Journal of Academic Ophthalmology
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Probability of Success in the Ophthalmology Residency Match: Three-Year Outcomes Analysis of San Francisco Matching Program Data
No full textObjective To develop a probability model of matching into a US ophthalmology residency program using San Francisco Matching Program (SF Match) data.
Design Retrospective data analysis of de-identified application and matching data.
Participants Registrants for the 2013, 2014, and 2015 ophthalmology residency matches conducted by the SF Match.
Methods Descriptive statistics of candidates, comparison of continuous and categorical variables between matched and nonmatched candidates, and linear regression modeling were performed. A recursive partitioning method was used to create a probability of matching algorithm.
Main Outcome Measures Probability of successfully matching based on quantifiable candidate characteristics.
Results Over the 3-year period, 1,959 individuals submitted an average of 64 applications and received a mean of nine interview invitations. The overall match rate was 71%, with 78% matching at one of their top five choices. Successful matches were more likely to occur in US medical school graduates (78% vs 20%, p \u3c 0.001) and applicants on their first attempt (76% vs 29%, p \u3c 0.001). The association between matching and number of programs applied became negative with \u3e 48 applications. Probability of matching was “high” (\u3e 80%) among US graduates with a step 1 United States Medical Licensing Examination (USMLE) score \u3e243 (regardless of number of programs applied to), a step 1 USMLE score of 231 to 243 who applied to at least 30 programs, and first-time applicants with a step 1 score \u3e232. No international medical graduates or repeat applicants had a “high” probability of matching.
Conclusions Although advice must be individualized for each candidate, applicants for ophthalmology residency who fall into a “high” probability of matching group are likely to be successful with applications to 45 or fewer programs. Applying to 80 or more programs should be considered for international medical graduates and/or applicants who are previously unmatched. Modification of the match application data form may allow more detailed analysis of variables such as Alpha Omega Alpha or Gold Humanism Honor Society membership, research activity, and composite evaluation on a standardized letter of recommendation
Implementation of a Standardized Patient Safety Checklist in Ophthalmic Surgery
No full textObjective To develop and institute a standardized ophthalmology-specific operating room checklist, and to test adherence to the surgical checklist components after implementation.
Design An ophthalmology-specific operative room checklist was developed using recommendations from surgical preoperative checklists from other subspecialties and checklists specific to cataract surgery. This standardized checklist was then implemented into the operating rooms. Operative room staff was trained on its use. Adherence to the checklist was measured prospectively.
Setting Surgical centers at Kellogg Eye Center in Ann Arbor and Livonia, Michigan.
Participants Patients undergoing ophthalmic surgery at the Livonia and Ann Arbor surgical centers.
Main Outcome(s) and Measure(s) The primary outcome measures were surgical team adherence to each category of the operative checklist (preop, prebrief, preanesthesia verification, time-out, intraocular lens measurement/confirmation for cataract cases, debrief). Adherence to the subsections of the operative checklist was measured during three periods over the course of 1 year: baseline, postintervention (after introduction of the checklist in all operating rooms), and postadjustment (after additional training was provided to operating room staff and incentives to collect data were provided to personnel responsible for collecting it).
Results A total of 2,532 surgical cases were included in the analysis. Baseline adherence ranged from 87 to 90% across preop, prebrief, preanesthesia, and time-out verification sections of the operative checklist. After the institution of the intervention and adjustments, adherence to the surgical checklist improved significantly across all areas of the checklist to 97–98% (p \u3c 0.01).
Conclusions and Relevance The development and implementation of an ophthalmology-specific operative room checklist increase adherence to recommended safety checks prior to the start of surgery. To maximize patient safety, the same or similar checklist is recommended for use in all ophthalmology operating rooms
Recruiting the Digital-Age Applicant: The Impact of Ophthalmology Residency Program Web Presence on Residency Recruitment
No full textBackground The phenomenon of internet dependence has changed the way the rising generation seeks information. This mentality has caused medical students to turn to online resources as they seek information about potential residency training programs. Residency program web presence (PWP) is increasingly important, and may even impact recruitment efforts. Improvement of PWP could enhance programs\u27 recruitment of ideal candidates.
Objectives The purpose of this study is to assess how ophthalmology residency PWP is impacting the residency recruitment process by understanding how it influences applicants\u27 application and rank list choices as well as to identify the contributing factors.
Methods Applicants applying for ophthalmology residency training at Penn State University during the 2015–2016 and 2016–2017 application cycles were surveyed using Research Electronic Data Capture (REDCap). Surveys sought applicants\u27 perspectives with respect to their experiences with PWP and how those experiences shaped their application and rank list decisions.
Results Of 860 applicants, 214 (24.9%) responded, accounting for 17.4% (214/1,228) of all ophthalmology residency applicants during the respective cycles; 72.4% of respondents expressed PWP does impact where they apply, how they form their rank list, or both; 93.4% said websites are an important resource during the application process; 47.2% conveyed interest in programs utilizing social media tools; and 76.5% of respondents felt websites gave sufficient information less than 50% of the time.
Conclusion Ophthalmology PWP does impact resident recruitment. By enhancing program websites and adding social media tools, programs can improve recruitment efforts
Educational Value of a 3D Printer in Ophthalmology Training
No full textAbstract
Three-dimensional (3D) printers are increasingly being used in medicine for surgical planning, medical education, patient education, research, and device development. We explore the educational value of a 3D printer for trainees in an ophthalmology residency program. A 3D printer was made available to medical students, residents, and clinical and research fellows in the Department of Ophthalmology at Case Western Reserve University. One of the medical students was proficient in the technology and was available to help. Multiple projects were initiated including the manufacturing of slit-lamp cellphone adapters and various interface and integral custom-made parts for research applications. The 3D printer was found to be useful by 20 of 21 trainees surveyed with 17 of 20 saying they would use it after graduation if they had access to one. All the respondents felt that the availability of the technology can contribute to increased innovation in the ophthalmology department. We encourage other ophthalmology departments to experiment with 3D printing as a tool to foster innovation and creativity for trainees
Cataract Surgery Cancellations: An Analysis of Financial and Resident Training Implications at a Major Eye Institution
No full textPurpose The objective of this study was to assess reasons for cancellation of resident-performed cataract surgery, identify modifiable barriers to completion of the surgery on the scheduled date, and analyze the healthcare reimbursements and educational experiences lost as a result of cancellations.
Setting General eye clinic staffed by residents in a major urban center.
Design Retrospective, observational study.
Methods The study compared patients (older than 18 years) who canceled their cataract surgery to patients who underwent surgery on their scheduled date. Cancellation and reimbursement information was obtained from the surgical coordinator\u27s scheduling book and billing information. Demographic information was obtained from patient electronic medical records, and scheduling logs. A brief phone survey was implemented to identify patient\u27s barriers to surgery if a reason for cancellation was undocumented.
Results The overall cancellation rate over 1-year was 29.54% and most common overall reason for cancellation was that preadmission testing (PAT) was not completed in time for the procedure. Overall, 72% of the cancellations were made within 7 days of the surgery. The total estimated lost potential reimbursement due to cancellation was $844,370. The relative loss of surgical opportunities for residents throughout this 1-year period was 230 cases or 29 surgeries per resident.
Conclusion These findings have prompted a new study testing whether on-site mandatory PATs conducted on the same day as the patient\u27s ophthalmology evaluation will reduce cataract surgery cancellation rates
Evaluating Resident Training in Oculoplastic Surgery: A Case Series of 104 Eviscerations
No full textPurpose The aim of this study is to evaluate resident surgical performance based on complications after ocular evisceration.
Methods A retrospective chart review of eviscerations performed between October 2011 and May 2017 by ophthalmology residents as the primary or assistant surgeon under the guidance of a single oculofacial plastic surgeon (M.O.G.) was completed. Data collected included reason for evisceration, resident participation in the case and resident\u27s month of oculoplastic training, surgical technique, subsequent complications, and duration of follow-up.
Results There were no significant differences in complication rates or surgical sequelae in resident-led versus attending-led surgeries. The complication rate for all cases in total was 5.77%. A slight negative correlation existed between the resident\u27s month of training and the presence of postoperative complications. The number of adverse events was found to be significantly correlated with the duration of patient follow-up.
Discussion Ocular eviscerations performed by ophthalmology residents as primary surgeons achieve outcomes equivalent to published reports, suggesting ocular eviscerations are a safe, effective procedure wherein residents can refine surgical skills. Some surgical sequelae may be linked to particular surgeons, implying evisceration outcomes can be used to assess resident surgical performance. Fewer adverse events arose as the resident\u27s length of oculoplastic training increased, but this finding did not reach significance. Larger studies are needed to explore these trends
Not a Cheap Investment: Estimating the Cost of the 2017 to 2018 Ophthalmology Residency Match to the Applicant and Program
No full textPurpose To estimate the cost of the match process for all ophthalmology applicants and the departmental costs at the University of Kentucky during the 2017 to 2018 match cycle.
Design Financial analysis.
Methods Using the available national match statistics for the 2017 to 2018 ophthalmology residency match and the mean of all residency interview costs available in the literature, the estimated mean and total match costs were calculated for all applicants, including application fees and interviews. Program costs were estimated based on direct interview costs, lost productivity, and fixed costs.
Results Of 625 applicants, 475 matched into an ophthalmology residency position in 2017 to 2018. The mean estimated cost was US4,646,950 on the match in aggregate. Our department spent an estimated US3,736 per each of 48 interviewed applicants.
Conclusions and Relevance Matching into an ophthalmology residency position is expensive not only for the applicant but also the program. Reforms to the process would likely be beneficial to both parties
Near-Peer Teaching Outreach Programs to Increase Minority Physician Recruitment
No full textProblem Health disparities among racial and ethnic groups exist in the United States despite improvements in health status and access to care. These inequalities may be reduced by increasing minority physician recruitment; however, how best to recruit these physicians remains unclear.
Approach Near-peer teachers are not professionally trained, but have recently learned material that they themselves teach. Near-peer teaching in minority student outreach programs may be effective in increasing minority physician recruitment. The authors used a near-peer teaching model to promote interest in medicine, specifically ophthalmology, as a potential career path for both volunteer near-peer teachers and minority high school students participating in an educational outreach program. Twenty-one college and graduate-school near-peer teachers of various racial and ethnic backgrounds participated to teach 31 inner-city high school students. The program was evaluated using pre- and posttest surveys assessing students\u27 knowledge about and interest in science, medicine, and ophthalmology; analysis used pairwise t-test comparisons. Qualitative responses and an end-of-training survey also assessed students\u27 and near-peer teachers\u27 satisfaction with the program and perceptions about medicine as a career.
Outcomes Students\u27 knowledge about and interest in medicine and ophthalmology increased significantly after participation. Near-peer teachers agreed that teaching in the program was beneficial to their careers and made it more likely that they would enter medicine and ophthalmology.
Next Steps The authors will track the near-peer teachers\u27 career paths and, in the next iteration, will increase the number of program days. This intervention may serve as a model for outreach for other specialties beyond ophthalmology
Eye Care Industry Analysis
No full textAbstract
Eye care is a large and growing industry in the United States. Demographic and lifestyle trends will spur increased demand in coming years, but industry earnings will depend on the state of regulation and health care reform. Ophthalmologists and optometrists are the two major service providers in the industry. While the markets for both professions are currently fragmented, the wave of consolidation and commoditization in health care will likely catch up to eye care in coming years. Scope of practice legislation continues to be a topic of heated debate. As it evolves, consolidated practices will move toward an integrated model that uses both types of providers to meet demand
Preferences and Practices of U.S. Ophthalmology Residency Program Directors Regarding Post-interview Communication with Residency Applicants
No full textImportance Little is known about the perspectives and practices of U.S. ophthalmology residency program directors (PDs) regarding communication between PDs and applicants during the post-interview residency match period.
Objective To investigate the preferences and practices of ophthalmology residency PDs regarding post-interview communication between PDs and residency applicants during the residency match period.
Design and Setting Web-based anonymous survey.
Participants Directors of ophthalmology residency programs accredited by the Accreditation Council for Graduate Medical Education.
Results The response rate was 64% (74/116). The majority (75%; 55/73) of PDs preferred that PDs and residency applicants not communicate during the post-interview period; the main reasons were that such communication was not ethical and not productive. In addition, 62% (46/74) of PDs believed that the Ophthalmology Matching Program should institute a policy of no post-interview communication between applicants and faculty during the residency match period.
Conclusion and Relevance The majority of U.S. ophthalmology residency PDs favor instituting a policy of no post-interview communication between applicants and faculty during the residency match period