Journal of Academic Ophthalmology
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Impact of Area of Deprivation Index on Ophthalmology Consultation in the Emergency Department
No full textPurpose: To evaluate if individual sociodemographic and Area of Deprivation Index (ADI) are associated with receiving an Ophthalmology consultation when self-presenting to the Emergency Departments (EDs) with an eye-related chief complaint. Methods: Retrospective review of patients presenting to Harborview Medical Center and University of Washington Medical Center EDs between 2/2022 and 1/2023. Individual sociodemographic were obtained from medical records; ADI was calculated based on the patient\u27s home address. Encounters were categorized as emergent, nonemergent, or could not be determined based on final diagnosis. Chi-Square and ttest were used for categorical and continuous variables, respectively. Odds ratios (OR) and confidence intervals (CI) were calculated using binomial logistic regression. Results: 1,212 patients were included; 36.1% were 18-39, 44.2% were 40-64 and 19.6% were ≥65 years old. The median and interquartile range of ADI scores was 14.0 and 17.0 respectively. Although overall ADI scores were similar for patients who received (47.3%) or did not receive a consultation (56.7%) (17.3 ± 14.1 vs. 16.7 ± 13.9, p=0.419), patients with emergent diagnoses who received a consultation had higher ADI scores (more disadvantage) (19.1 ± 15.9 vs. 15.3 ± 13.7, p=0.018). Younger age group (OR 1.83; CI 1.27-2.63) and nonemergent diagnosis (OR 3.82; CI 2.72-5.36) were associated with higher odds of not receiving a consultation (p≤0.001). Conclusions: Among patients with a final diagnosis in the emergent category, those with higher ADI scores were more likely to be seen by Ophthalmology, while patients in the age 18 to 39 years old group had higher odds of not receiving a consultation
Ophthalmology Educators’ Perspectives on Supporting Medical Students to Become Competitive Residency Applicants
No full textPurpose: Changes in medical education metrics challenge ophthalmology educators in preparing strong residency applicants. We surveyed ophthalmology educators on traits perceived to be the most important for matching into ophthalmology residency and how factors like program size, student rotation structure, and mentorship experience influence valued applicant traits and first-time match rates.
Methods: An anonymous, 12-question online questionnaire was approved and distributed by the Association of University Professors in Ophthalmology (AUPO) to program directors (PDs), associate program directors (APDs), and directors of medical student education (MSEs). Questionnaire responses were collected August-November 2023. Kruskal-Wallis and post hoc Dunn’s tests were performed on Likert data; χ2 tests were performed on categorical variables.
Results: Ninety-one educators on the AUPO listserv, including 47 of 120 PDs (39.2%), 8 of 87 APDs (9.9%), and 36 of 87 MSEs (41.4%) completed the questionnaire. Respondents reported the most valued applicant traits were academic performance, clerkship grades, strong letters of recommendation, USMLE Step 2 score, and demonstration of resilience. Pacific programs valued publications more than East-South-Central programs (p = 0.048). Programs with 5-7 residents per class valued ophthalmology publications (p = 0.018) and gap years (p = 0.007) more than programs with \u3e7 residents. Programs with 2-4 residents per class valued away-rotations more than programs with 5-7 residents (p = 0.016) and \u3e7 residents (p = 0.014). There were no significant relationships between reported first-time match rates and medical student rotation formats, curriculum structures, or length of mentorship experienced.
Conclusions: Ophthalmology residency educators valued different qualities in their applicants based on their geographic location and residency class size. Although reported first-time match rates were not associated with specific rotation formats, curricula, or mentorship structures, students could benefit from greater access to academic resources, competitive Step 2 performance, and strong letters of recommendation
A Novel 3D-printed Silicone Simulation Model for Effective Instruction of Marginal Eyelid Laceration Repair
No full textPurpose We performed a prospective study to determine the efficacy of a novel silicone eyelid model in helping train residents to repair marginal eyelid lacerations. Methods 3D design software was used to create a scaffold for a silicone eyelid mold. A total of 18 ophthalmology residents participated in a training session on marginal eyelid laceration repair, practicing on these models. Prior to and following the session, residents anonymously responded to a survey assessing their degree of confidence in repairing marginal and non-marginal eyelid lacerations, as well as their overall opinion of the workshop. Questions related to their confidence and ability utilized a five-point Likert Scale, with higher numbers representing more positive responses. The responses were compared using the Wilcoxon Rank-Sum test. Results Following the training session, the residents showed a significant improvement in confidence and knowledge in the repair of marginal eyelid lacerations. Amongst all residents, the median confidence level for repairing marginal eyelid lacerations increased from 2.00 to 3.00 (p=0.042). The residents with no prior marginal eyelid repair experience reported a larger increase in the degree of confidence with median scores rising from 1.00 pre-session to 2.00 post-session (p=0.01). Residents found the simulation to be beneficial with a median score of 5.00 (IQR 4.00-5.00). When compared to other eyelid simulation models for training, the silicone model was found to be superior with a score of 4.50 (IQR 4.00-5.00). Conclusions 3D printed silicone eyelid models provide an effective and realistic simulation of marginal eyelid laceration repair
Education Outcomes from an Ophthalmology Microsurgery Course for Medical Students
No full textBackground: Microsurgery training programs are critical for developing the skills needed by ophthalmology residents, but they are not typically offered to medical students. However, incorporating a microsurgery course into medical school curricula may help students more carefully consider a career in ophthalmology and improve learning outcomes during their training. Purpose: This article describes a microsurgery course for medical students and evaluates its educational impact. Methods: A microsurgery course was developed and implemented for third (MS3) and fourth (MS4) year medical students at Duke University School of Medicine. The fourweek course included six didactic lectures, three hands-on skills sessions, and the use of a dissection microscope for home practice. Participant knowledge and suturing skills were measured at the course\u27s beginning and end via a written assessment and a timed suturing challenge. Results were analyzed using SAS/STAT software. Results: Fifteen students participated in the microsurgery course, including eight MS3 and seven MS4 students. Participants showed significant improvements in microsurgical skills, measured by count, quality, and self-reported confidence during the suturing challenge. They also showed significant improvement in their knowledge of microsurgical techniques, as measured by written assessment scores. There was no significant difference between MS3 and MS4 students. Additionally, there was no correlation between final written assessment scores and the final number of sutures. Conclusion: Medical students participating in this microsurgical curriculum in its entirety improved their skills and knowledge, providing an example of how an affordable educational program can deepen instruction and engage future ophthalmologists even during their pre-residency medical training
Perceptions of an “Application Cap”: A Survey of Ophthalmology Residency Program Directors
No full textPurpose: To determine residency program directors’ (PD) perceptions of the ophthalmology match process, particularly regarding their opinions on a potential application cap that would limit the number of programs to which an applicant can apply. Methods: An Association of University Professors of Ophthalmology (AUPO)-endorsed survey targeted U.S. PDs from the 2021 and 2022 cycles. A survey was initially distributed on 02/14/2023 with a single email reminder approximately 3 months later. All responses were anonymous and collected via a secure Qualtrics link. Results: Of the 45/121 PD respondents (37.2% response rate), 88.9% supported an application cap and suggested a median of 40 (interquartile range: 33.75-50) programs per applicant. Additionally, 93.3% agreed that applying to less programs will not disadvantage URiM candidates or hinder the goal of DEI in ophthalmology. PDs highlighted the following benefits of capping: sharper applicant focus, holistic reviews, and reduced costs. Concerns with capping included biases against international medical graduates and osteopathic applicants and fostering an anticompetitive attitude. Conclusion: The majority of PDs support an application cap. Such a move may reduce administrative and financial burden, while enabling a holistic application review. Whether through an application cap or other means, reducing the number of applications that programs receive is likely to benefit all parties
Academic Ophthalmology Physician Financial Compensation in the United States: Trends and Distribution by Rank, Sex, Race/Ethnicity, and Geography
No full textBackground: Despite diversity efforts, under-representation and compensation inequities persist in academic ophthalmology.
Purpose: To investigate the trends and distribution of academic ophthalmology physician financial compensation in the United States and compare them by rank, sex, race/ethnicity of faculty, and geographic location of programs. Methods: This was a cross-sectional, retrospective study of the compensation of full-time ophthalmology faculty with a medical doctorate or equivalent degree at U.S. medical schools from 2017 to 2023. This national study uses data from the AAMC Faculty Salary Report. The main outcome measure was total compensation. Total compensation was analyzed by faculty rank (instructor, assistant professor, associate professor, professor, chair, chief) and demographic factors.
Results: Overall, academic ophthalmology faculty compensation increased an average of 2.65% to 3.37% from 2017 to 2023. Female faculty had consistently lower median compensation than males across all ranks, with the disparity widening for chairs. Black faculty had lower median compensation than White faculty across all reported ranks. Hispanic-Latino faculty of assistant professor and professor rank had an 8% and 12% lower median compensation, respectively, compared with White faculty with the same rank. However, Hispanic-Latino faculty of associate professor ranking had a 3% higher median compensation compared with White faculty of the same rank. Asian faculty had a lower median compensation than White faculty at the instructor, assistant, and associate professor ranks but greater median compensation at full professor, section chief, and chair ranks. Faculty in the Central United States had the highest median compensation for all professor ranks.
Conclusions: Overall, annual salary increases failed to keep pace with national inflation. Moreover, there continued to be disparities in compensation between male and female faculty of the same rank, as well as between Black and White faculty of the same rank. This study emphasizes the value of monitoring salary trends over time to ensure fair and adequate compensation for ophthalmologists. It also elucidates persistent salary inequities between groups that should be addressed as part of the broader effort to improve diversity, equity, and inclusion within ophthalmology
Website Transparency of Ophthalmology Residency Programs: A Cross-sectional Study
No full textBackground: There is an increasing call for transparency in the ophthalmology residency application process. With programs shifting to virtual interviews, the availability of information regarding each program is limited to website searches, which as is, are not reflective of the programs and what they offer to potential residents.
Purpose: To assess the transparency of the residency application process through assessment of program for the period 1 November 2022 to 31 December 2022.
Methods: Four main categories of variables were studied: selection criteria, interview process, program priorities, and program requirements. Every program’s website was reviewed and the four categories were noted as a binary “Yes” or “no” as in, are these factors present on the website or not.
Results: The program requirements section was generally the most well reported, with adequate information provided in more than 90% of websites. The selection criteria section was the least well reported, with letters of recommendation, research, and step score cut-offs listed on less than 10% of program websites.
Conclusion: We identified gaps in transparency on residency websites across four categories. Identifying these gaps can guide improvement efforts for residency websites that will allow for more uniform access to important information regarding programs, which can support the continuation of a virtual application process
Mastering the Retrobulbar Block: Using a Novel 3D-printed Simulator for Practical Training
No full textTopic The use of simulation offers a safe environment for practicing challenging and potentially dangerous techniques. We developed a 3D-printed model which realistically simulates critical orbital anatomic features and enables safe practice of the retrobulbar block (RBB). Clinical Relevance The RBB provides optimal regional anesthesia for procedures of the eye and orbit, but requires a level of hands-on training and practice which is often not readily available. Methods The simulation device was created using 3D computer modeling tools to mimic the anatomical structures, and printed with select plastic and silicone materials cast using 3D-printer generated molds. Subjects included 75 ophthalmologists with varying levels of experience who administered simulated retrobulbar anesthesia into the training model and completed pre- and post-training surveys. The primary outcomes measured were the subject’s impression of the model’s anatomical fidelity and utility for practice. Additionally, data was collected grading the participants’ successful delivery of the simulated medication injection, prior experience with retrobulbar training, and level of training in ophthalmology. Results The 3D-printed training model realistically simulated the ocular and orbital structures and enhanced the learning experience of the procedure. 17% (n=13) of participants had never previously performed an RBB. 70% (n=53) of participants recalled that performing an RBB was part of their residency training, and none had performed an RBB with a simulator. 53% (n=38) indicated that the model was similar or very similar to the actual procedure. Paired t-test analyses comparing pre-training to post- training outcomes suggested that the training improved the subjects’ level of comfort with performance of an RBB (P \u3c 0.0001). The extent to which the participants would include or plan to include an RBB as part of their clinical practice improved between the pre-training and post-training periods (P= 0.0004). Similarly, the extent to which participants believed that using a training model would improve their clinical practice increased between the pre-training and post-training periods (P=0.0086). Conclusion Live simulation training for retrobulbar anesthesia using 3D-printed training model can realistically mimic ocular and orbital structures sufficiently to enhance acquisition of the skill and potentially improve its safe performance by ophthalmologists at all levels of experience
Publication Rates For Abstracts Presented At The Aapos Annual Meeting
No full textBackground: American Association for Pediatric Ophthalmology and Strabismus (AAPOS) annual meetings provide opportunities to present research abstracts to a sub-specialty audience. However, these abstracts may undergo less rigorous peer review and may be associated with risks of non-publication or publication bias. This study aims to evaluate and analyze publication rates and potential factors that contribute to non-publication. Methods: We examined all abstracts (paper, hardboard posters, and electronic posters) accepted for presentation (n=1093) at the AAPOS annual meetings between 2015 and 2019. A comprehensive search was conducted to quantify the abstracts that were published to a peer reviewed journal within three years from presentation. Results: 41% of all presented abstracts went on to be published within three years. The most common journal was the Journal of AAPOS (31%). There were over three times more hardboard posters (n=624) than paper abstracts (n=180). Paper abstracts were published at the highest rate (53%) while electronic posters had the lowest rate (36%). The 2015 meeting had the lowest publication rate (36%) while the 2019 meeting had the highest publication rate (46%). Conclusion: There was an increasing trend in publication rates from 2015 to 2019 but a decreasing trend in publication rates into the Journal of AAPOS. Over half of the abstracts presented at AAPOS remain unpublished into peer reviewed journals within three years. Abstracts accepted as papers are more likely than other types to be published. With less than half of all abstracts being published, there is a significant opportunity to improve publication rates
Assessing the Impact of COVID-19 Pandemic on Surgical Trends of Ophthalmology Residents Graduating After 2020
No full textPurpose: To examine the effects of the COVID-19 pandemic on surgical volumes of ophthalmology residents who completed training after 2020. Methods: Aggregated average case logs of primary surgeon and surgeon + assist (S+A) procedures for graduating ophthalmology residents in the U.S. between 2012 and 2023 were gathered from the Accreditation Council for Graduate Medical Education (ACGME). Trends for primary surgeon and S+A procedures were assessed. The annual percent change in primary surgeon and S+A procedures was determined using linear regression to compare changes over three time periods: 2012-2019, 2019- 2020, and 2020-2023. Results: Total cases as a primary surgeon and in S+A roles increased each year from 2020-2023. Primary surgeon and S+A experiences exceeded pre-pandemic levels by 2023 and 2022, respectively. Recovery from pre-pandemic levels was seen in both primary surgeon and S+A for total cornea, glaucoma, and other retinal procedures. For primary surgeon and S+A procedures, the post-pandemic cohort experienced an increase in annual percent change in total procedures compared to the pre-pandemic cohort (5.1% vs 3.2%, p = .002 and 3.4% vs 1.2%, p \u3c .001, respectively). Conclusions: Residents graduating after 2020 performed more primary surgeon and S+A procedures than their peers who graduated in 2020. The average annual percent change in total procedures for primary surgeon and S+A cases from 2020-2023 was greater than that seen from 2012-2019 for total procedures and many subcategorie