Journal of Academic Ophthalmology
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Ophthalmology Education in COVID-19: A Remote Elective for Medical Students
No full textAbstract
Background The novel coronavirus disease (COVID-19) has created obstacles for medical student education, as clinical rotations were temporarily halted. Recent literature shows online electives may provide an alternative learning platform. We developed a teleophthalmology student elective for rising third-year medical student (MS3) and fourth-year medical student (MS4) to continue teaching and exposure to the field.
Methods A 4-week remote elective was approved by Emory University School of Medicine and offered between April 18, 2020, and May 15, 2020, for rising MS3s and MS4s. The curriculum consisted of online self-study materials, student presentations, chart review assignments, case-based discussions with faculty, and telehealth experiences. All students were surveyed and tested with questions from United States Medical Licensing Examination World (UWorld) test bank at the end of the course.
Results A total of 18 students were enrolled, with 66.7% MS3 and 33.3% MS4 participants. The mean rating of fulfillment of course learning objectives was 8.1/10 (range, 6.7–8.8), with mean ratings of 8.2 for MS3s and 7.7 for MS4s. There was a significant increase in self-reported knowledge in ophthalmology, with an increase from 4.6 to 8.1 for MS3s (p = 0.002) and 6.7 to 8.0 for MS4s (p = 0.04). Students also reported higher interest in the field, with an increase from 4.9 to 7.8 for MS3s (p = 0.01) and 7.5 to 8.7 for MS4s (p = 0.1). The students performed significantly higher on the postcourse test (94.8%) than UWorld question bank users (74.1%) (p \u3c 0.001).
Conclusion Our novel ophthalmology elective significantly enhanced self-reported medical student knowledge and interest in the field during a crisis that required transition to remote learning. Further study of student telehealth experience and objective assessment is needed to improve online learning in ophthalmology
Carelign: A Novel Handoff System for Medical and Surgical Consultants
No full textAbstract
Background Patient handoffs are ubiquitous in hospital settings. Historically, formal handoffs of patient information have been conducted in the inpatient setting mainly by primary teams, as opposed to medical and surgical consultants. Carelign is a software developed by the University of Pennsylvania Health System to function as an interdisciplinary, patient-centered handoff. While mainly utilized by primary teams for work management and transitions, it has been enhanced to include specialty consultant handoff functionality.
Objective The aim of this study is to determine whether using Carelign for consultant handoffs improves clinical handoffs in comparison to the prior handoff system (a custom-built handoff report within the electronic health record) used by the Department of Ophthalmology at Penn Presbyterian Medical Center.
Methods A 7-item questionnaire assessing the effectiveness, efficiency, accessibility, reliability, communication, and security of the handoff using a 1 to 5 scale was distributed to residents prior to and 6 months subsequent to the implementation of Carelign.
Results Users reported a statistically significant increase in Health Insurance Portability and Accountability Act (HIPPA)-compliance (44 vs. 100%, p \u3c 0.0001) and ability to communicate with primary teams (38 vs. 70%, p = 0.019) after implementation of Carelign. There was a trend toward significance with ease of accessing information after switching to Carelign (67 vs. 85%, p = 0.185). There was no statistically significant difference in effectiveness, efficiency, accessibility from home, or reliability of information on handoff after converting to the new system.
Conclusion Carelign is perceived to be an effective tool that can be used by consulting providers to ensure HIPPA-compliance and the ability to communicate with primary teams without sacrificing effectiveness, efficiency, accessibility, or reliability
Social Media in Ophthalmology: The Educational and Professional Potential for Medical Students
No full textUtilizing Electronic Medical Records to Standardize Handoffs in Academic Ophthalmology
No full textAbstract
Purpose Formalized handoff procedures have been shown to increase patient safety and quality of care across multiple medical and surgical specialties,1–4 but literature regarding handoffs in ophthalmology remains sparse. We instituted a standardized handoff utilizing an electronic medical record (EMR) system to improve care for patients shared by multiple resident physicians across weekday, weeknight, and weekend duty shifts. We measured efficiency, efficacy, and resident satisfaction before and after the standardized handoff was implemented.
Methods Resident physicians surveyed were primarily responsible for patient care on consult and call services at two quaternary academic medical centers in a major metropolitan area. Patient care was performed in outpatient, emergency, and inpatient settings. Annual anonymous questionnaires consisting of 6 questions were used to collect pre- and postintervention impressions of the standardized EMR handoff process from ophthalmology resident physicians (9 per year; 3 preintervention years and 1 postintervention year). An additional anonymous postintervention questionnaire consisting of 12 questions was used to further characterize resident response to the newly implemented handoff procedure.
Results Prior to implementation of a standardized EMR-based handoff procedure, residents unanimously reported incomplete, infrequently updated handoff reports that did not include important clinical and/or psychosocial information. Following implementation, residents reported a statistically significant increase in completeness and timeliness of handoff reports. Additionally, resident perception of EMR handoff utility, efficiency, and usability were comprehensively favorable. Residents reported handoffs only added a mean of 6.5 minutes to a typical duty shift.
Conclusion Implementation of our protocol dramatically improved resident perceptions of the handoff process at our institution. Improvements included increased quality, ease-of-use, and efficiency. Our standardized EMR-based handoff procedure may be of use to other ambulatory-based services
Comparison of 12-Month Outcomes of Kahook Dual Blade Excisional Goniotomy Performed by Attending versus Resident Surgeons
No full textAbstract
Objective Kahook Dual Blade goniotomy (KDB) has proven effective in lowering intraocular pressure (IOP) and reducing the medication burden in patients with glaucoma. This study compares outcomes up to 12 months postoperatively after KDB combined with phacoemulsification (phaco-KDB) between an ophthalmology attending and residents.
Methods A retrospective analysis was performed on 160 eyes of 113 patients who received a phaco-KDB performed by either an ophthalmology attending or a resident under direct guidance of the attending. Data for each patient was collected preoperatively and at 1 day, 1 week, 1 month, 3 months, 6 months, and 12 months postoperatively. The primary outcome measure was surgical success, defined as 20% IOP reduction or at least 1 medication reduction at 12 months. The secondary outcome measures included mean IOP and medication reduction at each postoperative time point, adverse events, operating time, and survival time, defined as time to failure to meet the criteria for surgical success or requiring a secondary IOP-lowering procedure.
Results Preoperative mean IOP was comparable between the two groups (p = 0.585), while baseline medications were higher in the attending group (p = 0.040). Rate of successful outcomes was similar in both groups at 12 months (73.3% attending vs. 87.5% residents, p = 0.708). Mean IOP reduction (1.7 vs. 4.3%, p = 0.278) and medication reduction (0.7 vs. 0.6, p = 0.537) also did not differ at 12 months. Presence of adverse events was similar between the groups (21.6 vs. 27.3%, p = 0.938). The survival time was significantly longer in the attending group (356.3 ± 20.2 days vs. 247.1 ± 26.8 days, p = 0.003). Resident cases took ∼10 minutes longer compared with attending cases (p \u3c 0.001).
Conclusion IOP lowering outcomes and rate of adverse events of KDB were similar whether the primary surgeon was an attending or a resident surgeon. The survival time was significantly longer in the attending group, but overall success rate was 77.5% for both groups. This suggests phaco-KDB is an effective procedure that can be safely performed by a trainee under direct supervision of an experienced surgeon
Prevalence of Post-Interview Communication in the Ophthalmology Match and Its Impact on Program Directors\u27 Ranking of Applicants
No full textAbstract
Objective The aim of this study is to investigate the prevalence of post-interview communication (PIC) during the ophthalmology residency match process and its impact on program directors\u27 (PD\u27s) ranking of applicants.
Design Prospective cross-sectional survey.
Methods An anonymous, online survey was emailed to the PD of each ophthalmology residency program accredited by the Accreditation Council for Graduate Medical Education.
Results Fifty-four percent (63/116) of PDs completed the survey. Eighty-five percent (54/63) of PDs received PIC from applicants or applicants\u27 faculty mentors during the 2018 to 2019 application cycle; 62% (39/63) received PIC regarding \u3e25% of applicants interviewed. Although 41% (26/63) of PDs reported they would likely rank an applicant higher due to PIC endorsement from a faculty mentor known to the PD, only 3% (2/63) believed that applicants who did not have a faculty mentor conduct PIC on their behalf were disadvantaged. Fourteen percent (9/63) of PDs reported they would likely rank an applicant higher due to PIC endorsement from a faculty mentor unknown to the PD, and 3% (2/63) reported they would likely rank an applicant higher as a result of PIC from the applicant.
Conclusion There is a high prevalence of PIC during the ophthalmology residency match process. The potential impact of PIC on PDs\u27 ranking of applicants varies according to whether the PIC is from a faculty member known to the PD, a faculty member unknown to the PD, or the applicant. This may disadvantage applicants without faculty mentors known to PDs
Evaluating the Effectiveness of Small-Group Training in Teaching Medical Students Integral Clinical Eye Examination Skills
No full textAbstract
Objective The aim of this study is to evaluate the effectiveness of an interactive, small-group ophthalmology clinical training session by assessing medical students\u27 self-confidence with eye examination skills and long-term retention of direct ophthalmoscopy skills.
Methods The second-year medical students participated in a one-time small-group clinical training session that taught essential components of the eye examination. Students reported their confidence with each component in pre- and postsession surveys. Eight months later, direct ophthalmoscopy skills were reassessed by having students visualize the optic nerves of standardized patients and identify the matching optic nerve photograph in a multiple-choice quiz.
Results Among 197 second-year medical students who participated in the training session, 172 students completed the presession survey (87.3% response rate) and 108 students completed the postsession survey (54.8% response rate). Following the training session, students reported increased self-confidence (p \u3c 0.01) overall. A total of 107 (107/108; 99.1%) students reported that they visualized the optic nerve head, and 80 out of 85 (94.1%) students stated that they preferred the PanOptic ophthalmoscope over the traditional direct ophthalmoscope. Students reported greater self-confidence using the PanOptic ophthalmoscope (p \u3c 0.01). In the 8-month follow-up assessment, 42 medical students (42/197; 21.3%) completed the exercise. A total of 41 (41/42; 97.6%) students stated that they saw the optic nerve with the PanOptic ophthalmoscope; 24 (24/42; 57.1%) students identified the correct optic nerve image using the PanOptic ophthalmoscope on a standardized patient; 14 (14/42; 33.3%) students stated that they saw the optic nerve with the traditional direct ophthalmoscope; and 4 (4/42; 9.1%) students from the same cohort identified the correct optic nerve image with the traditional direct ophthalmoscope on a standardized patient.
Conclusion Our comprehensive, one-time eye examination skills training session seeks to prepare students to incorporate these skills in future patient care. Students\u27 overall confidence improved in each aspect of the eye examination that was covered. A follow-up assessment on students\u27 direct ophthalmoscopy skills suggests that the PanOptic ophthalmoscope allows for superior skills retention as compared with the traditional direct ophthalmoscope. We believe that the PanOptic ophthalmoscope should be further integrated into medical education and clinical practice
A Novel Microsurgical Suturing Pilot Course for Ophthalmology Residents Based on Kern\u27s Model for Curriculum Development
No full textAbstract
Background Sutureless ophthalmic procedures are becoming more commonplace, reducing opportunities for ophthalmology residents to learn microsurgical suturing techniques. There is no standard curriculum in place to address this gap in clinical training among ophthalmology residency programs.
Objective The aim of this study was to design, implement, and evaluate a preliminary microsurgical suturing curriculum for ophthalmology residents using Kern\u27s six-step approach for curriculum development as a guideline, and the principles of distributed practice and guided, self-directed practice.
Methods We designed a faculty-led teaching session on fundamental microsurgical suturing techniques for all 15 ophthalmology residents from Yale University over one academic year. Suturing skills were evaluated, followed by a guided teaching session, 30 days of self-directed practice time, and a re-evaluation of skills. The residents were evaluated through a written knowledge assessment and practical skills assessment. The residents also evaluated their skill level before and after the teaching session and practice period through written Likert-scale surveys. Data were evaluated in Excel using descriptive statistics and the paired t-test.
Results After the session, postgraduate year 2 (PGY-2) residents felt more confident in recognition and use of surgical instruments (p \u3c 0.01). PGY-3 residents felt less confident in their knowledge of microsurgical suturing after the session (p = 0.02). PGY-4 residents felt they were better able to identify different suture types after the session (p = 0.02). All residents improved on the written knowledge assessment (p \u3c 0.001) and in all categories of the practical skills assessment (p \u3c 0.001).
Conclusions Implementation of a faculty-led microsurgical suturing training session, followed by 1-month of practice time, significantly improved residents\u27 knowledge and practical application of various microsurgical suturing techniques that are necessary for performing common ophthalmic procedures
Ophthalmology Residents\u27 Experience with Complex Cataract Surgery at a VA Hospital over 10 Years
No full textAbstract
Objective The purpose of this study was to determine the proportion of complex cataract surgery performed by third-year ophthalmology residents at an academic Veterans Administration Medical Center.
Methods A chart review was conducted of all resident cataract surgeries performed at the James J. Peters Veterans Administration Medical Center in The Bronx, NY between July 1, 2007, and June 30, 2017. Correct categorization was confirmed by review of operative report and reason for complex categorization was recorded, as well as the use and type of nonstandard device or technique.
Results A total of 2,429 routine and 114 complex cataract surgeries were performed by 40 different residents over the 10-year period. In total, 4.5% of all cataract surgeries were categorized as complex. The most common reasons for complex categorization included intraoperative floppy iris syndrome (35.8%), miosis (38.4%), zonular instability (9.6%), mature cataract (7%), posterior synechiae (7.8%), and posterior capsular plaque (1.8%). Nonstandard techniques/devices included iris hooks (65.3%), pupil expansion device (8.5%), extracapsular cataract extraction (6.8%), synechiolysis (7.6%), mechanical iris dilation (0.8%), capsular tension ring (9.3%), and primary posterior continuous curvilinear capsulorhexis (1.7%).
Conclusion A review of third-year resident cataract surgery experience at our institution\u27s VA hospital where a significant amount of their surgical volume, approximately 50%, is obtained revealed that complex cataracts constituted a minimal portion of the cases. Education in cataract surgery should be competency based, extend beyond achieving minimums, and focus on variety and complexity of surgical experience. Formal tracking of routine versus complex cases should be considered to optimize training experience and assure patient safety