Journal of Academic Ophthalmology
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The Diagnostic Yield and Cost of Radiologic Imaging for Urgent and Emergent Ocular Conditions in an Eye Emergency Room
No full textAbstract
Objective The aim of this study is to assess the diagnostic yield and economic cost of radiologic imaging for urgent and emergent ophthalmic conditions in an emergency room (ER) setting
Design Retrospective, consecutive case series.
Methods Charts of all patients who underwent radiologic imaging in a dedicated eye ER over a single year were reviewed. Data collected included age, patient reported chief complaint, visual acuity, principal examination finding, indication for imaging, imaging modalities performed, and the current procedural terminology (CPT) codes billed for the imaging performed. Imaging results were classified into three groups with binary outcomes: normal or abnormal; significant if it led to a change in patient management, and relevant if the imaging findings were related to the chief complaint or principal examination finding. Imaging costs were calculated using the billed CPT codes.
Results A total of 14,961 patients were evaluated during the 1-year study and 1,371 (9.2%) patients underwent imaging. Of these, 521 patients (38.0%) had significant findings. A majority of this group had significant and relevant findings (469, 34.2% of total). Subgroup analysis was performed based upon patient chief complaint, principal examination finding, and indication for imaging. Overall, the total cost of imaging was 478.54 per patient.
Conclusion Imaging for urgent and emergent ophthalmic conditions in an eye ER resulted in significant management changes in 38.0% of patients. Radiographic imaging contributes to healthcare expenditures; however, these costs must be weighed against the substantial costs of delayed and misdiagnoses, especially when patients present with acute ophthalmological symptoms
The Utility of Virtual Reality Simulation in Cataract Surgery Training: A Systematic Review
No full textAbstract
Introduction Cataract surgery is a fundamental intraocular procedure with a steep learning curve. Virtual reality simulation offers opportunity to streamline this aspect of ophthalmic education by exposing trainees to operative techniques in a controlled setting.
Materials and Methods A systematic review of the PubMed database was conducted through December 2019 for English language studies reporting on use of virtual reality simulation in cataract surgery training to assess usefulness. Studies meeting inclusion criteria were examined for pertinent data: study design, number of subjects and live cases, simulator model, training regimen, surgical skills assessed, and overall outcomes.
Results Of the 41 analyzed studies, 15 investigated the impact of virtual reality simulation-based training on performance in live surgery or wet laboratories; 20 used simulation as a device for direct assessment of operative proficiency; 6 explored simulation-based training\u27s effect on performance in simulated surgery. Thirty-seven studies employed an iteration of the Eyesi simulator, though methodologies varied widely with a few randomized trials available. The literature endorsed validity of simulator-based assessment and benefits of structured training on live complication rates, operative times, and self- and faculty-perceived competency, particularly in novice surgeons.
Discussion The literature surrounding simulation in cataract surgery training is characterized by significant heterogeneity in design. However, most works describe advantages that may outweigh the costs of implementation into training curricula. Collaborative efforts at establishing a structured, proficiency-based cataract surgery curriculum built around virtual reality and wet laboratory simulation have the potential to improve outcomes and enhance future surgical training
Relationship between Didactic Attendance and Average Ophthalmic Knowledge Assessment Program Performance
No full textAbstract
Background The Accreditation Council for Graduate Medical Education\u27s ophthalmology-specific program requirements indicate that a resident must participate in 360 hours of educational activities over the course of residency. The requirements allow a variety of options by which this educational process may occur. Furthermore, the current generation of learners has used a large array of learning tools in their careers: digital media, online resources, question banks, flipped classrooms, problem-based learning, and asynchronous lectures in addition to the traditional face-to-face didactic lectures.
Objectives This article determines if the traditional face-to-face didactic lectures play a significant role in the education of ophthalmology residents, attempts to quantitate this role, and estimates the relative importance of this method.
Methods Lecture hours beginning immediately after an Ophthalmic Knowledge Assessment Program (OKAP) examination and up to the subsequent exam was tabulated for 40 residents over 8 years. From 2012 through 2019 each of the residents took the OKAP exam one to three times. The average overall OKAP score for each resident was then regressed against his or her logged hours of didactics that year. This rate of average OKAP score to lecture hours was then evaluated for significant differences on the basis of postgraduate year (PGY). “STATA 13.1 IC,” was used for all statistical analysis.
Conclusion Traditional synchronous didactic lectures play a statistically significant role in the education of ophthalmology residents. For each 3.5 hours of lectures per year there is a 1% increase in the average OKAP score, p = 0.0064. However, the amount of variability explained by this single factor is low, R 2 = 0.067, and other factors are presumed to play a large part in learning. PGY subgroup analysis showed significant difference in the OKAP performance to lecture hour relationship, the number of lecture hours attended, and the OKAP performance
Visiting Student Away Rotations in Ophthalmology: A Study of Medical Students\u27 Experiences and Perspectives
No full textAbstract
Background Despite the frequency of medical students\u27 participation in ophthalmology clerkships away from their home institution, the impact and benefit of these clerkships have remained uninvestigated. To date, no study has focused specifically on medical student perspectives of away ophthalmology clerkships.
Objective The purpose of the study was to evaluate the medical students\u27 perspectives on and experience with away rotations in ophthalmology, and assess their effect on residency Match outcomes.
Methods An anonymous, original, online survey was designed and distributed to applicants of the 2015 to 2018 ophthalmology Match cycles.
Results A total of 69 responses from nine medical institutions were collected (62% response rate). Forty-one respondents (59%) chose to perform at least one away rotation. Among away rotators, the mean number performed was 1.44. Thirty-seven away rotators (90%) reported receiving an interview from at least one host institution they visited. The average estimated cost of an away rotation was ∼1,709 U.S. dollars. With a 95.7% overall match rate among the respondents, no statistically significant difference was seen in match rates between away rotators and nonaway rotators (p = 0.564). Among the away rotators, the mean position on their rank order list matched was 2.34, while the nonaway rotators matched at a mean position of 2.13 (p = 0.383).
Conclusion No association between away participation and success in the San Francisco Match was observed in this study. However, study participants did experience non-Match-related benefits from away elective participation
A U.S. Survey of Sexual Harassment in Ophthalmology Training Using a Novel Standardized Scale
No full textAbstract
Objective This study aimed to assess the frequency and severity of sexual harassment toward ophthalmology trainees.
Design Present study is an anonymous retrospective online survey.
Participants U.S. ophthalmology residents and fellows participated in this study.
Methods Sexual harassment comments directed toward University of Iowa ophthalmology trainees and faculty members were compiled. Statements were ranked by severity to develop the Iowa Verbal Sexual Harassment Scale. A brief, anonymous online survey incorporating the scale was sent to all United States ophthalmology residency program directors to distribute among trainees. Participants rated the prevalence, severity, and frequency of verbal and physical sexual harassment during training.
Main Outcome Measures Response to the survey questions on the prevalence, severity, and frequency of reporting of verbal and physical sexual harassment in ophthalmology training.
Results Among 112 respondents (59 men and 53 women), 72 (64.3%) experienced sexual harassment in the workplace from patients (86.8% of women vs. 44.1% of men; p \u3c 0.0001, 95% confidence interval [CI]: 1.48–2.74). Trainees rarely experienced harassment by colleagues (10.7%) or supervisors (8.9%). Women experienced more severe and frequent sexual harassment compared with men, with 54.7% women and 30.5% men experiencing sexual harassment weekly (p = 0.013, 95% CI: 1.29–5.71). Unwanted touching was the most common physical harassment type. The trainees\u27 threshold for reporting sexual harassment was higher than their worst actual experience (p\u3c 0.0001, F(2,282) = 67.59). Few trainees formally reported verbal (6.3%) or physical sexual harassment (1.8%). Trainees most commonly responded to harassment by redirecting the harasser (67.9%). Only 33.9% of trainees rated their institution\u27s sexual harassment training as helpful preparation for addressing harassment.
Conclusion Most ophthalmology trainees experienced sexual harassment with almost all harassment coming from patients. Female trainees reported substantially greater severity and frequency of sexual harassment. There remains an unmet need for targeted response training in ophthalmology training programs
The Role of Gender in Ophthalmology Resident Evaluations
No full textAbstract
Background Gender affects various aspects of medical training. Prior research in surgical specialties has shown that female residents are given less positive feedback, granted less autonomy in the operating room, perform fewer procedures, and achieve competency milestones at a slower rate as compared with their male counterparts.
Purpose The purpose of this research is to evaluate whether gender affects ophthalmology resident evaluations at a single institution.
Methods Ophthalmology resident evaluations at a single residency program from 2010 to 2018 were reviewed. Data were collected on faculty gender, resident gender, and year of resident training. A linear mixed-effects model was utilized to analyze the degree to which differences in evaluation scores could be predicted from demographic data, while accounting for multiple sources of nonindependence of data.
Results A total of 490 evaluations for 43 residents by 34 faculty were analyzed. Evaluations consisted of up to 23 questions graded on a scale from 0 (poor) to 9 (excellent). Female residents received marginally higher scores than male residents on average (coefficient of male residents = −0.2). Both male and female residents received marginally lower scores from male faculty than from female faculty on average (coefficient of male faculty = −0.21). Male faculty also appeared to have scored male residents lower to a greater degree than did female faculty (coefficient of male faculty by male resident interaction = −0.14), though this result was sensitive to model specifications. There was no significant interaction between year of resident training and gender.
Conclusion In contrast to other procedural specialties, female residents appear to have been graded at a similar level or higher than male residents on average. Male faculty gave slightly lower scores to both male and female residents than female faculty did. Male faculty also may have graded male residents marginally lower than female residents to a greater degree than female faculty did
Exploring the Benefit of an Integrated Ophthalmology Internship (PGY-1)—Perceived Preparedness and the Recommended Duration of Training
No full textAbstract
Objective The effective utilization of intern training for ophthalmology residency is undermined by its variability across postgraduate programs. As residency programs shift toward integrating the first postgraduate year (PGY-1) into the ophthalmology-training curriculum, there are no definitive guidelines to build upon.
Methods This is a retrospective cross-sectional study of new second postgraduate year (PGY-2) ophthalmology residents. Residents were surveyed in their first 2 months of ophthalmology training. Residents were asked to self-assess preparedness for ophthalmology based on their PGY-1 curriculum. A survey was composed and modified from the Accreditation Council for Graduate Medical Education\u27s assessment of resident training. The Wilcoxon\u27s rank-sum test was used to evaluate survey differences between the transitional year (TY) versus preliminary internal medicine (IM) year and compare survey responses between residents who were below versus above optimal cut points for weeks of ophthalmic training.
Results There were 72 PGY-2 residents who responded to blinded surveys collected from July to August of 2017 and 2018. Thirty-nine (54%) residents graduated from a TY, 28 (39%) from preliminary IM, 3 (4%) from preliminary surgery, and 2 (3%) from a categorical ophthalmology year. Both categorical ophthalmology and surgery year were excluded from training year comparison due to low sample size. Using weeks of ophthalmology training as the control variable, there were significant increases in preparedness for addressing the ophthalmic complaint (p = 0.003) with at least 8 weeks of clinical ophthalmology, ability to perform ophthalmic exam (p = 0.018) with at least 12 weeks, ophthalmology medical knowledge (p = 0.005) with at least 10 weeks, and proficiency with hospital electronic health record (p = 0.003) with at least 12 weeks.
Conclusion While our study did not find significant differences in perceived preparedness for ophthalmology residency based on the type of PGY-1 programs completed, there were statistically significant associations for specific ophthalmology tasks. These findings suggested a potential merit of integrating 12 weeks of clinical ophthalmology training as a benchmark for resident preparedness
Medical Student Ophthalmic Knowledge Proficiency after Completing a Clinical Elective or an Online Course
No full textAbstract
Background As more information is being packed into medical school curricula, mainstream medical topics legitimately receive more attention than specialty topics such as ophthalmology. However, general practitioners, as gatekeepers of specialty care, must attain competency in ophthalmology. We have investigated whether an online ophthalmology course alone would be noninferior to the same online course plus an in-person clinical elective in providing ophthalmic knowledge.
Methods Students at the University of Michigan Medical School voluntarily enrolled in one of two groups: an Online Only group requiring satisfactory completion of an online course entitled “The Eyes Have It” (TEHI) or a Clinical + Online group requiring students to complete a 2-week clinical rotation and the TEHI online course. The outcome metric was the score on an independent 50-question written examination of ophthalmic knowledge. Students also completed a survey assessing confidence in managing ophthalmic problems.
Results Twenty students in the Clinical + Online group and 59 students in the Online Only group completed the study. The Clinical + Online group slightly outscored the Online Only group (86.3 vs. 83.0%, p = 0.004). When the two outlier questions were removed from the analysis, there was no difference in mean scores between the two groups (85.8 vs. 85.4, p = 0.069). Students in the Clinical + Online group devoted 80 more hours to the experience than did the students in the Online Only group. The number of hours devoted to the course and interest in ophthalmology were weakly correlated with examination performance. After completion of the experiment, there was no difference in student-reported comfort in dealing with ophthalmic problems between the two groups.
Conclusion The examination scores of the students who completed the in-person alone were only slightly inferior to those of the students who completed the in-person clinical elective and the online course. These results suggest that an online course alone may provide a satisfactory ophthalmic knowledge base in a more compact timeframe, an alternative that should have appeal to students who do not intend to pursue a career in ophthalmology
