Journal of Academic Ophthalmology
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Ophthalmology Program Director Perspectives of Scoring Step 1 Pass/Fail
No full textAbstract
Background Scoring for the United States Medical Licensing Examination (USMLE) Step 1 was recently announced to be reported as binary as early as 2022. The general perception among program directors (PDs) in all specialties has largely been negative, but the perspective within ophthalmology remains uncharacterized.
Objective This article characterizes ophthalmology residency PDs\u27 perspectives regarding the impact of pass/fail USMLE Step 1 scoring on the residency application process.
Methods A validated 19-item anonymous survey was electronically distributed to 111 PDs of Accreditation Council for Graduate Medical Education-accredited ophthalmology training programs.
Results Fifty-six PDs (50.5%) completed the survey. The median age of respondents was 48 years and the majority were male (71.4%); the average tenure as PD was 7.1 years. Only 6 (10.7%) PDs reported the change of the USMLE Step 1 to pass/fail was a good idea. Most PDs (92.9%) indicated that this will make it more difficult to objectively compare applicants, and many (69.6%) did not agree that the change would improve medical student well-being. The majority (82.1%) indicated that there will be an increased emphasis on Step 2 Clinical Knowledge (CK) scores, and many (70.4%) felt that medical school reputation will be more important in application decisions.
Conclusion Most ophthalmology PDs who responded to the survey do not support binary Step 1 scoring. Many raised concerns regarding shifted overemphasis on Step 2 CK, uncertain impact on student well-being, and potential to disadvantage certain groups of medical students including international medical graduates. These concerns highlight the need for reform in the ophthalmology application process
Ocular Trauma: Trends and Considerations for Resident Education
No full textAbstract
Objective Ocular trauma is a mendable cause of morbidity and preventable blindness. Our goal is to confirm the relationship between ocular trauma and seasonality, to establish an association between ocular trauma and temperature, and to discuss implications on resident education.
Methods Consults for the University of Tennessee Health Science Center Hamilton Eye Institute Ophthalmology residency (Memphis, TN) were recorded in the New Innovations database from 2006 to 2016 and analyzed retrospectively. International Classification of Diseases-9 diagnosis codes were used to identify all cases of ocular trauma. Temperature data were obtained from the National Oceanic and Atmospheric Association. The main outcome measures were the monthly, seasonal, annual, and temperature trends in ocular trauma in an emergency department setting, necessitating an ophthalmology consultation.
Results A total of 8,400 patients were screened by ophthalmology residents in Memphis, TN from 2006 to 2016, 3,540 carried a diagnosis of ocular trauma, out of which 2,290 were male (64.7%) with a mean age of 34.6 years and 1,250 were female (35.3%) with a mean age of 34.9 years. The most common diagnoses were orbital fracture (36.6%), eyelid laceration (20.2%), and nonpenetrating corneal/conjunctival injury (13.6%). Peak months were July (37.3 cases/year) and September (36.6 cases/year) with trauma more likely to occur in nonwinter months (p = 0.0069). Trauma was more likely to occur in the summer/fall seasons (p = 0.0014) corresponding to mean temperatures 82.8 and 64.6°F, respectively.
Conclusion Ocular trauma exhibits an annual and temperature cycle, peaking in the summer and fall months, and coinciding with the beginning of the academic year. Special attention should be taken in July to prepare residents for the proper management of ocular trauma to prevent blindness as traumatic cases are more likely to require surgical intervention
Surgical Aptitude Testing among Ophthalmology Residency Applicants: Current Utilization and Residency Program Directors\u27 Perspectives
No full textSurgical Aptitude Testing among Ophthalmology Residency Applicants: Current Utilization and Residency Program Directors\u27 Perspective
Association between Industry Payments and Scholarly Impact among Academic Ophthalmologists
No full textPurpose The aim of this article is to examine the association between industry payments to ophthalmologists and scholarly impact.
Design Retrospective cross-sectional study.
Methods All ophthalmology faculty at United States accredited ophthalmology residency programs were included in this study. The main exposure was industry payments to ophthalmologists in 2016, as reported in the Centers for Medicare and Medicaid Services Open Payments Database. The primary outcome was Hirsch index (H-index), a measure of scholarly impact.
Results Among 1,653 academic ophthalmologists in our study, 1,225 (74%) received industry payments in 2016. We did not observe a difference between the mean H-index of ophthalmologists receiving any industry payments versus those not receiving any payments (p = 0.68). In analysis including only ophthalmologists who received industry payments, H-index differed significantly by payment amount: 12.6 for ophthalmologists receiving less than 100 to 1,000, 18.8 for those receiving 10,000 to 100,000, and 29.4 for those receiving greater than 1,000 were associated with a higher H-index (p \u3c 0.05).
Conclusions Although our analysis cannot prove causality, we observed a significant association between industry payments and scholarly impact among academic ophthalmologists, even after adjusting for gender, academic rank, and subspecialty. Prospective studies should further evaluate this relationship
Needs Assessment of Emergency Department Residents in Examining and Managing Patients with Ophthalmologic Complaints
No full textPurpose Emergency medicine residents are trained to deal with a variety of emergency conditions; eye emergencies represent only a small portion of their clinical experience. This study was a targeted needs assessment of the comfort level of emergency medicine residents in diagnosing and managing patients who present with an ophthalmic chief complaint, with the goal of targeting future educational interventions.
Methods This was a cross sectional survey conducted at a large tertiary-care hospital between June 2016 and August 2016. Participants were 1st, 2nd, or 3rd year emergency medicine residents in an Accreditation Council for Graduate Medical Education (ACGME)-approved emergency medicine residency.
Results The total response rate was 67.4% (29/43). The majority of residents did not expect equivalent availability of ophthalmology consultation services post-graduation. They generally believed ophthalmology and examination skills to be important to their future career and became more comfortable with the slit lamp exam through residency, although the average level of comfort was only 6.9 on a 1 to 10 scale for 3rd year residents (standard deviation [SD] = 2.6). A majority of residents were not confident with their diagnostic, examination, or management skills when queried about specific ophthalmic conditions or presenting symptoms. They indicated a variety of reasons why their comfort with ophthalmologic patients was limited.
Conclusion There is both need and desire for increased ophthalmic skills training for emergency medicine residents. Given time constraints in residency training, possible solutions will need to be innovative and multifaceted in order to target this goal
Emergency Department Ophthalmology Consultations in a Tertiary Care Hospital
No full textObjective The main objective of this article is to characterize ophthalmology consultations in the emergency department (ED) of a tertiary care hospital and identify specific ways to modify the curriculum for ophthalmology and emergency medicine residency programs to train residents to effectively manage eye-related consultations.
Design This is a retrospective chart review study of ED encounters between January 1, 2008 and January 1, 2017 during which ophthalmology was consulted.
Setting Single-center urban tertiary care center.
Participants All adult patients who were seen by the ophthalmology consultation service in the ED during the study time period.
Main Outcome Measured We identified the reason for and timing of ophthalmology consultation; diagnoses made in the ED and follow-up ophthalmology clinic visit; procedures resulting from consultation; and communication with a senior resident, fellow, or attending.
Results We identified 3,583 consecutive ED encounters with an ophthalmology consultation over a 9-year period. About 51.1% of patients were female and mean age of patients was 49 years. Blurry vision/vision loss was the most common reason for consultation (24.8%) and posterior vitreous detachment was the most common diagnosis made in the ED by the ophthalmology team (11.0%). Of the patients with documented follow-up ophthalmology clinic visits, 96.7% of diagnoses made at the first ophthalmology clinic visit were the same as those determined in the ED. About 12.7% of visits resulted in a procedure with the most common being eyelid laceration repairs, pars plana vitrectomy, and laser retinopexy. Overall, 40.4% of visits required communication with a senior resident, fellow, or attending. The frequency of residents seeking assistance from more senior ophthalmologists decreased over the course of the academic year (p \u3c 0.0001).
Conclusions This study provides data that ophthalmology residency training programs can use to more effectively prepare residents for consultations in the ED. Furthermore, identifying the reasons for consultation and subsequent diagnoses can guide the education of emergency medicine physicians to improve their ability to diagnose and triage ophthalmologic presentations
“Biology of the Eye,” A Novel Multiformat Translational Elective for Medical Students
No full textObjective To allow medical undergraduate students an exposure to ophthalmology in the preclinical years as well as introduce concepts of basic and clinical science in ophthalmology for medical students.
Methods The 10-session elective was offered to 2nd year medical students in the fall of 2016 and to 1st and 2nd year medical students in the fall of 2017 at the University of Colorado School of Medicine. The curriculum included a dissection laboratory, lectures, and journal reviews of key topics in ophthalmology with a basic scientist and clinician. At the conclusion of the sessions, the students evaluated this course by survey.
Results Six medical students participated in the fall of 2016 and 11 students in the fall of 2017. The response rate was 83.33 and 100%, respectively. On a five- point Likert\u27s scale, the students in both fall 2016 and 2017 rated the course as 4.7, indicating a positive reaction. Quality of learning objectives was rated as 4.4 and 4.5 in 2016 and 2017, respectively. Course management had a score of 4.4 and 4.6 in 2016 and 2017, respectively. Comments included: “I learned a lot about the eye I would not have known if I had not taken the course,” “I enjoyed the interplay between the clinical and basic science experts,” and “I liked the model of learning about a subject then looking at the research [sic].”
Conclusions Based on the students\u27 responses and level of satisfaction, we concluded that the elective course was successful at increasing medical students\u27 exposure to ophthalmology at the University of Colorado School of Medicine while incorporating both basic and clinical science. Based on review of the students\u27 feedback, modifications to the course included, expanding the course to 1st year medical students, limiting presentation times, simplifying presentation topics, and adding worksheets to guide article review sessions
Patient Preferences for Physician Attire in Ophthalmology Practices
No full textImportance Interest is growing in targeting physician attire to improve the patient experience. Few studies in ophthalmology have examined patient preferences for physician attire.
Objective To understand patient preferences for physician attire in ophthalmology practices in the United States.
Design Survey-based, cohort study.
Setting Two private and two academic ophthalmology practices.
Participants A convenience sample of patients receiving ophthalmic care between June 1, 2015 and October 31, 2016.
Methods A questionnaire containing 22 questions and photographs of a male and female physician in seven forms of attire were presented to patients; 14 unique questionnaires were randomly distributed. Patient preference for physician attire was the primary outcome determined by summing ratings of how knowledgeable, trustworthy, caring, approachable, and comfortable the pictured physician made the respondent feel. One-way ANOVA assessed differences in mean composite scores. Comparisons between respondent demographics, practice type, and attire preferences were assessed by chi-square tests. Patient satisfaction was assessed by agreement with questions about importance of physician attire and whether this influences happiness with care.
Results In total, 1,297 of 1,826 (71.0%) questionnaires were completed. Physician attire was rated as “important” by 62.9% of participants. A total of 43.6% of participants indicated that physician attire influenced how happy they were with their care. Overall, formal attire with white coat was preferred to casual, formal, and business attire (all comparisons, p \u3c 0.05). No differences in composite scores between formal attire with white coat, scrubs alone, scrubs with white coat, or casual attire with white coat were observed. However, compared with formal attire with white coat, physicians wearing scrubs without white coat appeared less knowledgeable (mean [standard deviation]: 8.2 [1.8] vs. 7.4 [2.1]; p \u3c 0.05) and trustworthy (8.3 [1.8] vs. 7.6 [2.1]; p \u3c 0.05). Additionally, casual attire with white coat was rated as less knowledgeable compared with formal attire with white coat (7.4 [2.0] vs. 8.2 [1.8]; p \u3c 0.05). Preferences for attire varied by clinical setting: patients preferred surgeons (45.2%) and physicians in emergency rooms (41.7%) in scrubs rather than formal attire with white coat.
Conclusions Physician attire is important to patients receiving ophthalmic care. Policies aimed at physician attire in ophthalmology practices should be considered
Neuroimaging in the Emergency Department for Patients with Symptoms of Vitreoretinal Traction
No full textNeuroimaging in the Emergency Department for Patients with Symptoms of Vitreoretinal Tractio