Journal of Academic Ophthalmology
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A Gendered Analysis of Canadian Academic Ophthalmology Leaders
No full textObjective
To describe and analyze the gender distribution of Canadian academic ophthalmology leadership.
Methods
This study assessed the characteristics of ophthalmology department chairs, program directors, undergraduate directors, fellowship directors, and research directors in Canada. Gender, subspecialties, graduate degrees, and academic rank were collected from institutional websites. Research productivity measures (number of published documents, h-index, and years active) were extracted from Elsevier SCOPUS. All statistical analyses were performed using SPSS.
Results
In the 15 Canadian ophthalmology programs, 132 leadership positions were held by 122 physicians. 33 (27.0%) of those physicians were women, and 89 (73.0%) were men, with a significant proportion difference (p
Conclusion
Compared to the 28% of active women ophthalmologists (Canadian Medical Association, 2019), our study demonstrates a similar proportion of women leaders with 27% overall. Positive outlooks are noted when regarding the proportions of women chairpersons (28.6%) and program directors (35.3%). Women leaders were underrepresented in academic ranks and most ophthalmic subspecialties, while there were no significant differences in their research scores (h-index and m-quotient). Future directions include understanding factors contributing to advancement in leadership and strategies to improve the gender gap in ophthalmology
Real-world assessment (RWA): validity evidence for cataract surgery with a tool your faculty will actually use
No full textBackground: We developed and implemented a real-world assessment tool (RWA) for resident surgery. It was designed to improve utility by reducing faculty and trainee cost (completion and training time, cognitive burden). RWA uses an entrustability scale where higher scores indicate a resident’s readiness for independent surgical practice. We describe a two-phase implementation of RWA and report validity evidence for cataract surgery assessment.
Methods: RWA was developed iteratively with resident and faculty input and piloted at a single residency program in phase 1. Phase 2 implemented RWA at 11 ophthalmology residency programs. The main outcome measures were 1) number of surgical assessments submitted and 2) correlation between entrustment score on resident cataract surgery assessments and time in training.
Results: After implementation of RWA, completed assessments increased for all participating programs. 1384 assessments of 111 residents by 112 faculty assessors were collected. Cross-sectional analysis of the assessments that examined cataract surgical procedural competency demonstrated that higher entrustment scores correlated with postgraduate year in training in both the single site (P=
Conclusions: RWA demonstrates low cost, high acceptability, construct validity and reliability for cataract surgical skills assessment. Thus, RWA has shown high utility for assessment of cataract surgery. Because it is procedure agnostic it can be used to assess resident surgical skill for any procedure. RWA provides useful data for residency programs to monitor trainee development
Utilizing Real-Time Video Display to Enable Interactive and Collaborative Slit-Lamp Biomicroscopy Learning
No full textPurpose: To use a real-time video display-equipped slit lamp biomicroscopy system to foster a team-based, collaborative learning environment and enable interactive, inter-peer slit-lamp education.
Methods: Medical students enrolled in a four-week ophthalmology clinical rotation participated in a newly developed slit-lamp biomicroscopy teaching curriculum. The curriculum included a one-time interactive group teaching session that utilized a video system capable of displaying in real-time students’ slit-lamp examinations to other students and instructors, which enabled individualized feedback and group-wide collaboration. An anonymous Likert scale and free-response survey assessed student feedback on the real-time video display curriculum.
Results:Twenty-three students participated in the curriculum and fifteen (65%) completed the survey. Students reported positive impressions of the video display system across all survey domains (all p
Conclusions: Student experience was highly favorable, and students reported inter-peer and collaborative learning as strengths of slit-lamp biomicroscopy teaching. Adapting our collaborative, real-time video display curricula may be of interest to medical schools seeking to incorporate technology-enhanced approaches and collaborative learning principles into their ophthalmology curricula
Telemedicine Training in Ophthalmology Residency Programs
No full textPrior to the coronavirus pandemic, surgical specialties utilized telemedicine sparingly. One study cites prepandemic rates of surgical telehealth use to be less than 1% of new patient encounters,[1] while another study found fewer than 2% of clinicians provided any outpatient care via telemedicine.[2] Within the field of ophthalmology, telemedicine models were largely limited to screening and referral for diabetic retinopathy,[3] age-related macular degeneration,[4] and glaucoma.[5] With the onset of the coronavirus pandemic, however, telemedicine utilization for triage, diagnosis, and management of disease increased considerably. An astonishing 34% of new patient encounters across surgical specialties were conducted via telehealth at the height of the pandemic.[1]
Two significant questions have arisen in the wake of the early adoption of telemedicine: what is the staying power of telemedicine among surgical subspecialties, and are physicians appropriately trained to utilize telemedicine?
Telemedicine utilization declined in late 2020 with the resumption of in-person care, though the proportion of patient visits conducted via virtual means remained markedly higher than it had been prepandemic.[1] [6] Notably, the proportion of care conducted via telemedicine appears to have stabilized in recent years.[6] Trends such as these suggest that telemedicine will likely continue to play a role in care delivery into the future.
Within the field of ophthalmology, similar initial increases and subsequent persistent utilization of telemedicine in the wake of the pandemic signal that telemedicine will likely continue to serve an important role in the years ahead.[7] [8] Several specific advantages to the use of ophthalmic telemedicine have been identified including the provision of care to patients with limited access to tertiary eye care centers across state lines[9] and the screening of urgent ophthalmic conditions.[10] [11] [12] Continued innovation signals that ophthalmic telemedicine will likely play a role in future patient care.[4]
However, the preparedness of physicians to perform telemedicine is still an open question.[13] [14] [15] Telemedicine requires specific training due to the requisite array of skills needed that are distinct from in-person clinical care—identifying appropriate use cases for telemedicine, guiding patients through physical exams, establishing meaningful rapport in the virtual context, and performing clinical assessments reliably.[14] [16] [17] [18] Until recently, studies describing telemedicine curricula targeted to the resident level are few and generally limited to nonsurgical fields such as family medicine, internal medicine, pediatrics, and neurology.[18] [19] [20] [21] [22] [23]
In ophthalmology, formal telemedicine curricula have been developed that show positive impacts on resident perceived confidence and skill completing telemedicine eye exams.[24] Curricular components included instruction on navigating logistics of virtual telemedical platforms, gathering virtual eye exam metrics, and tips on diagnosing, managing, and triaging various acute and chronic eye diseases. Notably, 80% of the participating ophthalmology residents surveyed believed teleophthalmology will be an important aspect of their future ophthalmic practice.
Previously unpublished survey data of ophthalmology residency program directors (PDs), presented here for the first time, show that 56.3% (9 of 16 respondents) of those surveyed believe that telemedicine would be utilized in the future day-to-day practice of ophthalmologists. The Association of University Professors of Ophthalmology distributed an institutional review board-approved survey to all ophthalmology residency PDs in the United States, which was open to responses for a total of 2 weeks (March 29, 2021 to April 11, 2021). The majority of PDs had been in the role for 1 to 5 years (n = 9, 56.3%). While only 18.8% (3 of 16 respondents) of the PDs had implemented a telemedicine curriculum at the time of the survey, 50% indicated that they are planning to implement or augment their telemedicine curriculum. Curricular components for established programs included history-taking (n = 3), clinical examination (n = 3), documentation (n = 3), educational oversight (n = 2), and setup/logistics (n = 2). None taught ethics, professionalism, or health disparities as related to telemedicine. Four PDs (25%) had residents care for telemedical patients through direct patient care, while one of these programs additionally offered shadowing experiences. The majority of PDs felt that the best modalities to train residents in telemedicine were online seminars (n = 12) and practical experience seeing telemedical patients (n = 12). Perceived barriers to telemedical education included difficulty performing the ophthalmic clinical exam, technological limitations, limited curricular time and flexibility, and telemedical reimbursement concerns. While there was a low response rate (14.8%, 16 of 108 PDs), the results are telling of the perceived importance of telemedicine among those tasked with training future generations of ophthalmologists.
These findings may be reflective of similar views among PDs in other surgical fields, though data are lacking on current telemedical curricular offerings and perceptions of telemedicine\u27s role in future day-to-day practice among surgical educators. Given the emerging centrality of telemedicine in various dimensions of clinical care, professional organizations, including the American Medical Association and the Association of American Medical Colleges, have begun to embed telehealth into core competencies for trainees.[25] [26] [27] [28]
As the crisis response to the pandemic subsides and advances in telemedicine are projected to remain as central components of health systems, it becomes essential that educators reflect on ways to best prepare ophthalmology trainees to conduct telemedicine visits and foster effective surgeon-patient communication and connection in a telemedical age
The Matthew Effect: Prevalence of Doctor and Physician Parents among Ophthalmology Applicants
No full textObjective
This article determines the prevalence of physician parents among ophthalmology residency applications.
Design
Retrospective, single-center cohort study.
Subjects
All applicants to the University of Kentucky Ophthalmology Residency between 2018 and 2023.
Methods
Residency applications were reviewed, with data collection including applicant gender, self-identified Under-Represented in Medicine (URiM) status, United States Medical Licensing Examination (USMLE) Step 1 score, USMLE Step 2 score, and whether the application identified a doctor or physician as a parent. Doctor was defined as a profession requiring a doctorate degree, and similarly, physician as a profession requiring a medical degree.
Results
A total of 2,057 applications were reviewed, representing 54% of all match participants during the study period. Fourteen percent (296) of applications indicated a parent was a doctor and 12% (253) a parent was a physician. There were no differences between gender, URiM, USMLE Step 1, and Step 2 scores between applicants indicating a doctor or physician as a parent and those that did not (p all \u3e 0.4 and Cohen\u27s d all \u3c 0.02). Of the type of doctors, 85% (253) were physicians, 6% (17) optometrists, 6% (17) Doctors of Philosophy, 3% (8) dentists, 1% (1) pharmacist, and 1% (1) veterinarian. Eighty-six percent (217) of applications with a physician parent provided the type of physician, with ophthalmologist the most common (93, 43%). Ninety-eight percent (249) of applications with a physician parent provided the gender of the parent, with father (168, 68%) more common than mother (42, 17%) or both parents (39, 16%).
Conclusion
Physician parents are substantially overrepresented in ophthalmology residency applicants. This raises concerns regarding diversity and inclusion efforts for recruitment in medicine
Ophthalmology Residency Program Director Survey on Pass/Fail U.S. Medical Licensing Exam Step 1 Scoring
No full textBackground Beginning January 26, 2022, the U.S. Medical Licensing Exam (USMLE) Step 1 changed from a numerical score to pass/fail (P/F). The purpose of this study was to determine the perspective of ophthalmology program directors regarding this change in evaluating applicants.
Methods After institutional review board approval, a survey was sent out to program directors of all 125 ophthalmology programs accredited by the Accreditation Council for Graduate Medical Education. Survey questions asked for program demographics, the utility of USMLE Step 1 and 2 Clinical Knowledge scores in assessing applicants, and the importance of 16 different applicant metrics before and after Step 1 becomes P/F. The metrics examined were: letters of recommendation; clerkship grades; class ranking; Alpha Omega Alpha Membership; Gold Humanism Honor Society Membership; Dean\u27s Letter; involvement and leadership; personal statement; number of abstracts, presentations, and publications; mean number of research experiences in the specialty; Step 2 Clinical Knowledge score; volunteering; preclinical grades; away rotation in the specialty; the applicant having another graduate degree; and graduation from a top 40 National Institutes of Health-funded program. Data were analyzed using nonoverlapping 95% confidence intervals.
Results The survey was completed by 50 (40%) program directors. Sixty-eight percent of respondents stated a student\u27s ranking would be considered more after USMLE Step 1 scores become P/F, and 60% stated medical schools should share clerkship shelf exam scores with residency programs. There were no significant differences in program directors\u27 rankings of applicant metrics following the transition to P/F Step 1.
Conclusion Based on our data, program directors will likely not place a greater emphasis on Step 2 scores, despite it being the only remaining objective measure for all applicants following the switch to a P/F Step 1. Nevertheless, program directors expressed an interest in receiving other objective measures, such as shelf exam scores and class ranking, as part of the application process. Notably, we found no significant changes in the rankings of various applicant metrics before and after the transition to P/F Step 1, indicating that the metrics that were important to program directors prior to the change remain just as critical in the new era of admissions
Virtual versus In-Person Ophthalmology Interviews: Perceptions of U.S. Ophthalmology Fellowship Applicants in 2022–2023
No full textPurpose
Despite easing restrictions on social distancing and travel since the beginning of coronavirus disease 2019 pandemic, virtual interviews remain a widely used format for ophthalmology fellowship interviews. This study aims to evaluate the relative benefits and drawbacks of in-person versus virtual interviews during a cycle where both formats were prevalent.
Methods
A prospective cross-sectional study surveyed all fellowship applicants (N = 311) who applied to Wills Eye Hospital and Bascom Palmer Eye Institute during the 2022 to 2023 application cycle.
Results
A total of 59 (19%) applicants responded to the survey, with the majority being male (53.0%) and between the ages of 20 and 35 (91.3%). There was no statistically significant difference between the number of virtual and in-person interviews attended or the total number of interviews attended. The highest ranked limitations of the virtual interview process were limited exposure to details of the program structure, limited opportunity to exhibit applicants\u27 strengths to the program, and limited exposure to the fellows. The highest ranked strengths were less pressure during interviews, greater scheduling flexibility, and ability to interview at more fellowship programs. The highest ranked limitations of the in-person interview process were more pressure during interviews, inability to interview at all desired fellowship programs, and decreased scheduling flexibility. The highest ranked strengths based on median rankings were greater exposure to details of the program structure, greater ability to exhibit an applicant\u27s strengths to the program, and greater exposure to the geographic location/city.
Conclusion
While both in-person and virtual interviews have their own benefits and limitations, virtual interviews appear to be more cost-effective and time-efficient while in-person interviews provide better opportunities to assess program fit and culture. A hybrid format that combines the ideal aspects of both formats may be an optimal solution
Nurse Practitioner Students\u27 Knowledge Assessment and Perceived Preparedness to Triage Ophthalmology Complaints in a Primary Care Setting: An Educational Intervention
No full textPurpose
In this proof-of-concept pilot study, we aimed to increase nurse practitioner (NP) student knowledge of ophthalmology to prepare NPs for encounters in primary care settings. The Association of University Professors of Ophthalmology (AUPO) and the American Academy of Ophthalmology (AAO) endorse core knowledge that medical students should achieve. We assess the effectiveness of an innovative ophthalmologist-led curriculum based on these competencies tailored to issues NPs encounter in primary care.
Methods Johns Hopkins University NP students enrolled in a pre–post-cohort study and educational intervention. The didactic program was developed according to AUPO and AAO core ophthalmology content for medical students and was taught in-person by an ophthalmologist. Pre–post-assessments evaluated students\u27 perceived readiness to encounter ophthalmic issues in the clinic and baseline knowledge of core competencies of ophthalmology.
Results
A total of 42 NP students were included in the analysis. NP students improved in core knowledge and readiness to encounter ophthalmology issues. After the educational event, there was a statistically significant improvement in students\u27 ratings of preparedness to obtain a focused history, exam, perform initial management and decide the urgency of a referral for acute painless vision loss (p \u3c 0.001), chronic vision loss (p \u3c 0.001), or a patient with a red/painful eye (p \u3c 0.001). Students showed a statistically significant improvement in postdidactic event core ophthalmology knowledge assessment scores (p = 0.002).
Conclusion
Primary care NPs are increasingly the initial point of contact for patients with ophthalmic complaints, and thus, high-quality and thorough education regarding ophthalmology triage and referral for NPs is necessary. NP student comfort with and knowledge of ophthalmic complaints and triage may be improved by a brief educational intervention taught by an ophthalmologist early in the NP curriculum
Community Outreach Vision Screenings with Student-led Eye Health Education Improves Student Eye Health Knowledge and Ophthalmic Health Disparities Awareness
No full textBACKGROUND: The high prevalence of vision impairment and discordant lack of eye care utilization makes it essential to develop effective avenues to educate the future physician work force regarding basic eye health knowledge and ophthalmic health disparities. The public is often not aware that blinding eye diseases can begin asymptomatically. It is important for medical students to understand basic eye health knowledge, such as blinding eye diseases can begin asymptomatically. The purpose of this study was to assess the impact of an eye health knowledge 5-Point Teaching Intervention (5PTI) and structured patient intake form on student eye health knowledge and ophthalmic health disparities during community vision screenings. METHODS: Between 2015 and 2018, 71 first through fourth year medical students medical students participated in community vision screenings via the Vision Detroit Project (VDP). They conducted structured patient interviews including ophthalmic and systemic health history, burden of eye disease, and barriers to eye care. Students delivered a 5-Point Teaching Intervention (5PTI) for patients.. Pre- and post-surveys assessed changes in student eye health knowledge, using descriptive statistics, t-tests for chi-square test, ANOVA and multiple regression for analysis. RESULTS: Analysis of 97 paired pre- and post-surveys indicated a significant increase in student eye health knowledge (
Ophthalmology Career Choices Among Medical Students, House Officers, and Medical Officers in Northern Ghana
No full textBackground
There is an unequal distribution of ophthalmologists globally, particularly in low- and middle-income countries and rural areas. In Northern Ghana, this shortage of ophthalmologists makes it especially difficult for individuals to get eye care.
Objective
This study aimed to understand the factors influencing career choices among medical students, house officers, and medical officers in Tamale Metropolis, Northern Ghana.
Methods
A mixed-methods approach employing questionnaires and in-depth interviews was used to examine factors, perceptions, and strategies to raise interest in ophthalmology.
Results
A total of 401 participants completed the survey. The majority of respondents were male (62%). 18 participants (4.5%) chose ophthalmology as their first career choice, ranking it as the sixth most preferred first choice specialty out of 16 specialties. Ophthalmology was predominantly selected as a third-choice career by 36 participants (9%).
The primary factors that influenced individuals choosing ophthalmology were personal interest (27.5%), the desire for more family time (18.8%), the influence of role models, and the potential for part-time work (11.25%).
Conversely, the most common negative aspects associated with ophthalmology were inadequate exposure in training (37.8%), the perception of the field as boring (21.9%), and the belief that ophthalmology is a narrow specialty with insufficient career prospects (13.0%). In contrast, a smaller proportion (19.02%) considered ophthalmology a fulfilling specialty.
Conclusion
We found that ophthalmology was most commonly selected as a third choice of specialty, while surgery was predominately chosen as the first choice. Income was not a major influencing factor in pursuing ophthalmology, however, non-stressful rotation, personal interests, increased family time, and opportunities for other part-time employment influenced those who chose ophthalmology. The lack of exposure to ophthalmology appears to be a barrier to participant’s interest in ophthalmology. We identified a need for exposing medical students to the full breadth of ophthalmology and increasing self-confidence through direct involvement in order to address the lack of eye care in Northern Ghana and worldwide