Journal of Academic Ophthalmology
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Learning Curve of a Surgical Educator: Resident Cataract Surgery Outcomes under the Supervision of One Attending Surgeon over 5 Years
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Background The main purpose of this article is to determine the trend of intraoperative complications of resident-performed cataract surgery under the supervision of one attending surgeon during the initial 5 years of surgical teaching.
Methods A retrospective chart review was conducted at the Wilmer Eye Institute for all postgraduate year 4 resident-performed cataract surgeries between July 2013 and June 2018 that were supervised by one attending surgeon who was directly out of fellowship training. Recorded data included patient demographics, presence of preoperative risk factors (small pupil, dense cataract, history of ocular trauma, pseudoexfoliation syndrome, postvitrectomy, pre-existing zonular weakness, and high myopia), and intraoperative complications (posterior capsule tear resulting in vitreous loss and zonular dehiscence resulting in vitreous loss and/or loss of sulcus support). A generalized estimating equation model was constructed to determine factors associated with intraoperative complications.
Results A total of 1,253 resident cataract surgeries involving 988 patients were included. The overall complication rate was 3.6% (n = 45/1253), with a decreasing trend observed in the rate of intraoperative complications across the study years. Multivariate analysis found that complications during cataract surgery were more likely to occur in earlier years of the supervising surgeon\u27s career (p = 0.01), at the beginning of the academic year (p = 0.03), in eyes with preoperative risk factors (p \u3c 0.001), black patients (p = 0.02), and left eyes (p = 0.02).
Conclusion A learning curve exists for novice attending surgeons during their initial years of resident cataract surgery supervision. Residency programs should consider resources to educate novice surgical educators, especially on how to effectively supervise resident-performed complex cases
Ophthalmology Program Directors\u27 Perspectives on the Impact of the United States Medical Licensing Examination Step 1 Change to Pass-Fail Scoring
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Purpose This article investigates the perspectives of ophthalmology residency program directors (PDs) regarding the impact of the United States Medical Licensing Examination (USMLE) Step 1 change from graded to pass-fail scoring on ophthalmology resident selection and medical education.
Methods The PDs of all United States ophthalmology residency programs accredited by the Accreditation Council for Graduate Medical Education were identified using a public, online database. An anonymous web-based survey constructed using REDCap was emailed to each PD in February 2020.
Results Surveys were completed by 64 (54.2%) PDs, with the majority (81.2%) disagreeing with the change to pass-fail scoring. The majority of PDs believe this change will negatively impact the ability to evaluate residency applicants (92.1%) and achieve a fair and meritocratic match process (76.6%), and will decrease medical students\u27 basic science knowledge (75.0%). The factors identified most frequently by PDs as becoming more important in evaluating residency applicants as a result of the Step 1 scoring change include clerkship grades (90.6%), USMLE Step 2 Clinical Knowledge score (84.4%), and a rotation in the PD\u27s department (79.7%). The majority of PDs believe the Step 1 grading change to pass-fail will benefit applicants from elite medical schools (60.9%), and disadvantage applicants from nonelite allopathic schools (82.8%), international medical graduate applicants (76.6%), and osteopathic applicants (54.7%).
Conclusion The majority of ophthalmology PDs disagree with the change in USMLE Step 1 scoring from graded to pass-fail and believe this change will negatively impact the ability to evaluate residency applicants and achieve a fair and meritocratic match process, and will decrease medical students\u27 basic science knowledge
Factors Influencing Postgraduate Career Decisions of Ophthalmology Residents
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Objective This study aims to identify factors that influence ophthalmology residents\u27 decision to pursue fellowship training or to practice comprehensive ophthalmology after residency.
Design This is a cross-sectional study.
Methods An anonymous survey was sent to ophthalmology residents in the United States from the graduating class of 2018. The main outcome measure was the decision to seek fellowship training or to practice comprehensive ophthalmology. Information on demographics, residency program characteristics, and factors influencing career choices were collected.
Results The overall response rate was 24.0% (112/467). Among the 112 respondents, 88 (78.6%) matched into subspecialty training. Compared with residents entering comprehensive ophthalmology, there was a greater proportion of Asians (37.5 vs. 8.3%) and a smaller proportion of non-Hispanic whites (47.7 vs. 70.8%, p = 0.029) among residents pursuing fellowship training. Residents pursuing fellowships had fewer children (0.4 vs. 0.8, p = 0.049), had less debt (median debt ≤ 200,000, p = 0.008), had more first-author publications (4.3 vs. 1.2, p\u3c 0.001), decided on their postgraduate career path earlier (median time postgraduate second year [PGY2] versus postgraduate third year [PGY3], p = 0.016), and were more likely to plan to practice in an academic setting (51.1 vs. 29.2%, p\u3c 0.001) and in an urban location (44.3 vs. 12.5%, p = 0.004). In a multiple logistic regression model, factors predictive of fellowship training included a desire to acquire special skills (odds ratio [OR] =4.39; 95% confidence intervals [CI]: 1.70–16.37) and work with new technology (OR = 2.92; 95% CI: 1.16–10.02). Factors that predicted a career in comprehensive ophthalmology were higher levels of educational debt (OR = 0.35; 95% CI: 0.12–0.77), a later timing of postgraduate decision (OR = 0.17; 95% CI: 0.02–0.65), and lifestyle considerations (OR = 0.13; 95% CI: 0.03–0.36). Gender, prestige, or perceived favorable job market was not significant factors.
Conclusion The majority of U.S. ophthalmology residents matched into fellowships. A desire to gain special skills and a desire to work with new technology were major factors influencing residents to seek fellowship training. Lifestyle considerations and educational debt were more important in the decision to choose a comprehensive ophthalmology career. Future research that includes more trainees and programs may minimize the selection bias issues present in this study
Speed of Online and Print Peer-Reviewed Ophthalmology Publications and Correlation to Journal Bibliometric Measures
No full textAbstract
Objective This study aimed to explore the relationship between publishing speeds and peer-reviewed journal bibliometric measures in ophthalmology.
Methods Journal Citation Reports and Scopus Database were accessed for identification of journal bibliometric measures in ophthalmology. Twelve randomly selected articles from 2018 for all identified journals were studied. All outcome measures were extracted from the full text of articles and correlated with journal bibliometric measures. Statistical analysis was performed on measured parameters in comparison to a previous study.
Main Outcomes and Measures Journal impact factor, Eigenfactor score, and CiteScore were correlated with time from submission or acceptance of manuscripts to online and print publication. The correlation between study design and publishing speeds was also assessed.
Results A total of 55 journals were included for a total of 657 articles. Online publications were significantly faster than print publications for almost every journal (p \u3c 0.001). Laboratory experimental studies had significantly shorter times from submission to online publication (p = 0.002) and acceptance to online publication (p \u3c 0.001) compared with observational and interventional studies. Journal impact factor was positively correlated to publishing speed from acceptance to online publication (p = 0.034). CiteScore was positively correlated to speed from submission to print publication (p = 0.04), acceptance to print publication (p = 0.013), and acceptance to online publication (p = 0.003). Eigenfactor score was not statistically significant when correlated with any outcome measures.
Conclusion Online publication has increased speed of dissemination of knowledge in the ophthalmology literature. Despite reporting higher numbers of submissions every year, ophthalmology journals with higher bibliometric measures of impact tend to publish peer-reviewed articles faster than journals with lower impact scores. Study design of an article may affect its speed to publication
Flipped Ophthalmology Classroom: A Better Way to Teach Medical Students
No full textAbstract
Objective While medical education has generally progressed, advancements in ophthalmic education have been minimal. The flipped classroom technique is a research-supported approach to adult learning that encourages active participation. The effectiveness of widely implementing the flipped classroom modality in ophthalmology had not been studied. The purpose of this study was to evaluate a flipped classroom, primary care-focused curriculum for medical students in their ophthalmology clerkship.
Methods The ophthalmology clerkship curriculum was changed from a traditional, diagnosis-focused, lecture-based system to a chief complaint-based, flipped classroom structure. The study was performed over a 3-year period from 2016 (full traditional lecture-based system) to 2018 (full flipped classroom structure). Medical students\u27 evaluations of the clerkship, recorded lecture viewership, and exam scores were retrospectively reviewed. Cohorts from study years 2016 and 2018 were used to assess knowledge acquisition and the attitudes of learners after implementing a flipped classroom structure.
Results The primary care-focused, flipped classroom received a higher clerkship rating than the diagnosis-based traditional classroom (mean 4.18 vs. 3.82, respectively, p = 0.008). Students of the flipped classroom modality found the teaching sessions more valuable, experienced more direct interaction with faculty and residents, regarded the faculty and residents as excellent teachers, and received feedback that helped them assess their individual skills and progress. These improvements were made without changing test performance while only modestly increasing hours spent studying.
Conclusion A chief complaint-based, flipped classroom approach to the basic ophthalmology clerkship increased student satisfaction, without changing the amount of knowledge gained. This resulted in more valuable and effective learning experiences for medical students
Ophthalmology Applicant Perceptions of Two Residency Application Services: The San Francisco Match Central Application Service and Electronic Residency Application Service
No full textAbstract
Purpose Given ophthalmology residency programs are transitioning to include the internship year, either through “joint” or “integrated” 4-year programs, we set out to identify applicant preferences regarding the match and their experiences with two residency application systems: (1) the Central Application Service (CAS) and (2) the Electronic Residency Application Service (ERAS).
Design This study is designed as a retrospective repeated cross-sectional survey.
Methods A 15-question online survey was sent to 196 and 461 applicants to the 2019 and 2020 ophthalmology match cycles, respectively. Questions from the survey assessed user experiences with specific components of both application services and evaluated preferences regarding the future of the ophthalmology match.
Results Responses were received from 208 (32%) applicants. A majority of users had positive experiences with both application services; for CAS, 162 (78%) applicants had a positive experience, compared with 111 (53%) for ERAS. When compared directly, applicants favored the CAS (60%) to ERAS (21%). Furthermore, 108 (52%) respondents stated that they would prefer ophthalmology continue to use both the CAS and ERAS, while 47 (23%) respondents indicated a desire for the CAS to become the only application system for both matches.
Conclusion Although half of all respondents prefer that both the CAS and ERAS systems are utilized for the match process, many express a desire for a single matching program. As ophthalmology residency programs move to joint and integrated 4-year programs, the complexity of matching will increase. Further evaluation of applicant preferences during this transition phase is needed as applicants are required to apply to a variety of different joint and integrated internship and ophthalmology programs
A Systematic Approach to Orbital CT Scans: Integrating the BALPINE Method into Ophthalmology Curriculum
No full textAbstract
Objective While multiple approaches to the evaluation of orbital computed tomography (CT) imaging have been proposed in both ophthalmology and radiology literature, there remains a paucity of standardized approaches to orbital CT interpretation education for the ophthalmologist in training. To address this, the bones, anterior chamber, lens, posterior globe, intraconal orbit, neurovascular structures, and extraocular muscles (BALPINE) method was selected and its utilization tested as an education tool to improve resident competency in the proper assessment of orbital CT imaging.
Methods The BALPINE method is an established systematic approach to reading orbital CT scans. This approach was selected as a standardized education tool after a systematic review of orbital CT evaluation methods in the ophthalmology and radiology literature. A 15-item test, comprised of frequently diagnosed orbital pathologies developed in conjunction with a radiologist, was designed to test a group of ophthalmologists in training across multiple residency programs. The in-training ophthalmologists were first given this test prior to being taught the BALPINE standardized method to assess orbital CT imaging. The study participants were then administered a lecture describing the BALPINE method approach to orbital CT imaging. The same study participants were then administered the same test to assess improvement. The lecture was developed and administered by a board-certified Oculoplastic surgeon. The lecturer was blinded to the images included in the examination during lecture development. The radiologist was blinded to the lecture and the BALPINE method; thus, the images selected were not specific to the method being taught.
Results Overall, 27 residents, interns, and medical students completed the prelecture test, BALPINE method curriculum lecture, and postlecture test. There was an average of a 2.3-point (15%) significant improvement per test score (p \u3c 0.0001). Each level of training demonstrated improvement pre- and posttest and overall scores improved with each additional year of training, indicating the test was an appropriate measurement of ability and understanding.
Conclusion Teaching a systematic approach to the evaluation of orbital CT scans improves an ophthalmologist in training\u27s ability to diagnose orbital pathology efficiently and effectively. Widespread residency curriculum adoption of the BALPINE method would enhance the training ophthalmologist\u27s diagnostic capability
Integrating Mental Practice into a COVID-19 Appropriate Virtual Reality Cataract Surgery Course for Ophthalmology Residents
No full textAbstract
To present a revised, publicly available virtual reality cataract surgery course for ophthalmology residents that integrates a novel mental practice program into the curriculum, fulfills the six core competencies of the Accreditation Council for Graduate Medical Education, and adheres to the Centers for Disease Control and Prevention educational recommendations for the coronavirus disease 2019 pandemic
No-Show Rates and Associated Patient Factors in an Ophthalmology Resident Practice
No full textAbstract
Background In resident family medicine practices, a \u3e20% no-show rate is common, often resulting in suboptimal care. Few studies have evaluated resident ophthalmology practices in a similar fashion. The objective of this study was to determine no-show rates and factors related to missed appointments in a resident-based ophthalmology clinic.
Methods We reviewed 19,237 de-identified appointments over one academic year. Appointments were divided into general clinic visits and subspecialty visits (these two clinics function separately at our institution). The number of days between an appointment being made for a patient and the scheduled visit was defined as “lead time.” Each appointment was labeled “show” or “no-show.” Pertinent factors available in the analysis included lead time to appointment, patients age, month, time of day, practitioner training level (postgraduate years 2 to 4, fellow), and proximity to holiday. Subspecialty clinics included oculoplastics clinic, strabismus clinic, neuro-ophthalmology clinic, uveitis clinic, cornea clinic, glaucoma clinic, and retina clinic. Generalized linear mixed effects models were fit on the no-show status with these factors.
Results The overall no-show rate for general clinic was 31.4%. Longer lead time to appointment, younger age, afternoon appointments, new patients, December appointments, and lower residency level were associated with higher odds of no-show (p ≤ 0.05). The overall no-show rate for subspecialty clinic was 21.8%. Longer lead time to appointment, younger age, and lower residency level were associated with higher odds of no-show (p ≤ 0.05). Patients were significantly less likely to show up for retina clinic, oculoplastics clinic, and glaucoma clinic.
Conclusion The overall no-show rate in our clinic was on the higher end of reported no-show values from other specialties. Patient status and the lead time to appointment play a significant role in patient compliance. The significance of other factors (patient age, subspecialty, time of day, appointment month, and resident level) have been found in previous studies but are not consistent factors across all clinical environments
Michigan Ophthalmology Pipeline: Exploring a Mentorship Model to Increase Diversity in Ophthalmology
No full textAbstract
Background Ethnic concordance between physicians and patients improves compliance and therapeutic benefit. Current literature shows a lack of diversity within ophthalmology. Thus, we aimed to develop a longitudinal mentorship program between first year ophthalmology residents (PGY2s) and first year medical students (M1s) coming from minority communities underrepresented in medicine (URM) to provide early exposure to the field.
Methods M1 members of URM organizations were recruited and paired with PGY2 ophthalmology residents in a mentorship program between 2017 and 2019. All participants were surveyed twice annually.
Results All 2017 M1s stated increased interest in ophthalmology, felt “satisfied” or “very satisfied” with the program, and completed all requirements. At the year-end, the mean educational value of the program for 2017 M1s was rated 4.33/5, and interest in ophthalmology 4.67/5. Quality of the clinical experiences for 2017 PGY2s 3.5/5, and the overall effectiveness of the program 3.5/5. At the year-end, the average educational value of the program for 2018 M1s was 4.4/5, and interest in ophthalmology 4.0/5. Quality of the clinical experiences for 2018 PGY2s was 3.1/5, and the overall effectiveness of the program was 3.4/5.
Conclusion Our “pipeline” program represents an ongoing effort to increase URM interest in ophthalmology. Continued assessment to identify areas for growth and improvement can optimize the program to aid other programs in initiating efforts to tackle this important issue