Journal of academic ophthalmology (2017)最新文献

Purpose  This study aimed to perform a comprehensive review of publications proposing educational programs for resident skills assessment in corneal suturing. Methods  An extensive online article search in PubMed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PISMA) reporting guidelines was performed to identify prospective comparative studies or prospective before/after studies published up to March 2021 and reporting the assessment of ophthalmology residents' skills in corneal suturing during dedicated training sessions. Results  Three studies were identified for review. The first reported the efficiency of an electromagnetic tracking system placed on the surgeon's fingers coupled with a computer analysis of movements and time to identify surgeons with different backgrounds in corneal suturing. The second reported the efficiency of the reference system in assessing the improvement of corneal suturing conducted by residents after a training session, with video-based assessment for economy and confidence of movement, limiting tissue damage and precision of operative technique, reviewed by blind assessors. The third proposed an innovative remote corneal suturing training method using Zoom for direct feedback to the residents. The stitch quality was assessed for length, depth, radiality, and tension. The results were similar when compared with a group of residents without feedback. Conclusion  This review underlines the rarity and disparity of available tools for corneal suturing assessment, justifying the need for more complete models to be designed. These should consider body ergonomics and stitch quality and time. Comparative studies involving novices and attendings may provide reliable evaluation of existing gaps and specific metrics to target, helping residents to approach their superiors' experience.

Purpose  Only from reviewing applications, it is difficult to identify which applicants will be successful ophthalmology residents. The change of the USMLE Step 1 scoring to "Pass/Fail" removes another quantitative metric. We aimed to identify application attributes correlated with successful residency performance. This study also used artificial intelligence (AI) to evaluate letters of recommendation (LOR), the Dean's letter (MSPE), and personal statement (PS). Design  Retrospective analysis of application characteristics versus residency performance was conducted. Participants  Residents who graduated from the Dean McGee Eye Institute/University of Oklahoma Ophthalmology residency from 2004 to 2019 were included in this study. Methods  Thirty-four attributes were recorded from each application. Residents were subjectively ranked into tertiles and top and bottom deciles based on residency performance by faculty present during their training. The Ophthalmic Knowledge Assessment Program (OKAP) examination scores were used as an objective performance metric. Analysis was performed to identify associations between application attributes and tertile/decile ranking. Additional analysis used AI and natural language processing to evaluate applicant LORs, MSPE, and PS. Main Outcome Measures  Characteristics from residency applications that correlate with resident performance were the primary outcome of this study. Results  Fifty-five residents and 21 faculty members were included. A grade of "A" or "Honors" in the obstetrics/gynecology (OB/GYN) clerkship and the presence of a home ophthalmology department were associated with ranking in the top tertile but not the top decile. Mean core clerkship grades, medical school ranking in the top 25 U.S. News and World Report (USNWR) primary care rankings, and postgraduate year (PGY)-2 and PGY-3 OKAP scores were predictive of being ranked in both the top tertile and the top decile. USMLE scores, alpha-omega-alpha (AOA) status, and number of publications did not correlate with subjective resident performance. AI analysis of LORs, MSPE, and PS did not identify any text features that correlated with resident performance. Conclusions  Many metrics traditionally felt to be predictive of residency success (USMLE scores, AOA status, and research) did not predict resident success in our study. We did confirm the importance of core clerkship grades and medical school ranking. Objective measures of success such as PGY-2 and PGY-3 OKAP scores were associated with high subjective ranking.

Importance  In-person interviews have traditionally been considered a crucial component of the residency application process. Virtual interviews (VIs) became the standard format for the 2020 to 2021 application cycle due to the novel coronavirus disease 2019 (COVID-19) pandemic. VIs offer a new perspective and challenge to this process which warrants unique considerations and further understanding of effects on applicants. Objective  This study aimed to assess the perceived efficacy of a VI preparedness exercise for ophthalmology residency applicants in the 2021 residency application cycle. Design, Setting, and Participants  A cross-sectional survey was distributed online. All participants in a mock VI exercise conducted via video-telecommunication technology were invited to complete the survey. Data collection occurred from October 12, 2020, to November 2, 2020. A follow-up survey after a match results released was distributed to all participants and data collection occurred from February 18, 2021, to February 25, 2021. Main Outcome and Measures  Applicant demographics, comfort, and attitudes toward VIs and VI practice were the primary measurements of this study. Results  Responses to the initial survey were received from all 35 participants (100%) in the VI mock interviews. There was a statistically significant difference between the pre- and postinterview responses for "How prepared do you feel for virtual interviews with residency programs?" ( p  = 0.0003) and "How likely are you to practice virtual interviews with someone you know?" ( p  = 0.0023). Participants reported feeling more prepared for VIs with residency programs after the mock interview ( p  = 0.002). A greater proportion of participants responded with "Very Likely" after the mock interview in comparison to before the interview to the questions "How likely are you to practice interviews with someone you know?" ( p  = 0.039) and "How likely are you to practice virtual interviews in the same room/area as you will during the official interview season?" ( p  = 0.021). Of the 35 original participants, 20 completed the follow-up survey. There were an equal number of participants who responded either "Helped Somewhat" ( n  = 9) or "Helped Greatly" ( n  = 9) to "How much did the VI mock exercise help you for the actual interview season?" in the follow-up survey. The majority of follow-up survey respondents (17/20) reported that they had additional practice in the virtual environment for interviews after the VI mock exercise. There was no significant difference in perceived helpfulness of the VI mock exercise during the actual interview season between matched and unmatched participants. Conclusion and Relevance  As residency applicants prepare for future VIs, practice and adequate preparation will be essential. In this study, implementation of a VI preparedness exercise had a positive impact on

Objective  To assess ophthalmology trainees' self-reported use of and attitudes toward social media. Methods  An online survey was distributed by email to ophthalmology residency applicants of the Bascom Palmer Eye Institute between September 2016 and January 2020. Results  Of the 1,688 email recipients, the survey was filled by 208 ophthalmology trainees (12.3%). Nearly all trainees reported using social media for personal purposes (92.3%), while less than half used social media for professional purposes (43.4%). There were mixed sentiments regarding the impact of social media on the patient-physician relationship, with the majority feeling that it challenges a physician's authority (55.2%) but also empowers the patient (57.5%) and encourages shared care (92.8%). Twenty-five percent of trainees had reviewed professional social media guidelines, and most rated the quality of medical information on social media as "poor" (60.9%). There were low rates of trainees looking up patients (13.8%), providing their account information to patients (1.5%), responding to patients' messages (2.6%), following patients' accounts (2.6%), and being followed by patients (2.6%). Conclusion  The majority of ophthalmology trainees are active on social media. As these trainees enter practice, ophthalmology will likely see a rise in social media use. Training programs should consider a formal social media policy that is shared with all trainees as part of their education.

Purpose  This study aimed to evaluate trends in ophthalmology resident operative experience and the early impact of the novel coronavirus disease 2019 (COVID-19) pandemic. Design  Present study is a retrospective analysis of the Accreditation Council for Graduate Medical Education (ACGME) Case Log System. Participants  Anonymized graduating resident case logs from 2011 to 2020 academic years (AYs) were examined for this study. Methods  Regression analysis for each procedure category was performed to identify trends between 2011 and 2019 AYs. Unpaired two-tailed t -test compared 2018 to 2019 and 2019 to 2020 AY's for each category surgeon (S) and as surgeon and assistant (S + A). Main Outcome Measures  Mean and median cases as (S) and (S + A) during 2011 to 2019 AYs. Comparison between 2018 to 2019 and 2019 to 2020 AY's for each category as (S) and (S + A) to evaluate the impact of the COVID-19 pandemic. Results  Total ophthalmology procedures as (S) rose from a mean of 479.6 to 601.3 ( p  < 0.001; R ²  = 0.96; Δ/year = 16.9) and a median of 444 to 537 ( p  < 0.001; R ²  = 0.97; Δ/year = 13.1). Total procedures as (S + A) rose from a mean of 698.1 to 768 ( p  < 0.01; R ²  = 0.83; Δ/year = 9.07) and a median of 677 to 734 ( p  < 0.05; R ²  = 0.61; Δ/year = 6.64). Cataract procedures as (S) rose from a mean of 152.8 to 208 ( p  < 0.001; R ²  = 0.99; Δ/year = 7.98) and a median of 146 to 197 ( p  < 0.001; R ²  = 0.97; Δ/year = 7.87). Cataract procedures as both (S + A) rose from a mean 231.4 to 268.7 ( p  < 0.001; R ²  = 0.95; Δ/year = 5.5) and a median of 213 to 254 ( p  < 0.001; R ²  = 0.93; Δ/year = 5.33). Between 2018 to 2019 and 2019 to 2020 AYs, the first pandemic year was associated with significant reductions in total procedures (601.3-533.7 [ p  < 0.0001]) as (S) and 768.0 to 694.4 ( p  < 0.0001) as (S + A), cataract surgery (208-162.2 [ p  < 0.0001]) as (S) and 268.7 to 219.1 ( p  < 0.0001) as (S + A), and glaucoma surgery (16.3-14.2 [ p  = 0.0068]) as (S) and 25.6 to 22.6 ( p  = 0.0063) as (S + A). Conclusion  During 2011 to 2019 AYs, cataract, intravitreal injections, glaucoma, and total procedures increased significantly. During the early period of the COVID-19 pandemic (2019-2020 AY), national halting of elective procedures had a precipitous effect on resident cataract surgery experience to volumes similar to 2013 to 2014 AY where the mean was twice the current required minimum number. With few exceptions, other procedure volumes remained stable.

Background  The coronavirus disease 2019 (COVID-19) pandemic has necessitated a shift of medical education to online learning in lieu of traditional clinic-based rotations. The flipped classroom model, which has been shown to be an effective approach to the medical student ophthalmology curriculum, shows promise as a method of learning that can be shared virtually. As such, the aim of this study was to investigate the effectiveness of a flipped classroom approach to the primary care-focused ophthalmology clerkship delivered entirely online in the face of the COVID-19 pandemic. Methods  Medical students who completed the 2-week introductory clinical ophthalmology clerkship from July 2019 to July 2020 were included in this study. The curriculum centers on a flipped classroom model and was delivered in person prior to March 2020, after which it transitioned to an online format for 5 months. A survey was administered to students completing this rotation, which utilized 6-point Likert scales to assess students' interest in the field of ophthalmology, perceptions of the flipped classroom curriculum, and confidence in evaluating ophthalmic complaints. The cohort that completed in-person learning was then compared with the cohort that completed online learning. Results  A total of 112 responding students were included in our analysis, with 68/82 students from the in-person cohort and 44/66 students in the online cohort responding to the survey. Students who participated in the online virtual clerkship were equally likely to feel comfortable evaluating eye complaints than those who participated in the in-person clerkship, and more likely to report that the course enhanced their interest in ophthalmology. However, online students were less likely to feel comfortable using the direct ophthalmoscope compared with those in the in-person cohort. Conclusion  Regardless of its mode of delivery, the flipped classroom model is able to impart confidence in evaluating ophthalmic complaints and interest in the field of ophthalmology to medical students. While online learning can never serve as a full replacement for learning physical examination skills and other important clinical experiences, there are aspects of the virtual flipped classroom that do not compromise student's learning and engagement and may be implemented into curricula even after clinical activities are allowed to resume.

Purpose  The aim of the study is to investigate sex differences in academic rank, publication productivity, and National Institute of Health (NIH) funding among oculoplastic surgeons and whether there is an association between American Society of Ophthalmic Plastic and Reconstructive Surgery (ASOPRS) membership and scholarly output. Methods  Sex, residency graduation year, and academic rank were obtained from institutional websites of 113 U.S. ophthalmology programs. H-indices and m-quotients were obtained from the Scopus database. NIH funding information was obtained from the NIH Research Portfolio Online Reporting Tool. Results  Of the 272 surgeons, 74 (30.2%) were females. When adjusted for career duration, differences in female to male proportions were only significant at the rank of assistant professor (assistant: 74.3 vs. 48.5%, p  = 0.047; associate: 18.9 vs. 24.6%, p  = 0.243; full professor: 13.0 vs. 37.2%, p  = 0.114). Women had a shorter career duration than men [10.0 (interquartile range or IQR 12.0) vs. 21.0 (IQR 20.0) years; p  < 0.001] and a lower h-index [4.0 (IQR 5.0) vs. 7.0 (IQR 10.0); p  < 0.001], but similar m-quotients [0.4 (IQR 0.4) vs. 0.4 (IQR 0.4); p  = 0.9890]. Among ASOPRS members, females had a lower h-index than males [5.0 (IQR 6.0) vs. 9.0 (IQR 10.0); p  < 0.001] due to career length differences. No difference in productivity between sexes was found among non-ASOPRS members. ASOPRS members from both sexes had higher scholarly output than their non-ASOPRS counterparts. Just 2.7% (2/74) of females compared with 5.3% (9/171) of males received NIH funding ( p  = 0.681). Conclusion  Sex differences in academic ranks and h-indices are likely due to the smaller proportion of females with long career durations. ASOPRS membership may confer opportunities for increased scholarly output.

Purpose  The aim of this study was to evaluate whether the simulated tissue models may be used in place of animal-based model for corneal laceration repair for surgical skills acquisition. Design  Prospective randomized controlled trial. Participants  Seventy-nine military and civilian 2nd- and 3rd-year ophthalmology residents and 16 staff ophthalmologists participating in the Tri-Service Ocular Trauma Skills Laboratory at the Uniformed Services University (Bethesda, MD). Methods  Resident ophthalmologists underwent preliminary evaluation of their ability to close a 5-mm linear, full-thickness corneal laceration involving the visual axis. They then were randomized to undergo 90 to 120 minutes of either simulator-based (SIM) or swine cadaveric-tissue-based (CADAVER) corneal laceration repair. The same evaluation was performed post training. On a more limited basis, the study was repeated for attending ophthalmologists to act as a pilot for future analysis and test efficacy for "refresher" training. Main Outcome Measures  Successful wound closure with secondary outcomes of suture length, tension, depth, and orientation, as graded by attending ophthalmologists. Results  No significant difference in CADAVER versus SIM groups in the primary outcome of watertight wound closure of the corneal laceration. CADAVER group performed better than SIM group for certain metrics (suture depth, p  = 0.009; length, p  = 0.003; and tension, p  = 0.043) that are associated with poor wound closure and increased amount of induced corneal astigmatism. For attending ophthalmologists, six of the eight in each group (SIM and CADAVER) retained or improved their skills. Conclusions  For resident ophthalmologists, SIM training is sufficient for achieving the primary outcome of watertight wound closure. However, CADAVER training is superior for wound metrics for the ideal closure. For attending ophthalmologists, SIM training may be useful for retention of skills.

Background  To determine objective resident characteristics that correlate with Ophthalmic Knowledge Assessment Program (OKAP) performance, as well as to correlate OKAP performance with Accreditation Council for Graduate Medical Education (ACGME) milestone assessments, written qualifying examination (WQE) scores, and oral board pass rates. Methods  Review of administrative records at an ACGME-accredited ophthalmology residency training program at an urban, tertiary academic medical center. Results  The study included data from a total of 50 resident physicians who completed training from 2012 to 2018. Mean (standard deviation) OKAP percentile performance was 60.90 (27.51), 60.46 (28.12), and 60.55 (27.43) for Years 1, 2, and 3 examinations, respectively. There were no statistically significant differences based on sex, marital status, having children, MD/PhD degree, other additional degree, number of publications, number of first author publications, or grades on medical school medicine and surgery rotations. OKAP percentile scores were significantly associated with United States Medical Licensing Examination (USMLE) Step 1 scores (linear regression coefficient 0.88 [0.54-1.18], p  = 0.008). Finally, continuous OKAP scores were significantly correlated with WQE ( r _s  = 0.292, p  = 0.049) and oral board ( r _s  = 0.49, p  = 0.001) scores. Conclusion  Higher OKAP performance is correlated with passage of both WQE and oral board examinations during the first attempt. USMLE Step 1 score is the preresidency academic factor with the strongest association with success on the OKAP examination. Programs can utilize this information to identify those who may benefit from additional OKAP, WQE, and oral board preparation assistance.