Journal of Academic Ophthalmology
Not a member yet
320 research outputs found
Sort by
Comparison of Simulation-Based versus Cadaveric-Tissue-Based Ocular Trauma Training on Novice Ophthalmologists: Repair of Corneal Laceration Model
No full textAbstract
Purpose The aim of this study was to evaluate whether the simulated tissue models may be used in place of animal-based model for corneal laceration repair for surgical skills acquisition.
Design Prospective randomized controlled trial.
Participants Seventy-nine military and civilian 2nd- and 3rd-year ophthalmology residents and 16 staff ophthalmologists participating in the Tri-Service Ocular Trauma Skills Laboratory at the Uniformed Services University (Bethesda, MD).
Methods Resident ophthalmologists underwent preliminary evaluation of their ability to close a 5-mm linear, full-thickness corneal laceration involving the visual axis. They then were randomized to undergo 90 to 120 minutes of either simulator-based (SIM) or swine cadaveric-tissue-based (CADAVER) corneal laceration repair. The same evaluation was performed post training. On a more limited basis, the study was repeated for attending ophthalmologists to act as a pilot for future analysis and test efficacy for “refresher” training.
Main Outcome Measures Successful wound closure with secondary outcomes of suture length, tension, depth, and orientation, as graded by attending ophthalmologists.
Results No significant difference in CADAVER versus SIM groups in the primary outcome of watertight wound closure of the corneal laceration. CADAVER group performed better than SIM group for certain metrics (suture depth, p = 0.009; length, p = 0.003; and tension, p = 0.043) that are associated with poor wound closure and increased amount of induced corneal astigmatism. For attending ophthalmologists, six of the eight in each group (SIM and CADAVER) retained or improved their skills.
Conclusions For resident ophthalmologists, SIM training is sufficient for achieving the primary outcome of watertight wound closure. However, CADAVER training is superior for wound metrics for the ideal closure. For attending ophthalmologists, SIM training may be useful for retention of skills
Perceptions of a Virtual Interview Exercise for Ophthalmology Residency Applicants
No full textAbstract
Importance In-person interviews have traditionally been considered a crucial component of the residency application process. Virtual interviews (VIs) became the standard format for the 2020 to 2021 application cycle due to the novel coronavirus disease 2019 (COVID-19) pandemic. VIs offer a new perspective and challenge to this process which warrants unique considerations and further understanding of effects on applicants.
Objective This study aimed to assess the perceived efficacy of a VI preparedness exercise for ophthalmology residency applicants in the 2021 residency application cycle.
Design, Setting, and Participants A cross-sectional survey was distributed online. All participants in a mock VI exercise conducted via video-telecommunication technology were invited to complete the survey. Data collection occurred from October 12, 2020, to November 2, 2020. A follow-up survey after a match results released was distributed to all participants and data collection occurred from February 18, 2021, to February 25, 2021.
Main Outcome and Measures Applicant demographics, comfort, and attitudes toward VIs and VI practice were the primary measurements of this study.
Results Responses to the initial survey were received from all 35 participants (100%) in the VI mock interviews. There was a statistically significant difference between the pre- and postinterview responses for “How prepared do you feel for virtual interviews with residency programs?” (p = 0.0003) and “How likely are you to practice virtual interviews with someone you know?” (p = 0.0023). Participants reported feeling more prepared for VIs with residency programs after the mock interview (p = 0.002). A greater proportion of participants responded with “Very Likely” after the mock interview in comparison to before the interview to the questions “How likely are you to practice interviews with someone you know?” (p = 0.039) and “How likely are you to practice virtual interviews in the same room/area as you will during the official interview season?” (p = 0.021). Of the 35 original participants, 20 completed the follow-up survey. There were an equal number of participants who responded either “Helped Somewhat” (n = 9) or “Helped Greatly” (n = 9) to “How much did the VI mock exercise help you for the actual interview season?” in the follow-up survey. The majority of follow-up survey respondents (17/20) reported that they had additional practice in the virtual environment for interviews after the VI mock exercise. There was no significant difference in perceived helpfulness of the VI mock exercise during the actual interview season between matched and unmatched participants.
Conclusion and Relevance As residency applicants prepare for future VIs, practice and adequate preparation will be essential. In this study, implementation of a VI preparedness exercise had a positive impact on applicants\u27 perception of their preparedness and intention to practice the format in the future
U.S. News & World Report Ophthalmology Hospital Rankings and Research Productivity
No full textAbstract
Introduction Despite the wide usage of U.S. News & World Report (U.S. News) rankings of ophthalmology hospitals among the public, residency applicants, and ophthalmologists, there is disagreement in the literature on the role of quality of care, research productivity, and other factors in the ranking system. This study investigated the association of U.S. News ranking of ophthalmology hospitals and objective measures of research productivity.
Methods The 2020 U.S. News “Best Hospitals for Ophthalmology” ranking lists 38 hospitals by reputation score and numerically ranks the top 12 institutions. For our analysis, top 12 hospitals were classified as group A and the remaining 26 as group B. The Clinicaltrials.gov, National Institutes of Health (NIH) Research Portfolio Online Reporting Tools Expenditures and Results (RePORTER), and NIH Research Portfolio Online Reporting Tools (RePORT) were systematically searched for total clinical trials, NIH funding, and the National Eye Institute (NEI) funding for fiscal years 2017, 2018, and 2019. Faculty size and the number of publications by ophthalmology faculty per hospital were recorded from a previous study in 2016.
Results Independent measures of research productivity significantly associated with group A status after multivariate logistic regression analysis were mean faculty Hirsch\u27s index (h-index) over 15 (odds ratio [OR]: 6.13, 95% confidence interval [CI]: [1.14–32.94]) and conducting five or more total clinical trials (OR: 8.77, 95% CI: [1.39–55.16]).
Conclusion This study suggests that the reputation-based U.S. News ranking may serve as a proxy for an ophthalmology department\u27s contribution to research measured by mean faculty h-index and number of clinical trials
Examining the Relationship between Altmetric Score and Traditional Bibliometrics in the Ophthalmology Literature for 2013 and 2016 Cohorts
No full textAbstract
Background In this study, we reviewed a select sample of ophthalmology literature to determine if there was a correlation between Altimetric and traditional citation-based and impact factor metrics. We hypothesized that Altmetric score would more closely correlate with impact factor and citations in 2016.
Methods Journal Citation Reports for the year 2013 was used to find the 15 highest impact factor ophthalmology journals in 2013. Then Elsevier\u27s Scopus was used to identify the 10 most cited articles from each journal for the years 2013 and 2016. Metrics for all identified articles were collected using the Altmetric Bookmarklet, and date of Twitter account creation was noted for journals with such an account. Altmetric scores, impact factor, and citation counts were tabulated for each article. Pearson\u27s correlation coefficient (r) determined correlation of independent variables (number of citations or impact factor) with dependent variable (Altmetric score). For our Twitter analysis, account age was the independent variable and calculated correlation coefficients (r) were the dependent variable. Proportion of variance was determined with a coefficient of determination (R 2).
Results This study included 300 articles, evenly split between 2013 and 2016. Within the 2013 cohort, three journals had significant positive correlations between citation count and Altmetric score. For the 2016 cohort, both Altmetric score and citation count (r = 0.583, p \u3c 0.001) and Altmetric score and impact factor (r = 0.183, p = 0.025) revealed significant positive correlations. In 2016, two journals were found to have significant correlations between Altmetric score and citation number. Neither year revealed a significant correlation between the age of a journal\u27s Twitter profile and the relationship between Altmetric score and citation count. In each year, Twitter accounted for the highest number of mentions.
Conclusion The findings suggest that correlation between Altmetric score and traditional quality metric scores may be increasing. Altmetric score was correlated with impact factor and number of citations in 2016 but not 2013. At this time, Altmetrics are best used as an adjunct that is complementary but not an alternative to traditional bibliometrics for assessing academic productivity and impact
Responding to Patient-Initiated Verbal Sexual Harassment: Outcomes of a Pilot Training for Ophthalmologists
No full textAbstract
Background Sexual harassment of physicians by patients is highly prevalent and rarely reported. Little is known on how to prepare physicians to handle verbal sexual harassment that detracts from their ability to provide care but does not meet the threshold for reporting.
Purpose To assess the impact of a sexual harassment workshop and toolkit for ophthalmologists and ophthalmology trainees on responding to patient-initiated verbal sexual harassment.
Methods A survey study of ophthalmology faculty, fellows, and residents who participated in workshops on responding to patient-initiated verbal sexual harassment was performed at an academic center. A toolkit of strategies for response was distributed. Volunteer participants completed a retrospective pretest–posttest evaluation at the conclusion of the workshop and follow-up survey 3 weeks after the workshops on whether they experienced harassment and intervened. The pretest–posttest surveys assessed the workshop\u27s effect on ophthalmologists\u27 perceptions of and preparedness to respond to sexual harassment in the moment using a 5-point Likert scale, including bystander intervention. Participants described their responses observing and/or experiencing patient-initiated sexual harassment in the 3 weeks following the workshop and whether they had intervened toward the harassment.
Results Ophthalmologists (n = 31) felt significantly more prepared to respond to patient-initiated sexual harassment directed toward themselves or a trainee in the moment after participating in the workshop (4.5 ± 1.63) than before (3.0 ± 1.3) with a mean change of 1.6 (95% confidence interval: 0.98–2.2, p \u3c 0.001). After the workshop, 86.3% of participants felt mostly or completely prepared to respond to comments about their age, gender, marital status, appearance, attractiveness, a specific body part, and sexual or inappropriate jokes. Most participants (83.9%) said that they had not previously received training on techniques for responding to patient-initiated sexual harassment. Two-thirds (66.7%) of participants who experienced (n = 8) or observed (n = 13) harassment (n = 15) following the workshop intervened. All participants who intervened toward patient-initiated harassment behavior after the workshop (n = 10) found the Sexual Harassment Toolkit helpful in addressing harassment in the moment.
Conclusion Participation in a brief skills-based workshop significantly improved ophthalmologists\u27 preparedness to respond to verbal sexual harassment by patients
Electronic Health Record Use among Ophthalmology Residents while on Call
No full textAbstract
Background As electronic health record (EHR) use becomes more widespread, detailed records of how users interact with the EHR, known as EHR audit logs, are being used to characterize the clinical workflows of physicians including residents. After-hours EHR use is of particular interest given its known association with physician burnout. Several studies have analyzed EHR audit logs for residents in other fields, such as internal medicine, but none thus far in ophthalmology. Here, we focused specifically on EHR use during on-call shifts outside of normal clinic hours.
Methods In this retrospective study, we analyzed raw EHR audit log data from on-call shifts for 12 ophthalmology residents at a single institution over the course of a calendar year. Data were analyzed to characterize total time spent using the EHR, clinical volume, diagnoses of patients seen on call, and EHR tasks.
Results Across all call shifts, the median and interquartile range (IQR) of the time spent logged into the EHR per shift were 88 and 131 minutes, respectively. The median (IQR) unique patient charts accessed per shift was 7 (9) patients. When standardized to per-hour measures, weekday evening shifts were the busiest call shifts with regard to both EHR use time and clinical volume. Total EHR use time and clinical volume were greatest in the summer months (July to September). Chart review comprised a majority (63.4%) of ophthalmology residents\u27 on-call EHR activities.
Conclusion In summary, EHR audit logs demonstrate substantial call burden for ophthalmology residents outside of regular clinic hours. These data and future studies can be used to further characterize the clinical exposure and call burden of ophthalmology residents and could potentially have broader implications in the fields of physician burnout and education policy
Elevated Intraocular Pressure in Burn Patients Undergoing Fluid Resuscitation: An Opportunity to Avoid Orbital Compartment Syndrome
No full textAbstract
Objective This study aims to discuss clinical characteristics of burn patients who developed elevated intraocular pressure (IOP). We propose management strategies to prevent orbital compartment syndrome before invasive treatment is required.
Methods A retrospective review of 47 burn patients at the University of California San Diego (UCSD), Burn Intensive Care Unit (ICU; major regional burn center for San Diego county), was analyzed for demographics, fluid resuscitation volumes, and physical exam findings. Patients requiring topical treatment for high-IOP, defined as ≥30 mm Hg in either or both eyes, were compared with those who did not require treatment, using the t-test and Fisher\u27s exact test. Linear regression tested for an association between peak IOP and fluid volume. Logistic regression evaluated the association between total fluid and treatment of high IOP, while adjusting for other characteristics.
Results Six of 47 patients required IOP-lowering treatment. Of the patients requiring treatment, one drop of dorzolamide/timolol in both eyes twice daily was the most common treatment recommendation. Presence of periocular burns was a significant risk factor in patients who required treatment for high IOP. No patients developed orbital compartment syndrome or required surgical intervention to lower IOP. The mean total fluid volume delivered in the first 24 hours was 0.8 times the level prescribed by fluid resuscitation guidelines.
Conclusion By treating early clinical signs and properly managing fluid resuscitation, development of orbital compartment syndrome in burn patients can be avoided
Effect of Scribes on Efficiency in Academic Ophthalmology Practice
No full textAbstract
Objective The aim of the study is to determine the effects of scribes on efficiency in an academic ophthalmology practice.
Design This is a quality improvement study conducted by two ophthalmologists at an academic ophthalmology practice at UT Health San Antonio from January 2018 to April 2018. Implementation of scribes in practice was the primary intervention. Session time, patient encounter time, and template time adherence were recorded pre- and post-intervention. A second retrospective arm of the study at the same institution was performed to evaluate long-term effects of scribes on efficiency in ophthalmology practice on session times and patient volume 12 to 18 months after intervention.
Main Outcome Measures Primary study outcomes and measures were the effect of scribes in academic ophthalmology practice on physician efficiency in terms of clinic session time, individual encounter time, and amount of patients seen per session, in addition to time adherence based on type of patient encounter.
Results Eighty-three patients and 17 half-day clinic sessions and 169 patients and 21 half-day clinic sessions were included in the preintervention and post-intervention datasets, respectively. Number of patients per session was approximately 15 and was kept similar pre- and post-intervention (p = 0.45). Mean preintervention session time was 265.0 ± 31.4 minutes, in contrast to 223.4 ± 19.9 minutes after intervention (p \u3c 0.001). Mean preintervention patient encounter time was 15.0 ± 8.3 minutes, while the mean encounter time after intervention was 10.9 ± 7.0 minutes (p \u3c 0.005). In a retrospective analysis of 20 clinic sessions and 438 patients 12 to 18 months after intervention, session time increased to 266.0 ± 22.0 minutes on average, but the average number of patients per session increased to 21.9 ± 2.8 minutes.
Conclusion Utilizing scribes in an ophthalmology practice can increase efficiency, allowing more patients to be seen or allowing time for other activities such as teaching or research
Ophthalmology Practice during Peak of Coronavirus Disease 2019 (COVID-19) Pandemic: A Global Community Perspective
No full textAbstract
Objective The rise of coronavirus disease 2019 (COVID-19) from Wuhan, China, in December 2019 has spread to more than 188 countries and has affected more than 13 million people. In response to this crisis, recommendations by the World Health Organization have changed the practice of current medicine, but there is little research as to how high-volume ambulatory specialties such as ophthalmology are adapting. The purpose of this study is to determine how ophthalmology practices are reacting and changing during the COVID-19 pandemic.
Methods Approval was obtained from Saint Louis University School of Medicine Institutional Review Board. An anonymous survey was made on Google Forms and distributed to ophthalmologists throughout the world. Questions were divided into five sections: demographics, general questions, inpatient care/consults, practice management, and personal impact. The survey was opened on March 31, 2020, and closed on April 12, 2020. Statistical analysis was performed using Microsoft Excel.
Results A total of 494 responders from 42 countries completed the survey. Respondents were predominantly practicing ophthalmologists (85%), with the next highest demographic being ophthalmology trainees (8%). Fear of spreading COVID-19 to patients or loved ones was the highest source of anxiety among practitioners across all practice settings and continental location (p = 0.003). The second source of anxiety varied, with private practitioners identifying financial difficulty compared with employed clinicians listing self-contamination. Anxiety levels were the same throughout all practice settings, ages, and subspecialties (p = 0.2527). Ophthalmologists listed ophthalmological Web sites/societies, discussion with colleagues, and social media as primary sources of guidance with no difference based on practice setting (p = 0.143). Finally, all continents increased their application of telemedicine as a patient care modality, with North America expanding significantly more than other continents.
Conclusion The COVID-19 pandemic has drastically changed ophthalmology practice and has added a high level of stress to ophthalmologists globally. These results demonstrate that clinicians are largely alike across age group, country, and specialty, but key differences in source of anxiety and in application of telemedicine highlight diversity in culture and reaction to the pandemic
Guiding Residency Program Educational Goals Using Institutional Keyword Reports from the Ophthalmic Knowledge Assessment Program Examination
No full textAbstract
Introduction Residency programs receive an institutional keyword report following the annual Ophthalmic Knowledge Assessment Program (OKAP) examination containing the raw number of incorrectly answered questions. Programs would benefit from a method to compare relative performance between subspecialty sections. We propose a technique of normalizing the keyword report to determine relative subspecialty strengths and weaknesses in trainee performance.
Methods We retrospectively reviewed our institutional keyword reports from 2017 to 2019. We normalized the percentage of correctly answered questions for each postgraduate year (PGY) level by dividing the percent of correctly answered questions for each subspecialty by the percent correct across all subsections for that PGY level. We repeated this calculation for each PGY level in each subsection for each calendar year of analysis.
Results There was a statistically significant difference in mean performance between the subspecialty sections (p = 0.038). We found above average performance in the Uveitis and Ocular Inflammation section (95% confidence interval [CI]: 1.02–1.18) and high variability of performance in the Clinical Optics section (95% CI: 0.76–1.34).
Discussion The OKAP institutional keyword reports are extremely valuable for residency program self-evaluation. Performance normalized for PGY level and test year can reveal insightful trends into the relative strengths and weaknesses of trainee knowledge and guide data-driven curriculum improvement