Journal of Academic Ophthalmology
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Ophthalmology Residents\u27 Internship Selection and Initial Trainee Confidence: An Observational Study
No full textPurpose In this study, we set out to better understand the factors that influenced current ophthalmology residents\u27 internship selection. We then tested the hypothesis that certain clinical or research experiences in medical school and internship may influence residents\u27 confidence upon entering ophthalmology residency. Furthermore, we investigated whether completing internship at the same program as one\u27s residency is correlated with confidence at the start of residency.
Design Observational, cross-sectional, multicenter survey.
Participants U.S. ophthalmology residents (Post Graduate Year 2/3) belonging to the class of 2018. Eighty surveys were submitted of which 63 were analyzed based on established inclusion criteria.
Methods Residents responded to a 22-question online survey addressing how residents chose their internship, internship curriculum, exposure to ophthalmology in medical school and during internship, confidence level entering ophthalmology residency, confidence in managing various ocular pathologies, and factors that built confidence prior to ophthalmology residency. A Likert scale format was used for the majority of survey questions. Kruskal–Wallis testing and Fisher\u27s exact testing were used to compare outcome variables among three groups defined by sense of confidence entering ophthalmology training.
Main Outcome Measures Level of confidence at the start of ophthalmology residency.
Results Quality of life and geographic location were found to be the most important factors in choosing internship programs, while obtaining ophthalmology skills was least. Although 32.3% of residents either agreed or strongly agreed that they felt confident at the start of ophthalmology residency, 42.9% disagreed or strongly disagreed. Residents who felt most confident for ophthalmology training spent more time on ophthalmology rotations in medical school (p = 0.05) or internship (p = 0.02) and worked up patients independently during their internship ophthalmology rotation (s) (0.01). Completing one\u27s internship at the same institution as one\u27s ophthalmology residency did not correlate with confidence entering residency.
Conclusions Residents chose internships based on quality-of-life factors rather than enhancing ophthalmology training. Residents who felt confident at the start of ophthalmology residency had more hands on clinical ophthalmology experience than residents who did not feel confident. No statistically significant correlation was found between completion of internship at the same institution as one\u27s ophthalmology residency and confidence entering residency
Evaluation of an Ophthalmology Session for Third-Year Medical Students at the University of Colorado School of Medicine
No full textBackground Medical school ophthalmology education continues to be marginalized, creating the challenge of teaching students how to adequately diagnose and manage common ocular diseases in a limited time.
Objective This study aimed to improve the ophthalmic medical knowledge and clinical skills of third-year medical students.
Methods This curriculum was provided to 76 out of 124 third-year medical students in the 2016 class at the University of Colorado-Denver School of Medicine program. It was a half-day session that incorporated lectures, problem-based cases, and clinical skills. Participating students were given a self-reflection survey on their knowledge at the beginning and end of the session. Participating students were given a pre-test and post-test 6 months later via SurveyMonkey. Another quiz was given to all students within the class. Comparisons of pre- and post-tests, pre- and post-surveys, and quiz results in the participating and nonparticipating groups were made.
Results Participating students\u27 mean pre-test score was 61.8% (n = 76) and post-test score was 72.3% (n = 47), p \u3c 0.01, indicating a significant increase in knowledge. There was an increase in 2 points on the Likert scale of understanding in ophthalmology between surveys. Participating students received a quiz mean score of 61.2%, which was significantly higher than those in the nonparticipating group (54.3%), p \u3c 0.05.
Conclusion This session improved medical students\u27 confidence and medical knowledge in ophthalmology
Applicants\u27 Interest in International Ophthalmology during Residency Training: Influence in Selecting U.S. Residency Programs
No full textBackground In recent years, the Accreditation Council for Graduate Medical Education (ACGME) Residency Committee for Ophthalmology formally recognized international health electives for credit. By engaging in international health experiences, ophthalmology residents achieve the anchors essential to the core competencies set forth by the ACGME.
Objective To explore how the availability of international ophthalmology opportunities may influence applicants\u27 selection of U.S. ophthalmology residency programs and to identify applicants\u27 perceived goals and barriers of participation in international ophthalmology experiences.
Methods For this cross-sectional study, an electronic invitation to a 22-item questionnaire was sent to all 413 applicants to the ophthalmology residency program at the Penn State Eye Center during the 2017 Match.
Results Responses were received from 261 applicants, yielding a response rate of 63.2%. Nearly all respondents (95.4%) reported interest in participating in an international ophthalmology experience during residency training, with 52.1% of respondents reporting being “extremely interested.” More than half of respondents (53.6%) had previously participated in a healthcare-related experience in an international setting. The availability of international opportunities increased the interest of 67.4% of respondents when choosing which residency programs to apply to, and influenced 65.2% of respondents to rank a residency program higher, with the respondents with previous international experience more likely to be favorably influenced (p \u3c 0.001, p = 0.04, respectively). The goal identified by the largest number of respondents as “most important” was to “offer service to the underserved” (59.0%). The most commonly identified anticipated barriers to participating in an international experience during residency training included concern about scheduling conflicts and call coverage (81.7%), followed by lack of funding (71.4%).
Conclusion There is significant interest in international ophthalmology among ophthalmology residency applicants, and the availability of international opportunities during training may influence the applicants\u27 selection of programs. Statistically significant differences were found among respondents with and without previous international healthcare-related experience. These findings warrant further investigation into how residency programs can best address this interest and integrate international ophthalmology experiences into the residency curriculum
Breaking Bad: An Assessment of Ophthalmologists\u27 Interpersonal Skills and Training on Delivering Bad News
No full textPurpose This article aims to assess ophthalmologists\u27 practice patterns, experiences, and self-perceived skills when delivering bad news to patients and to compare this to patients\u27 experience and preferences in receiving bad news from ophthalmologists.
Design/Methods This is a prospective cross-sectional survey study of two populations: (1) Attending ophthalmologists and current ophthalmologists-in-training (N = 202) at accredited ophthalmology residency programs in the United States and Canada. (2) Patients (N = 151) 18 years of age and older at a single academic center who had received bad news from their ophthalmologist. An e-mail was sent to ophthalmology department chairs and resident program directors requesting that they distribute an online survey to their faculty, fellows, and residents. Patients were recruited from the clinics at an academic center and completed a self-administered survey before their scheduled appointments. Both populations were surveyed on their experience in breaking and receiving bad news, respectively. Questions were rated on a standard five-point Likert scale, and mean score was calculated for statistical comparison. The primary outcome variable was the quantitative rating (Likert scale 1–5) of physicians\u27 communication skills when delivering bad news from physicians and patients\u27 responses.
Results Patients rated their physicians higher than physicians rated themselves with regard to ability to deliver bad news (mean score of 4.23 vs. 3.48, p \u3c 0.01). Multivariate analysis showed frequent delivery of bad news (mean score of 3.66 for once per day, 3.53 for per week, 3.40 for once per month, and 3.22 for once per year, linear trend; p = 0.004) and years of practice were associated with better self-perceived ability to deliver bad news (mean score of 3.75 for ≥15 years, 3.48 for \u3c15 years, and 3.30 for residents/fellows, linear trend; p \u3c 0.001). Having received formal training in breaking bad news was associated with better perceived ability score, yet not statistically significant (3.51 vs. 3.39, p = 0.31). Most patients (97.5%) and physicians (92.1%) believe delivering bad news can be taught.
Conclusion Physicians and patients agree that skills of delivering bad news can be learned. Patients are less critical of their physicians\u27 ability to deliver bad news than physicians are themselves. Further study of best methods to deliver bad news is clearly indicated for the field of ophthalmology
Comparison of Simulation-Based versus Live Tissue–Based Ocular Trauma Training on Novice Ophthalmologists: Repair of Marginal Eyelid Laceration Model
No full textIntroduction Simulation training in medical education provides the ability to teach valuable surgical skills in an environment free of risk to patients. Surgical simulation in ophthalmology continues to evolve as new technologies advance, though widespread use in ophthalmology outside of cataract surgery simulation is lacking. Here, we present a study into the efficacy of surgical simulation for eyelid laceration repair when compared with standard tissue-based instruction.
Materials and Methods The study included 43 ophthalmology residents and 16 staff ophthalmologists from the Ocular Trauma Surgery Laboratory (OTSL) at the Uniformed Services University of the Health Sciences (USUHS). After initial evaluation on their ability to repair marginal eyelid lacerations on a porcine eye, residents were randomized to receive training in marginal eyelid repair technique from faculty preceptors using either traditional porcine tissue or the Ocular and Craniofacial Trauma Treatment Training System (Medical Device and Simulation Laboratory). They were then reevaluated after training. Participating staff also underwent initial evaluation, self-guided training, and post-training evaluation. Outcome measures included successful repair of laceration, number of sutures required to close a 10-mm wound, time required to repair, and the following graded on a scale of 1–4 (1—poor, 2—fair, 3—good, 4—excellent): tarsal plate reconstruction and margin approximation.
Results Among residents, improved scores in marginal approximation were noted after training when comparing scores both within the simulator-trained group (pre-training score: 2.0, post-training score: 3.0; p = 0.03) and between the simulator (SIM) and live tissue (LIVE) groups (SIM: 3.0, LIVE: 2.0 p = 0.03). Neither residents nor staff demonstrated significant differences between SIM versus LIVE in other metrics evaluated. Response in a post-study survey was favorable to simulator training, with 79% noting the simulator was helpful in teaching skills, and 83% noting they would use the simulator again.
Conclusion Simulator technology for teaching marginal eyelid laceration repair appears to be noninferior to traditional tissue-based instruction. Additionally, it appears to be superior when evaluating the ability to approximate the eyelid margin appropriately. Simulators are safe and ethical alternatives to tissue-based instruction, and are favorably received among trainees, and therefore warrant additional investigation and development for ophthalmic surgical training
Impact of a Dedicated Research Rotation during Ophthalmology Residency
No full textBackground The Accreditation Council for Graduate Medical Education (ACGME) requires that ophthalmology residents participate in scholarly activity during residency. However, residents lack protected time for research.
Objective This article aims to determine the impact of a dedicated research rotation on scholarly productivity and research experience during residency.
Methods This cohort study compared two groups of ophthalmology residents. Residents who graduated between 2004 and 2009 did not have dedicated research time and served as control residents (CR), while residents who graduated between 2010 and 2015 had a dedicated research rotation and served as the intervention group (research residents, RR). Primary outcomes included publications and presentations recorded over a 4-year period, spanning the 3 years of residency and the first year after graduation. These were analyzed by linear regression and t-tests. Residents also took surveys regarding research experience and chi-squared tests and logistic regression were used to compare these results.
Results The RR had 0.97 more publications and 1.3 more presentations compared with the CR after adjusting for PhD status, pre-residency publications and presentations, age at graduation, gender, and race (p = 0.09 and p = 0.02, respectively). RR had higher odds of reporting adequate time to complete research (odds ratio [OR] = 13.11, 95% confidence interval [CI]: 3.58–48.03, p \u3c 0.001) and satisfaction with their research experience (OR = 6.96, 95% CI = 2.104–23.053, p = 0.002).
Conclusion Residents with a research rotation had more time to complete research, were more satisfied with their research experience, and generated more publications and presentations compared with residents without the research rotation. A research rotation can help meet ACGME requirements and help residents achieve greater scholarly activity
Cataract Video Coaching: Surgical Curriculum Enhancement in a U.S. Residency Program
No full textAbstract
The aim of this study was to examine the perceived utility of a video-coaching curriculum in cataract surgery training. This study took place in a conference room at the Emory University School of Medicine. This is an evaluation study using questionnaires after each resident\u27s presentation. A curriculum was developed with a resident presenting surgical cases to a group of students, residents, and faculty. All participants filled out a survey focused on video coaching, performance, and an Objective Structured Assessment of Technical Skill (OSATS) evaluation. Thirteen presenting residents, 99 observing residents, and 35 faculty provided responses for 12 video-coaching sessions. The average OSATS score was lower for presenting residents (3.32) compared with observing residents (4.14) and faculty (4.20) (p \u3c 0.01). All 13 presenting and 99 observing residents as well as all 35 faculty found benefit in video coaching with the subcategories of avoiding errors and overall performance rated as the most beneficial. All 13 presenting and 99 observing residents felt comfortable presenting cases with zero preferring an alternative setting. A formal surgical video-coaching curriculum in ophthalmology is a useful adjunct to traditional surgical curricula. There was a consensus that the curriculum was beneficial for cataract surgery preparation. All participants were comfortable taking part in the curriculum and none preferred an alternative curriculum
Impact of Satellite Practices on Academic Ophthalmology Departments
No full textBackground A recent small study described how “satellite” clinics (off-site and strategically situated) associated with six academic ophthalmology departments provided expansion opportunities, and also created unique challenges.
Objectives The aim of this study was to gather a wider viewpoint by surveying chairpersons about their opinions of satellite practices, and how these relate to their departmental mission.
Research Design Online survey.
Subjects Chairperson members of the Association of University Professors of Ophthalmology.
Results More than 60% of respondents had satellite practices affiliated with their departments. Most departments had two to five satellite practices; 33% had satellites that were located further than 50 miles away from the main hospital. On average, satellites accounted for 25 to 30% of total patient visits for the department. Departments whose satellites accounted for 50% or more of total patient visits to the department were those with the largest clinical volumes (\u3e100,000 annual patient visits). Comprehensive ophthalmology was the most common service offered at satellites. All Chairs believed satellite practices had at least maintained, if not improved, their departments\u27 reputation. Seventy percent were concerned about perceived competition with referring community doctors. Research endeavors and trainee education were not considered to be priorities of satellite practices.
Conclusion Overall, chairpersons in the United States believed that satellite practices had strengthened their departments. The geographical expansion of departments, particularly with comprehensive ophthalmology (inclusive of optometric services), has implications for relations with the referral base in the surrounding communities. Thoughtful management of these practices, with attention paid to both meeting financial goals as well as fulfilling the academic mission, is necessary to ensure that the advantages outweigh the drawbacks
Outcomes of Resident-Performed Descemet\u27s Stripping Automated Endothelial Keratoplasty
No full textPurpose This article aimed to evaluate outcomes of resident-performed Descemet\u27s stripping automated endothelial keratoplasty (DSAEK).
Methods This is a case series of patients who underwent DSAEK performed by PGY-4 ophthalmology residents at Lyndon B. Johnson Hospital from January 2013 to August 2016 staffed by a fellowship-trained cornea specialist. Patients with less than 1 month of follow-up were excluded. Demographics, baseline ocular characteristics, and intraoperative data were recorded. Vision and graft status were recorded at 1 week, 1 month, 3 months, and the last follow-up visits. Surgical failure was defined as graft detachment within 1 week of surgery and/or primary graft failure within 3 months of surgery.
Results Eighteen eyes of 18 patients who followed up for 14.9 months (±12.9) were included. Mean age of patients was 60.9 years (±13.2). Indications for DSAEK included pseudophakic bullous keratopathy (10), Fuchs endothelial dystrophy (4), and other causes of endothelial dysfunction (4). Eleven (61%) eyes had prior ocular surgery, and 7 (39%) had prior glaucoma surgery. There were no postoperative graft detachments and two (11%) primary graft failures. There was one primary graft failure in a glaucoma patient. Of the 16 graft successes, logMAR visual acuity improved by 0.46 logMAR (±0.73) from baseline.
Conclusion With appropriate staffing by an experienced cornea surgeon, DSAEK with residents as the primary surgeons is a safe and effective procedure with reasonably good outcomes
A Clinical Vision Research Training and Mentoring Program as a Model for Ophthalmology and Other Medical Specialties: Implementation and Evaluation
No full textBackground Over the past 50 years, there has been a decline in the number of physicians pursuing careers in clinical research. In ophthalmology, the need for clinician-investigators continues to grow with the increasing eye-care demands of the aging population. Expert panels have recommended exposing medical students early in their training to structured, didactic curricula with clinical research experience and mentoring opportunities.
Methods To address this need, the Department of Research, Wills Eye Hospital, developed an 8-week Clinical Vision Research Training and Mentoring Program for undergraduate and medical students. The curriculum included an 11-hour lecture series on topics in research methods in ophthalmology and a 10-hour scientific writing workshop series. The program also involved hands-on participation in vision research projects and shadowing in one of Wills\u27 subspecialty services. Students completed 40-question pre- and posttests on ophthalmology and research methodology. Scores were analyzed using a paired-sample t-test. The program also utilized a satisfaction survey.
Results During 2014 and 2015, a total of 34 students out of 56 applicants were accepted to the Clinical Vision Research Training and Mentoring Program. Students scored significantly higher on the posttest (mean [M] = 79.78%, standard deviation [SD] = 6.25) than on the pretest (M = 71.43%, SD = 8.43); p\u3c 0.001. Using a satisfaction survey, students strongly agreed that they were satisfied with the program and that the lecture series and manuscript writing workshops enhanced their learning.
Conclusions The Wills Eye Clinical Vision Research Training and Mentoring Program provided an evidence-based foundation in research methods and manuscript development for students interested in careers in ophthalmology. Students emerged with clinical research skills and an increased understanding and appreciation of vision research. Results of the pre- and posttest analysis indicate that lecture material supplemented with hands-on experience can lead to better understanding of ophthalmology. This pilot program can serve as a research training and mentoring model for ophthalmology and other medical and surgical specialties