Journal of Academic Ophthalmology
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Neuro-ophthalmology Training in Ophthalmology Residency Programs in the United States
No full textBackground The status of neuro-ophthalmology education in ophthalmology residency training in the United States is unknown. There are numerous articles in the literature detailing resident outcomes for surgical procedures; however, there are no articles detailing teaching of a nonprocedural specialty. There are no specific Accreditation Council for Graduate Medical Education (ACGME) requirements for neuro-ophthalmology training within ophthalmology residency. Each program determines the amount of neuro-ophthalmology training and level of training within ophthalmology residency. There are no publications that detail the extent of neuro-ophthalmology training during ophthalmology residency.
Objective To determine the status of neuro-ophthalmology education in ophthalmology residency training programs in the United States.
Methods A survey was sent in 2014 to residency directors and neuro-ophthalmologists of all ophthalmology residency programs who participated in the Ophthalmology Residency Matching Program in the United States to determine the amount of neuro-ophthalmology training that residents receive.
Results From a total of 113 ophthalmology residency programs in the United States utilizing the Ophthalmology Residency Matching Program, 104 surveys were returned (92% response rate). Duration of neuro-ophthalmology training ranged from 1 to 112 days, with an average of 34.5 days. Most rotations occurred within postgraduate year 2 or 3.
Conclusion This is the first evaluation of the amount of neuro-ophthalmology training within ophthalmology residencies participating in the matching program in the United States, which demonstrates large variability among the different programs. Future studies could ascertain if there is a correlation between resident satisfaction in neuro-ophthalmology training and the amount of training
Student Perceptions of the Ophthalmology Curriculum in Medical School
No full textPurpose There is no national standard for ophthalmology curricula in U.S. and Canadian medical schools. We aim to evaluate medical students\u27 perceptions of the current ophthalmology curriculum without mandatory rotation at New York University School of Medicine (NYUSOM).
Design A cross-sectional Internet survey.
Methods A cross-sectional Internet survey was distributed to all NYUSOM students in March to May 2017. The main parameters measured in the study were students\u27 self-reported confidence with ophthalmology skills and satisfaction with curriculum.
Results Response rate was 27.5% (166 of 604) of NYUSOM students. Many students reported they were not comfortable diagnosing eye emergencies (64%), using a direct ophthalmoscope (71%), or testing visual acuity (50%). The majority of students did not want ophthalmology to become a mandatory rotation, but reported additional in-person training would be most helpful, compared with videos, web-based didactics, lectures, or virtual training. Completion of an ophthalmology elective and more hours of ophthalmology training were associated with increased confidence with eye examination and greater satisfaction with the curriculum.
Conclusions It is critical for all physicians-in-training to have adequate skills in eye examination. Identifying areas of improvement and determining the best teaching modality will be important in updating the ophthalmology curriculum for medical students. The majority of medical students are not at all or only slightly confident with eye examinations. Increasing the amount of in-person ophthalmology training in medical school improves confidence with eye examination
The Current Online Face of U.S. Academic Ophthalmology
No full textPurpose To evaluate the comprehensiveness and navigation ease of online content from Web sites of U.S. academic ophthalmology departments.
Design Cross-sectional analysis of 117 U.S. academic ophthalmology department Web sites from October 1 to October 31, 2017.
Methods Data were obtained on various categories, including: clinical access and subspecialty services, social media, patient support and accessibility, residency and fellowship details, and research and faculty characteristics. Percent of Web sites possessing each feature was calculated. In addition, a comparison of content completeness and navigation metrics of Web sites between the US News and World Report top 13 ranked departments and the remaining 96 that possess an ophthalmology residency was performed.
Results Greater than 80% of Web sites list a basic core of information online: address, contact information, resident and faculty characteristics, and clinical expertise. However, only 69.2% have capabilities to donate online and 59.8% supply educational material for common eye conditions. Less than half of institutions list emergency and trauma, oncology, and low-vision rehabilitation services; only 49.6% provide a social network platform. Strikingly, accessibility features are limited; scalable text, changeable color, and multilingual capabilities are available in 20.5, 4.3, and 8.5% of Web sites, respectively. In the comparison of top 13 departments with the remaining 96, the high-ranking departments possess more Web site features, but are just as efficient to navigate.
Conclusion U.S. academic ophthalmology departments in 2017 provide a basic foundation of online content, but few contain abundant features from the viewpoints of different users
Availability of Resources for After-Hours Surgical Management of Eye Injuries
No full textBackground Approximately 2.4 million eye injuries per year occur in the United States. Because of the complexity of these injuries, many of these cases present to academic institutions. Ophthalmology residency programs have a wide range of resources available for eye injuries requiring after-hours surgical intervention.
Purpose The purpose of this study was to determine availability of resources for after-hours eye surgery and their effect on clinician satisfaction.
Methods Association of University Professors of Ophthalmology (AUPO) program directors were surveyed to assess the availability of eye-trained operating room (OR) nurses, functional operating microscopes, and suitable surgical supplies. The primary outcome measure was the availability of resources for after-hours eye surgery. Secondary outcome measures included the impact of resources on clinician satisfaction.
Results Fifty-seven program directors completed the survey. Most programs operated at level 1 trauma centers (95%), had access to a functional microscope (95%), and had frequent adequate surgical supplies (88%). On the other hand, only 28 (49%) programs reported consistent access to OR nurses with ophthalmologic training. Clinician satisfaction scores were three times higher for programs with frequent access to trained surgical OR staff than for programs without (p \u3c 0.001).
Conclusion Approximately half of programs report consistent access to ophthalmologic-trained OR staff after hours. In contrast, most programs report access to a functional microscope and surgical supplies. The results of this survey suggest that directing resources toward improving access to after-hours staffing with specialty OR staff may improve clinician satisfaction
Pediatric Ophthalmology Fellowship Survey: Fellows Selection Criteria for Training Programs
No full textPurpose This article investigates the characteristics that trainees look for in a pediatric ophthalmology fellowship program.
Methods A 14-question anonymous survey was created and sent out via the United States Postal Service to all physicians of American Association of Pediatric Ophthalmology and Strabismus. The survey addressed demographics, the interview process, and the qualities of fellowship training programs that were important factors in ranking fellowship training programs. A Likert scale was used to rate different qualities (1: not important, 9: very important) and summary statistics were reported as overall means and standard deviations.
Results In total, 1,061 were mailed out with 413 returned amounting to a 38.9% response rate. The qualities with the highest mean were diversity of surgical procedures, volume of procedures/surgeries, reputation of the fellowship director, advice from mentor, emphasis on type of surgery performed, program association with an academic institution, and national reputation of program. The characteristics that ranked the lowest were presence of a Veteran\u27s Administration hospital and presence of a county hospital. Females rated proximity to family significantly higher than males. Among responders who ranked volume of procedures/surgeries as very important, strabismus surgery was the most important.
Conclusion Pediatric ophthalmologists chose fellowship training programs based on the diversity and surgical volume of procedures and the reputation of the program director
Key Word Use in Letters of Recommendation for Ophthalmology Residency Applicants According to Race, Gender, and Achievements
No full textObjectives To identify differences in letters of recommendation (LORs) of applicants to a single ophthalmology residency program by gender, race, academic performance, and match outcome.
Design This was a retrospective analysis of LORS for 2,523 applicants (7,569 letters) to the University of California, Irvine ophthalmology residency program from 2011 to 2018.
Methods Programming scripts were employed to determine the number of times 22 key words from four thematic categories (standout words, ability, grindstone, and compassion) appeared in LORs for each applicant. A chi-square test was performed to assess for possible differences in the presence of each key word by the following characteristics: gender, underrepresented minority (URM) status, Alpha Omega Alpha (AOA) membership, the United States Medical Licensing Exam (USMLE) Step 1 score, and match outcome. Linear regressions were created to determine the frequency at which words in each thematic category appeared according to the same baseline characteristics.
Results In the LORs, females were more likely to be described as “empathetic” (p = 0.002), URMs were more likely to be described as “caring” (p = 0.002), high Step 1 scorers (≥240) were more likely to be described as “outstanding” (p = 0.002), and matched students were more likely to be described as “exceptional” (p = 0.001), “outstanding” (p \u3c 0.001), and “superb” (p = 0.001). Standout words appeared more often in the LORs of AOA members, matched candidates, and high Step 1 scorers (p \u3c 0.001 for all comparisons). “Competent” appeared more commonly in LORs for low Step 1 scorers (p \u3c 0.001) and unmatched applicants (p = 0.001).
Conclusion This study identifies differences in LORs by gender, URM status, and achievement including successful ophthalmology residency match. Females and URMs were more likely to be described as “empathetic” and “caring,” respectively; otherwise, we detected no gender or racial disparities in key word use in LORs. Candidates with high USMLE Step 1 scores or AOA membership had a higher frequency of standout words in their LORs. Whether they were truly more qualified in various dimensions or if they benefited from a halo effect bias warrants further investigation. There was a significant difference in the number of standout words in LORs between matched and unmatched applicants, suggesting that key word frequency may be a relevant metric for LOR appraisal
Quantifying the Impact of Research on Matching into Ophthalmology Residency
No full textPurpose This article aims to quantify the impact of research on matching into various tiers of ophthalmology residency programs.
Design In this study, 340 applicants who matriculated into ophthalmology residency programs in the United States from the class of 2019 were included. Data variables collected for each applicant composed of the following: Hirsch\u27s index (h-index), total number of publications, journal impact factor, type of publication, and number of publications relating to ophthalmology. The primary outcome was tier of ophthalmology program that each applicant matched into, which was determined by two metrics: (1) the h-index of the department\u27s faculty and (2) overall reputation of the residency program as characterized by the U.S. News and World Report Ophthalmology Rankings.
Results After multivariate analysis, only the h-index was found to be associated with an increased likelihood of matching at a higher tier program when measuring tier based on the metric of institutional research output (p \u3c 0.0001). However, no research variable was found to be significant on multivariate analysis when assessing the impact of research on matching into a certain tier program based on reputation. The h-index was noted to increase by 1 for every 3.1 papers as the first author, every 4.9 years since the first publication, every 6.4 ophthalmology-related publications, and every publication in a journal with an impact factor of 5.2.
Conclusion A higher applicant h-index is associated with matching at an ophthalmology program with greater research output; however, it is not associated with reputation of residency program
Subject and Academic Setting of Pre-residency Publications as Potential Predictors of Post-residency Academic Productivity in a Cohort of Ophthalmology Residents
No full textObjective This study aimed to determine if there is any association between the subject of pre-residency research publications (PRPs) and the academic settings in which they are produced with post-residency academic productivity among graduates from an academic ophthalmology residency program.
Design, Setting, Participants This is a cross-sectional study involving graduates of the Wilmer Eye Institute Residency Training Program from 1990 to 1999. An electronic survey was conducted and each participant was asked to submit his/her curriculum vitae, including a list of peer-reviewed publications. Publications were validated and then classified according to the academic setting in which the research was performed, and whether or not the research was related to ophthalmology.
Outcome Measures The primary outcome measure was the post-residency academic productivity score. The secondary outcome measures were the relationships of academic productivity with the settings in which PRPs were performed and the topics of the PRPs.
Results Fifty-one individuals were included. Regression analysis showed a positive association between the number of PRPs generated during undergraduate studies and medical school and the academic productivity score (ratio = 1.17, p = 0.006) but not during an advanced degree program, research fellowship, or a year off to perform research. Regardless of the setting in which it was performed, the subject of a PRP was not associated with academic productivity.
Conclusion It may be appropriate for ophthalmology residency programs whose mission is to train future academicians to place increased weight on applicants who have published articles related to projects performed during undergraduate years or in medical school and less weight on publications related to research performed during a more structured research period, such as an advanced degree program, regardless of the subject(s) of the publication(s)
Resident Stress Level during Steps of Cataract Surgery
No full textPurpose To investigate intraoperative stress levels using heart rate monitoring during each step of cataract surgery.
Setting Single tertiary hospital.
Design Observational study recording resident heart rate as a measure of acute stress level during cataract surgeries.
Methods Emory ophthalmology postgraduate year (PGY) 3 and PGY-4 residents operating at Grady Memorial Hospital during the time period of the study were eligible to participate. Chest-strapped Bluetooth devices recorded heart rate during the surgeries. The mean, maximum, and minimum heart rates were then analyzed individually for the following steps of surgery: incisions, continuous curvilinear capsulorhexis, hydrodissection, nucleus disassembly, quadrant removal, cortical cleanup, intraocular lens insertion, and closure. Data collection started in April 2017 and ended in February 2018.
Results Out of the 549 surgeries recorded, 427 yielded viable data. Across that dataset, quadrant removal had the highest adjusted mean heart rate value (90.3; 95% confidence interval [CI]: 82.9–97.7; p \u3c 0.0001), highest adjusted maximum heart rate value (97.3; 95% CI: 89.5–105.3; p \u3c 0.0001), and highest adjusted minimum heart rate value (82.1; 95% CI: 75.2–89; p \u3c 0.0001). Nuclear disassembly and incisions were second and third highest, respectively.
Conclusions Quadrant removal, nucleus disassembly, and incisions are the three most stressful steps for resident surgeons. This knowledge should be applied to enhance the resident experience by emphasizing these steps during surgical preparation and training. Future studies using intraoperative heart rate monitoring may be warranted to better understand the resident and attending experience and ultimately improve surgical outcomes
Burnout in Ophthalmology Residency: A National Survey
No full textPurpose To determine prevalence of burnout in ophthalmology residents in the United States using the Maslach Burnout Inventory—Human Services Survey and to identify factors associated with burnout and wellness.
Methods Anonymous survey distributed to residents via residency program directors.
Results Ninety-one programs out of 113 (80.5%) confirmed survey distribution. Of 267 included respondents, 23 (8.6%) met criteria for high burnout, and 169 (63.3%) met criteria for at least one aspect of burnout. Longer work hours, longer hours spent on call, higher number of consults seen on call, fewer hours of sleep on call, and not meeting recommended physical activity minimums were associated with higher emotional exhaustion. Most common factors cited to improve wellness included physical activity, nurturing relationships, and co-resident support, whereas most commonly cited factors that contributed to burnout included sleep deprivation, call, and workload.
Conclusion Burnout in ophthalmology residents is common, occurring at similar rates as reported in residencies of other specialties