Journal of academic ophthalmology (2017)最新文献

Background  Longitudinal Integrated Clerkships (LICs) are innovative educational models that allow medical student continuity with patients, preceptors, colleagues, and health care systems. Given their benefits, the number of LICs continues to increase. We share a pilot model for an ophthalmology LIC curriculum at the University of Colorado School of Medicine targeted for students to see patients through transitions of care. Methods  A needs assessment was performed including literature search, interviews with expert faculty, and a precurricular student questionnaire. Based on our findings, we developed a pilot two-part curriculum consisting of an introductory lecture and a half-day clinical experience designed to integrate patient eye care into the LIC model. At the end of the year, students completed a questionnaire assessing attitude, confidence, and knowledge. Precourse data were collected from students in the academic year (AY) 2018/2019 to aid with the needs assessment. Postcourse data were collected after completion of the curriculum from students in AY 2019/2020. Data from questionnaire were intended to improve our curricular experience. Results  Our curriculum was piloted between the 2019 and 2020 AY. The completion rate of our curriculum was 100%. The questionnaire response rate was 90% in pre- and postcurricular groups ( n =15/17 and n =9/10, respectively). Hundred percent of students from both groups responded that it is "very important"/"important" for all physicians to be able to identify when ophthalmology referral is indicated. After the intervention, there were significant differences in the rate of students responding that they were "confident" diagnosing acute angle-closure glaucoma (36 vs. 78%, p =0.04), treating a chemical burn (20 vs 67%, p =0.02), and diagnosing viral conjunctivitis (27 vs. 67%); 90% of students reported increased confidence in longitudinal care of patients in the eye clinic. Conclusions  Medical students believe in the importance of ophthalmic education regardless of their specialty of choice. We present a pilot model to introduce ophthalmology within an LIC model. Future studies with a larger sample are needed to determine the impact of this model in terms of knowledge acquisition and relationship between curriculum and ophthalmology interest among students. Our curriculum can be adapted to other underrepresented specialties in the medical school curriculum and is easily exportable to other LICs.

Purpose  We investigate trends in cornea fellowship positions filled over time and applicant characteristics associated with matching into cornea fellowship. Methods  Characteristics of cornea fellowship applicants were assessed using deidentified 2010 to 2017 San Francisco (SF) Match data. Publicly available SF Match cornea fellowship data including the number of participating programs, number of positions offered, number of positions filled, percentage of positions filled, and number of vacancies from 2014 to 2019 were also analyzed as data from 2010 to 2013 were unavailable. Results  From 2014 to 2019, the number of cornea fellowship programs increased by 11.3% (mean 2.3% per year, p  = 0.006) and the number of positions offered increased by 7.7% (mean 1.4% per year, p  = 0.065). Of 1,390 applicants from 2010 to 2017, 589 (42.4%) matched into cornea. After controlling for potential covariates, graduation from a U.S residency program (odds ratio [OR]: 6.15, 95% confidence interval [CI]: 4.05-9.35, p  < 0.001) and a greater number of interviews completed (OR: 1.35, 95% CI: 1.29-1.42, p  < 0.001) were associated with increased odds of cornea fellowship match. A greater number of applied programs (OR: 0.97, 95% CI: 0.95-0.98, p  < 0.001) was associated with decreased odds of matching into cornea fellowship. The proportion of applicants matching into cornea fellowship increased until 30 applications. Conclusions  The number of cornea fellowship programs and positions increased from 2014 to 2019. Graduation from a U.S residency program and a greater number of interviews completed were associated with an increased likelihood of cornea fellowship match. Unlike applying to any ophthalmology subspecialty fellowship, applying to greater than 30 cornea fellowship programs was associated with decreased odds of matching.

[This corrects the article DOI: 10.1055/s-0042-1756133.].

Objective  This article characterizes the resources used by ophthalmology residency applicants when deciding where to apply, interview, and rank. Design  Cross-sectional, online survey. Participants  All applicants to the University of California-San Francisco ophthalmology residency program during the 2019 to 2020 and 2020 to 2021 application cycles. Methods  A secure, anonymous, 19-item post-match questionnaire was distributed to participants inquiring about demographic information, match outcomes, and resources used to learn and make decisions about residency programs. Results were analyzed using qualitative and quantitative methods. Main Outcome Measures  Qualitative ranking of resources used to decide where to apply, interview, and rank. Results  One hundred thirty-six of 870 solicited applicants responded to the questionnaire, for a response rate of 15.6%. Digital platforms were ranked as more important resources than people (i.e., faculty, career advisors, residents, and program directors) when applicants were deciding where to apply and interview. Digital platforms became far less important when applicants were formulating their rank lists, at which time the program's academic reputation, perceived happiness of residents and faculty, interview experience, and geographic location were more important. When learning about residency programs, 100% of respondents engaged with program Web sites, and the majority engaged with program emails ( n =88 [85.4%]), Doximity ( n =82 [79.6%]), Reddit ( n =64 [62.1%]), Instagram ( n =59 [57.3%]), the FREIDA residency program database ( n =55 [53.4%]), and YouTube ( n =53 [51.5%]). All 13 digital platforms included in the survey were utilized by at least 25% of respondents, largely passively (i.e., reading rather than producing content). Respondents indicated that the most important topics to include on program Web sites were the number of residents accepted per year, current resident profiles, and resident alumni job/fellowship placement. Conclusion  Applicants engage heavily with digital media in deciding where to apply and interview but rely heavily on their personal experiences with the program in deciding where to rank. Ophthalmology programs may facilitate recruitment of applicants by optimizing their digital media platforms.

Purpose  This study characterizes the current landscape of uveitis specialists and their practice settings in the United States. Methods  An anonymous Internet-based survey with questions pertaining to training history and practice characteristics was distributed via REDCap to the American Uveitis Society and Young Uveitis Specialists listservs. Results  Forty-eight uveitis specialists in the United States responded to the survey out of 174 uveitis specialists that identify as practicing in the United States. Twenty-five of 48 respondents (52%) completed an additional fellowship. These additional fellowships ranged from surgical retina (12/25, 48%), cornea (8/25, 32%), and medical retina (4/25, 16%). Two-thirds of uveitis specialists managed their own immunosuppression, while one-third comanaged immunosuppression with rheumatologists. Thirty-three of 48 (69%) maintained a surgical practice. Conclusion  This is the first survey of uveitis specialists across the United States to provide understanding into training and practice characteristics. These data will provide insight into career planning, practice building, and assist in resource allocation.

Background  Few studies have evaluated associations between ophthalmology trainee characteristics and performance with postgraduate research productivity. Purpose  This article evaluates factors associated with post-residency research productivity among U.S. ophthalmology graduates. Methods  Publicly available information of residents graduating between 2009 and 2014 from 30 randomly selected U.S. ophthalmology programs was collected from June to September 2020. Differences in publications between the 5 years post-residency and pre-residency/residency period were used as metrics of productivity. Residents with incomplete records were excluded. Results  A total of 758 of 768 residents, 306 females (40.4%) and 452 males (59.6%), met inclusion criteria. The mean (standard deviation [SD]) number of pre-residency publications was 1.7 (4.0), residency was 1.3 (2.2), and post-residency was 4.0 (7.3). Mean (SD) H-index was 4.2 (4.9). Top-ranked residency ( p  = 0.001), Alpha Omega Alpha (AOA) medical honor status ( p  = 0.002), U.S. medical school graduates ( p  < 0.001), and academic career ( p  < 0.001) were all associated with higher pre-/post-residency mean publication difference. Pursuing fellowship training also was associated with higher total publications ( p  < 0.001). Of all pre-residency degrees, PhD had the greatest odds of high postgraduate publications (defined as > 4). There was a positive correlation between both pre-residency/residency and post-residency publications (rho = 0.441; p  < 0.001) and between mean difference of pre-residency/post-residency publications for residents at a program and that program's Doximity rank (rho = 0.497; p  < 0.001). Multivariate logistic regression revealed, academic career choice (odds ratio [OR] = 3.38; p  < 0.001), Heed fellowship (OR = 3.12; p  = 0.031), > 2 residency publications (OR = 2.89; p  < 0.001), AOA status (OR = 2.0; p  = 0.004), and top-ranked residency programs (OR = 1.89; p  = 0.007), had greatest odds of > 4 postgraduation publications. Conclusion  Higher post-residency productivity was associated with multiple factors, with choice of an academic career, Heed fellowship, and residency productivity playing key roles.

Purpose  In this pilot study, we aimed to investigate the efficacy of an electronic medical record (EMR) order set for lubricating ointment (four times daily) in the prevention of exposure keratopathy in ventilated patients in the intensive care unit (ICU) at the University of Utah. We attempted to capture the magnitude of morbidity, cost, and care burden in ventilated patients, as well as the utility of a systematic EMR-based preventative lubrication protocol in the ICU setting. Methods  After implementation of the order set, a retrospective chart review was performed to capture all ventilated ICU patients pre- and postintervention. Three separate study periods were used: (1) Six months prior to coronavirus disease 2019 (COVID-19) and prior to the ocular lubrication intervention; (2) the subsequent 6-month period including COVID-19 patients but prior to any intervention; and (3) the subsequent 6-month period postintervention, including COVID-19 patients. The primary endpoint of ointment use per day was analyzed with a Poisson regression model. Secondary endpoints including rates of ophthalmologic consultation and exposure keratopathy were compared with Fisher's exact test. A poststudy survey of ICU nurses was included. Results  A total of 974 ventilated patients were included in the analysis. Ointment use per day increased by 155% (95% confidence interval [CI] 132-183%, p  < 0.001) following the intervention. Rates also increased 80% (95% CI 63-99%, p  < 0.001) during the COVID-19 study period but prior to intervention. The percentage of ventilated patients requiring a dilated eye exam for any indication was 3.2, 4, and 3.7% in each of the study periods, respectively. There was an overall down trend in the rate of exposure keratopathy which was diagnosed in 33.3, 20, and 8.3% of those receiving ophthalmologic consultation, though these rates were not statistically significant. Conclusion  These preliminary data show a statistically significant increase in the rates of lubrication in mechanically ventilated patients using an EMR-based order set in the ICU setting. There was no statistically significant decrease in the rates of exposure keratopathy. Our preventative protocol with lubrication ointment was of minimal cost burden to the ICU. Further longitudinal and multicenter studies are needed to better assess the efficacy of such a protocol.

Introduction  The ophthalmology residency match remains competitive. Several prior studies have examined various factors that contribute to a successful match into an ophthalmology residency program; however, the role of geographic location in the ophthalmology residency match process is unclear. The purpose of our study was to evaluate geographic trends in the ophthalmology residency match and to determine whether geographic trends vary based on program level factors such as program rank or funding source and/or applicant factors such as year of training, gender, and medical degree earned. Specifically, we assessed associations with residents training at the residency program affiliated with their medical school and/or within the same geographic region as their medical school, using data obtained through publicly available sources and residency program surveys. Methods  We used the American Medical Association's Fellowship and Residency Electronic Interactive Database database to identify accredited ophthalmology residency programs. Residency program Web sites and email inquiries were used to collect demographic and geographic information for residents in the graduating classes of 2021 to 2023. Statistical analysis included χ ² testing and multivariate logistic regression. Results  In total, 1,378 residents were included from 110 ophthalmology residency programs and 218 medical schools. Residents who matched at the residency program affiliated with their medical school (18%) were evenly distributed among the Midwest, Northeast, South, and West regions ( p  = 0.2236). Residency programs in the West (31.7%) matched fewer regional medical students compared with programs in the South (61.2%), Midwest (57.4%), and Northeast (58.4%) ( p  < 0.0001). Attending a publicly funded medical school was associated with higher odds of matching into a regional residency program (odds ratio [OR], 1.45; 95% confidence interval [CI], 1.10-1.90; p  = 0.0001) and attending a privately funded medical school was associated with higher odds of matching into a top-ranked residency program (OR, 1.53, 95% CI, 1.34-1.82; p  = 0.0002). Conclusions  The majority of current ophthalmology residents trained at programs in the same geographic region as their medical schools, with nearly 20% of residents training at their medical school-affiliated program. Geographic differences in match results were observed based on resident gender, medical school characteristics, and residency program region.

Background  The coronavirus disease 2019 (COVID-19) pandemic was a disruption for all aspects of medical education, especially for clinical students preparing for residency applications. Clinical rotations are essential for a student's specialty choice, especially for subspecialties such as ophthalmology where students may not get significant exposure during preclinical years. The cancellation of home and visiting ophthalmology electives due to the pandemic brought a need for newer, innovative ideas of instruction. Methods  A 4-week not-for-credit virtual elective was developed at the Department of Ophthalmology for visiting medical students and was offered from August to October 2020. Visiting fourth-year medical students were paired with faculty and resident mentors for one-on-one virtual mentoring, in addition to participation in departmental conferences and research opportunities. Surveys were distributed to students and mentors, and results were analyzed using Microsoft Excel and GraphPad Prism 9. Results  A total of 12 visiting fourth-year medical students participated in the virtual elective, 67% of whom did not have a home ophthalmology program. There was a significant increase in students' perception of their ophthalmology knowledge, with all of students reporting that the elective contributed to this. Students (100%) were "very satisfied" with their faculty mentors on a five-point Likert scale, with high satisfaction from faculty and resident mentors toward students also. The two required events in the elective, the journal club and case virtual conferences, were highly rated from students and mentors. Conclusion  The virtual ophthalmology elective, which was developed to address medical education gaps due to the COVID-19 pandemic, was favorably viewed by all who participated. As dedicated ophthalmology instruction time has decreased over the years, it may become increasingly more important to turn to virtual resources for ophthalmology instruction and mentorship.

Objective  The aim of the study is to investigate the characteristics of first-year residents associated with attending a top-ranked United States (U.S.) ophthalmology residency program over the past decade. Methods  First-year ophthalmology residents in 2009, 2013, 2016, and 2019 were identified from institutional websites, Doximity, LinkedIn and the Wayback Machine. Publications were obtained from Scopus and Google Scholar; research productivity was measured using the h -index, and medical school region based on U.S. Census Bureau designations. Medical school and ophthalmology training program rankings were based on U.S. News & World Report (U.S. News) rankings and National Institutes of Health (NIH) funding. One-way ANOVA, Wilcoxon rank sum, χ ² , and t -tests were used to analyze trends, and odds ratios (ORs) were calculated using logistic regression. Results  Data were obtained on 81% (1,496/1,850) of the residents; 43% were female; 5% were international medical graduates (IMGs); and 10% had other graduate degrees. Over the decade, the mean h -index increased (0.87-1.26; p <0.05) and the proportion of residents who attended a top 20 medical school decreased (28-18%; p <0.05). In a multivariate logistic regression model, characteristics associated with being a first-year resident in a top 20 program ranked by U.S. News were female gender [OR: 1.32, 95% CI: 1.02-1.72], having a Master's degree [OR: 2.28, 95% CI: 1.29-4.01] or PhD [OR: 2.23, 95% CI: 1.32-3.79], attending a top 20 [OR: 5.26, 95% CI: 3.66-7.55] or a top 40 medical school by NIH funding [OR: 2.45, 95% CI: 1.70-3.54], attending a medical school with a mean USMLE Step 2 score above 243 [OR: 1.64, 95% CI: 1.01-2.67] or located in the Northeast [OR: 2.00, 95% CI: 1.38-2.89] and having an h -index of one or more [OR: 1.92, 95% CI: 1.47-2.51]. Except for gender, these characteristics were also significantly associated with matching to a top 20 ophthalmology program by NIH funding. Conclusion  Female gender, graduate degrees, research productivity, and attending a medical school with high research productivity, high mean USMLE Step 2 score or in the Northeast were key characteristics of first-year residents in top-ranked U.S. ophthalmology residency programs.