Journal of Academic Ophthalmology
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Resident Sleep During Traditional Home Call Compared to Night Float
No full textPurpose
This article aims to compare resident sleep while on night float with a traditional home call.
Methods
We conducted a crossover observational study assessing sleep patterns of seven postgraduate year-2 ophthalmology residents at the University of Washington from 2019 to 2021 using the Fitbit Alta HR device. Overnight call was scheduled from 5 p.m. to 8 a.m. on weekdays, and 8 a.m. to 8 a.m. on weekends. The residency program implemented a partial night float rotation, during which two to three nights of consecutive call were assigned to a resident without other clinical duties. Sleep was recorded using the Fitbit Alta HR for residents while on a 5-week partial night float rotation, on 10-week home call rotations, with postcall relief, and for stretches of seven or more days without call responsibilities. Mixed model regression analysis was used to compare average sleep on home call, night float, and periods without call.
Results
Sleep data were recorded for a total of 1,015 nights, including 503 nights on home call rotation and 230 nights on night float rotation. Residents slept more during periods away from call compared to either night float or home call rotations (p \u3c 0.001). Residents experienced increased average overall sleep during 10-week rotations on night float compared to home call (p = 0.008). While there was no difference in overnight sleep on call between night float and home call (p = 0.701), residents experienced more sleep overall while on call on night float compared to home call due to more sleep being recorded during postcall naps (p = 0.016).
Conclusion
Implementing a night float system can increase resident sleep by allowing for more sleep recovery during time away from clinical duties
Building Physician Leaders: Perceptions and Career Influences of an MBA in Ophthalmology
No full textPurpose
The landscape of healthcare delivery in the United States continues to evolve in reimbursement structure, emphasis on value, complexity of organizational structure, and more. A Master of Business Administration (MBA) degree may better equip ophthalmologists to meet the rising expectations to thrive in the field. This study aims to understand the utility of MBAs among ophthalmologists and as well as the perceptions of MD/MBA candidates among residency program leadership.
Methods
The authors distributed an online questionnaire covering perceptions & implications of an MBA to 108 MD/MBA ophthalmologists identified using AAO archives, Google search, and LinkedIn. Another online questionnaire covering perceptions of MD/MBA applicants was distributed to 120 residency program leaders via the Association of University Professors of Ophthalmology (AUPO).
Results
30 ophthalmologists and 30 program leaders completed questionnaires, resulting in a response rate of 28% and 25% respectively. Most ophthalmologists did not have pre-MBA business experience and completed their MBA during medical school or 5+ years post-residency. The majority of respondents spend \u3e50% of their time practicing clinically, but hold roles in health care administration, consulting, startups, and industry. Ophthalmologists perceive the MBA to be valuable to their clinical careers, with leadership and management skills gained, though highlight limited advantage in residency applications. A majority of program leadership reported positive perceptions of MD/MBA applicants though some voiced hesitations.
Conclusions
Ophthalmologists with an MBA endorse its significant value to their clinical careers and resulting ability to influence the healthcare landscape. Program directors also recognize the utility of the degree. The value of an MBA is acknowledged in the field and warrants closer evaluation as an indicator of attributes that contribute to future physician success
Publication misrepresentation among ophthalmology residency applicants and its correlation with match success
No full textPurpose: To determine prevalence of publication misrepresentation in SF match applications to a single US ophthalmology residency program between the 2017-2018 and 2021-2022 match cycle and its impact on match success.
Methods: Applicant characteristics and publications listed were recorded. Publications were searched and verified in PubMed, Google Scholar, and the journal or conference’s website. Applicant characteristics were compared with 2 test and t-test. Predictive factors for misrepresentation were analyzed using multivariate logistic regression that adjusted for relevant covariates.
Results: Our cohort included 1,165 applications and 4,467 publications with an average of 4.9 publications per applicant. From the 2017 to 2021 match cycle, the mean USMLE Step 1 score (239.8 vs 243.6, p=0.0081), Step 2 score (248.1 vs 252.6, p=.0001), and percentage of applicants with AOA status (11.5% vs 22.6%, p =
Discussion: Publication misrepresentation has significantly increased over the years, possibly related to the increase in research productivity required by residency programs. Potential methods to decrease misrepresentation include requiring a publication’s DOI, providing clearer descriptions for publications categories, and allowing applicants to amend publication statuses
Trends in Ophthalmologists Signing Medicare Opt-Out Affidavits
No full textBackground: In recent decades, many physicians have chosen to opt out of Medicare, allowing them to set their own pricing models for their patients. Characterization of Medicare opt-outs has not been thoroughly studied in any surgical specialty, including ophthalmology.
Purpose: To characterize the factors that may influence an ophthalmologist\u27s decision to opt out of Medicare acceptance and contextualize them both within the field and across various surgical specialties.
Methods: Retrospective cross-sectional analysis using Centers for Medicare and Medicaid Services (CMS) data on starting date of physician opting out as well as geographic state of practice for ophthalmologists and other specialty surgeons. Additional parameters were collected from publicly available profiles of ophthalmologists regarding medical school graduation year, subspecialty, and type of practice.
Results: 72 ophthalmologists opted out of Medicare. The rate of Medicare opt-outs was highest for ophthalmology and most surgical specialties between the years 2015 and 2017. 83.3% of opt-out ophthalmologists were exclusively private practice physicians while 8.3% practiced only in academic medicine and another 8.3% practiced in a mix of both private and academic settings. Most were comprehensive (33.3%), cornea and refractive surgery (26.4%), or oculoplastics specialists (20.8%). Most Medicare non-participating ophthalmologists chose to opt out in their mid-career compared to early or late career. A higher number of these ophthalmologists were located in the Southwest United States, particularly in Oklahoma, New Mexico, and Kansas.
Conclusions: The circumstances influencing an ophthalmologist’s decision to opt out of Medicare acceptance are multifaceted, and our findings suggest that physician experience, specialty, location, and practice structure may all play roles and should be further investigated
Underrepresented in Medicine and International Graduate Bias in the CASPer Situational Judgment Test for Ophthalmology Residency Applicants in 2022-2023
No full textPurpose: Situational Judgment Tests (SJTs) are increasingly utilized in medical trainee recruitment decisions yet little is known of their potential biases. This study was designed to evaluate the Computer-Based Assessment for Sampling Personal Characteristics (CASPer) SJT scores of ophthalmology residency applicants and compare these to Step 1 and Step 2 scores in different demographic groups.
Methods: All applicants to the ophthalmology residency match completed CASPer during the 2022-2023 recruitment cycle. Applicant scores were cross-referenced within the SF Match Residency Application System to collect data on applicant gender, self-identified Under-Represented in Medicine (URiM) status, and International Medical Graduate (IMG) status, as well as Step 1 and Step 2 scores.
Results: A total of 760 of 765 (99.3%) of applicants with CASPer scores were identified in SF Match, 41% of which were female, 15% URiM, and 11% IMG. Males scored slightly higher on all three tests, with the mean difference in Step 1 (4.3) reaching a statistical significance (Cohen’s d=0.29, p
Conclusions: The CASPer SJT demonstrated significant bias against URiM and IMG ophthalmology residency applicants. This bias was even greater than Step 1 and Step 2 performance, suggesting the continued need for caution when utilizing any standardized testing in recruitment decisions
Ophthalmology Career Choices Among Medical Students in Africa: A Cross-Sectional Survey of 36 Countries
No full textPurpose To explore the factors influencing medical students\u27 choice of ophthalmology as a specialty in Africa.
Design This was a cross-sectional, mixed methods survey study involving medical students in 36 African countries.
Methods The multi-center cross-sectional survey study was conducted between June and October 2023 explored factors influencing medical students\u27 choice of ophthalmology as a specialty. It involved medical students enrolled in 152 medical schools across 36 African countries. Convenience and snowball sampling was used with dissemination through social media platforms. The questionnaire explored factors influencing their choice of ophthalmology, including demographics, academic and personal interests, clinical exposure, lifestyle factors, desire for service, presence of mentors, and career opportunities. Descriptive statistics and linear regression models were used to analyze factors influencing specialty choice. Thematic analysis was employed to analyze qualitative data.
Results 1044 medical students from 36 countries responded to the survey. The average age was 23.2 years, and the gender distribution was nearly equal. Only 3.18% of students selected ophthalmology as their first choice specialty, indicating a low interest in the field. Clinical phase of training was a significant predictor of choosing ophthalmology, while other factors like age, gender, and substance use had no influence. Students interested in ophthalmology gave less importance to prestige and more importance to leisure time and lifestyle factors when considering specialty choices. Good work-life balance was the most selected positive factor for the field, while narrow focus and inadequate locations to practice were seen as negative aspects. Common themes related to lifestyle factors and technical aspects emerged in the qualitative analysis of student perceptions.
Conclusions Despite the global shortage of ophthalmologists, a small percentage of medical students in Africa expressed interest in ophthalmology. Ophthalmology interested students valued lifestyle more highly in our sample. These findings suggest the need for interventions to raise awareness of ophthalmology and its impact on patients\u27 lives among medical students in Africa
Using Mock On-Call Patient Encounters to Assess Ophthalmology Resident Peer Communication and Clinical Readiness: A Pilot Study
No full textIntroduction
Communication between co-residents is a crucial component of success among ophthalmology resident physicians who are part of the same on-call team. However, opportunities to assess and hone communication skills during residency training are limited. We developed a novel pilot workshop to improve and assess communication and collaboration between ophthalmology trainees.
Methods
Two standardized patient scenarios were developed in which residents collaborated in a mock on-call team. Encounters took place in a simulated clinic space. Team members consisted of a PGY-2 resident, PGY-3 resident, and a faculty evaluator. A critical action checklist was used to assess learners during the encounters. Peer and faculty evaluation forms were completed following each encounter. A structured debriefing session was conducted to facilitate guided reflection and teach about various communication methods and pitfalls. Post-workshop questionnaires were distributed to learners to assess the short- and long-term effectiveness of the workshop.
Results
Eight ophthalmology residents and four faculty evaluators participated in the workshop. PGY-2 residents felt that the workshop improved their patient care skills (mean rating of 4.7 on a 5-point scale) and their ability to communicate and collaborate with peers while on call (mean ratings of 5.0 and 4.7, respectively). PGY-3 residents reported improvement in their ability to coach and communicate with PGY-2s on call (mean ratings of 4.7 and 4.7, respectively). Evaluators indicated that the workshop was a useful method of evaluating the readiness of PGY-3 residents to independently manage an on-call team.
Conclusions
This pilot study supports the feasibility of using standardized patient encounters to improve communication and collaboration amongst ophthalmology residents and assess readiness to manage an on-call team
Investigation of change and stability in medical students’ ophthalmology specialty intention from matriculation to graduation: Gender and racial/ethnic differences
No full textPurpose
Using data from a national sample of graduating medical students, this study describes the patterns of change and stability in ophthalmology intentions relative to various other specialties and explains how those patterns vary by the intersection of gender and race/ethnicity.
Method
National survey data from MD-granting medical school graduates who matriculated between 2013-2014 and 2018-2019 and graduated by 2021-2022 were examined. The outcome consisted of four groups based on ophthalmology specialty intention at matriculation and graduation: non-ophthalmology, switched out, switched to, and reaffirmation. Percentages for “reaffirmation” and “switched to” were each compared to the median values for 13 major specialties (including ophthalmology). The outcome was examined by the intersection between gender (men vs. women) and race/ethnicity (White-alone, Asian-alone, underrepresented in medicine [URiM, including Black/African American, Hispanic, Alaska Native or American Indian, or Native Hawaiian or other Pacific Islander alone or in combination with any other race/ethnic group], and all other). Chi-square tests of independence and tests for the equality of proportions were employed.
Results
Of 59,908 respondents, 1,057 (1.8%) were ophthalmology-intending matriculants (OIMs), and 1,297 (2.2%) were ophthalmology-intending graduates (OIGs). The percentage of OIMs who reaffirmed their intention (33.7% [357/1,057]) was below (P \u3c 0.05) that of the median specialty (37.3%). The percentage of OIGs who switched to ophthalmology at graduation (72.5% [940/1,297]) did not differ from that of the median specialty (72.0%). Among OIGs, URiM men (2.1% [83/4,018]), URiM women (1.3% [69/5,467]), and White women (1.2% [207/17,498]) were underrepresented relative to White men (2.7% [457/16,956]) (each, P \u3c 0.05). Among OIMs, URiM women and White women each had lower percentages (1.4% [76/5,467] and 1.0% [180/17,498], respectively) relative to White men (1.9% [320/16,956]) (each, P \u3c 0.05). URiM women and White women also had lower percentages (26.3% [20/76] and 30.0% [54/180], respectively) of OIMs reaffirming at graduation relative to White men [43.1%; 138/320]) (each, P \u3c 0.05).
Conclusion
Findings provide further evidence that early recruitment and enrichment opportunities and ongoing retention are essential strategies for ensuring that the field is an attractive career option for a broadly diverse population of medical students. This study provides a template for investigating students’ career intentions during undergraduate medical education
United States Ophthalmology Residency Program Directors\u27 Description of the Interview Selection Process
No full textPurpose: To describe the methods ophthalmology residency programs use to determine which applicants receive an interview invitation.
Design: Anonymous online survey
Method: A validated questionnaire was distributed to all ophthalmology residency program directors through the Association of University Professors of Ophthalmology regarding their process to screen residency applications for the 2020 – 2021 application cycle. Question items consisted of a combination of multiple-choice (20), single-answer response (7), Likert scale (2), and free-response (1).
Results: The response rate was 40% (46/116). The average number of applications received per program was 486.5 ± 98.1. Most programs (78%) have multiple independent reviewers for each application (median number of reviewers = 3). A single faculty member reviews an average of 83.5 applications. Reviewers in 43.5% of programs utilize a standardized rubric. Following an initial screening, the program director most frequently makes the final decision (55.5%). At least 20% of programs exclude international medical graduates and D.O applicants. Most programs (83%) always grant interviews to students at their home institution.
Conclusion: There is wide variability in the interview selection practices among ophthalmology residency programs. Given the large number of applications that residency programs must review, exploring best practices for the process of interview selection may be beneficial for program directors
Core Entrustable Professional Activities and Qualities for Entering Ophthalmology Residency: A National Survey
No full textBackground
Little information is available regarding the competencies and qualities expected of incoming ophthalmology residents by ophthalmology residency program leadership. As exposure to ophthalmology in medical school declines, it is necessary to define the ophthalmology-related skills and qualities expected of ophthalmology trainees at the start of the internship period.
Objectives
The aim of this study is to assess which core skills and qualities medical graduates are expected to possess when entering the internship period of ophthalmology residency.
Methods
Development of a 29-question survey was guided by the Association of American Medical Colleges (AAMC)-published list of core entrustable professional activities for graduating medical students. The survey was distributed to Association of University Professors of Ophthalmology (AUPO) program directors (PDs) and associate program directors (APDs) on May 10th, 2023. Fisher’s exact test was used to compare responses based on respondent and program characteristics.
Results
45 complete surveys were received from 21.6% of queried participants. Thirteen core skills were felt to be at least moderately important by at least 50% of respondents. The three most highly valued skills were collaborating as a member of an interprofessional team (100%), gathering an appropriate ocular history (87%), and giving/receiving a patient handover (80%). Ranking of intern characteristics was highest for “Integrity” (mean ranking 3.9, standard deviation (SD) 3.7), “Professionalism” (mean ranking 4.1, SD 3.4) and “Compassion and empathy toward patients” (mean ranking 4.1, SD 3.6).
Conclusions
Incoming PGY-1 ophthalmology residents are expected to display proficiency in systems-based practice, patient care skills, and basic specialty-specific skills. This study may aid in curriculum development and guide self-directed learning of trainees pursuing ophthalmology residency