is associated with objective measures of resident performance. The objective of the present study was to determine the association between taking parental leave and key measures of resident performance.
Methods Educational records of ophthalmology resident physicians who graduated from 2015 to 2019 at the Johns Hopkins University School of Medicine Wilmer Eye Institute were reviewed. Measures of resident performance assessed were Ophthalmic Knowledge Assessment Program scores, number of publications during residency, Accreditation Council for Graduate Medical Education milestones scores, and surgical volumes. These outcomes were compared for residents who took parental leave compared with their peers who did not take parental leave.
Results Twenty-five residents were included in the study. Four female residents (16%) took parental leave 8 weeks in duration. There were no significant differences between residents who did and did not take parental leave when considering mean Ophthalmic Knowledge Assessment Program scores (p = 0.27), number of publications during residency (p = 0.19), milestone scores (p-value range 0.09–0.40), and surgical volume by subspecialty category (p-value range 0.11–0.45).
Conclusion Parental leave did not negatively influence any of the studied measures of resident performance
COVID-19 and the Ophthalmology Residency Match: Data from Applicants\u27 Perspectives
No full textAbstract
Background The coronavirus disease 2019 (COVID-19) pandemic has had a profound impact on medical education, particularly for those applying to residency programs in 2020 to 2021. This study describes the challenges for potential ophthalmology residency applicants so that residency leadership can make informed decisions about changes to the process.
Methods A survey was distributed electronically via social media and medical school ophthalmology interest groups from June 18, 2020 to July 2, 2020 to individuals interested in applying to ophthalmology residency in the United States. Survey questions included demographics and perceived impacts of COVID-19 on ability, confidence, intention to apply, and perceptions toward changes in the application process for the 2020 to 2021 ophthalmology residency application cycle.
Results One-hundred sixteen total responses were received. Eighty-six responses (74%) were from individuals intending to apply in the 2020 to 2021 application cycle. Most respondents (86%) felt that their application would be affected by COVID-19 with 51% feeling less confident. Only four (5%) felt that they could adequately compile a rank list following a video interview, and over half (51%) anticipated applying to more programs than they originally intended. Academic plans of seven (8%) respondents were significantly altered via deferral of application or cancellation of a research year. Thirty-nine (45%) students reported delayed ophthalmology electives, with less than half (41%) feeling that they had adequate clinical exposure to be prepared for residency.
Conclusion The COVID-19 pandemic has had a substantial impact on the 2020 to 2021 ophthalmology residency application cycle. As stakeholders begin to approach this cycle, these findings will help them make effective and informed decisions to create the best overall experience for all involved
Inefficiencies in Residency Matching Associated with Gale–Shapley Algorithms
No full textAbstract
Objective This study aimed to investigate emerging trends and increasing costs in the National Residency Matching Program (NRMP) and San Francisco Residency and Fellowship Match Services (SF Match) associated with the current applicant/program Gale–Shapley-type matching algorithms.
Design A longitudinal observational study of behavioral trends in national residency matching systems with modeling of match results with alternative parameters.
Patients and Methods We analyzed publicly available data from the SF Match and NRMP websites from 1985 to 2020 for trends in the total number of applicants and available positions, as well the average number of applications and interviews per applicant for multiple specialties. To understand these trends and the algorithms\u27 effect on the residency programs and applicants, we analyzed anonymized rank list and match data for ophthalmology from the SF Match between 2011 and 2019. Match results using current match parameters, as well as under conditions in which applicant and/or program rank lists were truncated with finalized rank lists, were analyzed.
Results Both the number of applications and length of programs\u27 rank lists have increased steadily throughout residency programs, particularly those with competitive specialties. Capping student rank lists at seven programs, or less than 80% of the average 8.9 programs currently ranked, results in a 0.71% decrease in the total number of positions filled. Similarly, capping program rank lists at seven applicants per spot, or less than 60% of the average 11.5 applicants ranked per spot, results in a 5% decrease in the total number of positions filled.
Conclusion While the number of ophthalmology positions in the United States has increased only modestly, the number of applications under consideration has increased substantially over the past two decades. The current study suggests that both programs and applicants rank more choices than are required for a nearly complete and stable match, creating excess cost and work for both applicants and programs. “Stable-marriage” type algorithms induce applicants and programs to rank as many counterparties as possible to maximize individual chances of optimizing the match
Resident Skills Assessment in Corneal Suturing: A Comprehensive Review of Currently Proposed Educational Programs and Evaluation Tools
No full textAbstract
Purpose This study aimed to perform a comprehensive review of publications proposing educational programs for resident skills assessment in corneal suturing.
Methods An extensive online article search in PubMed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PISMA) reporting guidelines was performed to identify prospective comparative studies or prospective before/after studies published up to March 2021 and reporting the assessment of ophthalmology residents\u27 skills in corneal suturing during dedicated training sessions.
Results Three studies were identified for review. The first reported the efficiency of an electromagnetic tracking system placed on the surgeon\u27s fingers coupled with a computer analysis of movements and time to identify surgeons with different backgrounds in corneal suturing. The second reported the efficiency of the reference system in assessing the improvement of corneal suturing conducted by residents after a training session, with video-based assessment for economy and confidence of movement, limiting tissue damage and precision of operative technique, reviewed by blind assessors. The third proposed an innovative remote corneal suturing training method using Zoom for direct feedback to the residents. The stitch quality was assessed for length, depth, radiality, and tension. The results were similar when compared with a group of residents without feedback.
Conclusion This review underlines the rarity and disparity of available tools for corneal suturing assessment, justifying the need for more complete models to be designed. These should consider body ergonomics and stitch quality and time. Comparative studies involving novices and attendings may provide reliable evaluation of existing gaps and specific metrics to target, helping residents to approach their superiors\u27 experience
A Retrospective Study of Disparities in an Academic Ophthalmic Emergency Department
No full textAbstract
Purpose Emergency medicine is a common access point to health care; disparities in this care by demographic characteristics, including race and ethnicity, may affect outcomes. The Massachusetts Eye and Ear (MEE) Emergency Department (ED) is a subspecialty emergency department; data from this site can be utilized to better understand social determinants of quality ophthalmic care.
Design This is a retrospective cross sectional cohort study in the MEE ED examining patient visits from June 1, 2016 to June 30, 2019.
Methods Using the electronic medical record system, all unique visits were identified between June 1, 2016 and June 30, 2019 (inclusive); patient demographics (sex, race, ethnicity [Hispanic vs. non-Hispanic], primary care provider [PCP] status, insurance type, zip code, primary language), date of visit, triage category and outcomes (final diagnosis, visit duration, and next visit at MEE within 3 months of the ED visit) were collected. Kaplan-Meier plots were used to visualize likelihood of follow-up visit to MEE for urgent patients based on demographics. Multivariate linear regression was used to examine factors affecting visit durations, as stratified by urgency, and Cox proportional hazards regression was used to establish hazard ratios for next visit to MEE.
Results Of the 46,248 ophthalmology ED initial visits, only triage status, season of visit, out-of-state residency, Medicare coverage, and Medicaid coverage led to statistically significant differences in visit durations for urgent visits compared with the respective reference groups. Similar trends persisted within the non-urgent visit cohort for visit durations. Residency, insurance coverage, season of visit, race, PCP status, and sex were identified as statistically significant predictors of the likelihood of a follow-up visit.
Conclusion Data from an ophthalmic emergency department suggest that demographic factors do impact patient visit duration and time to follow-up visit. These findings suggest a continued need for attention to social determinants of health and equitable care of patients within ophthalmology
Evaluating the Efficacy of Microsurgical Training Methods in Ophthalmology Education: A Systematic Review and Meta-analysis
No full textAbstract
Objective The objective of our paper is to review all of the relevant literature in ophthalmology microsurgical education and identify which teaching methodologies were most effective.
Methods A systematic review and meta-analysis of the literature was conducted. Electronic databases, including Ovid MEDLINE, Cochrane CENTRAL, and EMBASE, were searched with preset terms. The search was through December 11, 2019. Eligibility criteria included studies with sufficient data for analyzing associations between surgical teaching techniques and success rates in surgical skills and the organization of the intervention as a microsurgical skills course, curriculum, or program. The articles were independently reviewed by two authors. Each included study was evaluated for quality using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) approach and risk of bias using the Cochrane Collaboration\u27s tool for assessing bias.
Data Extraction and Synthesis Data extraction was performed by two reviewers and disagreements were checked by a third reviewer. A random-effects analysis was used to pool the outcomes of studies.
Main Outcomes and Measures Outcomes included time for completion of surgical task, level of preparedness, competency score, and number of surgeries with complications.
Results A total of 439 studies were reviewed and 13 studies (n = 8,790 surgical cases; n = 115 trainees) were included in the meta-analysis. Excluded articles studied cataract simulation training as the primary intervention or were not related to ophthalmology. All pooled results demonstrated a positive association with surgical outcomes; however, video-based education (standardized mean difference [SMD] = 2.49 [95% confidence interval (CI): 0.36–4.63]; four effects [four studies]; n = 69; I 2 = 90%) and stepwise teaching method (odds ratio [OR = 3.84 [95% CI: 2.66–5.55]; six effects [six studies]; n = 6,968; I 2 = 39%) interventions were the most favorable.
Conclusion and Relevance The following five interventions evaluated in this paper were found to be effective methods of improving performance outcomes in ophthalmic microsurgery: (1) didactic lectures, (2) video-based education, (3) surgical wet-laboratory, (4) stepwise method, and (5) direct supervision and feedback. Our meta-analysis concludes that video-based education and stepwise teaching interventions are the most effective methods for a microsurgical ophthalmology training curriculum. Combining the strengths of the interventions analyzed in this study should be considered when implementing and adjusting ophthalmic surgical skills curriculums