Journal of academic ophthalmology (2017)最新文献

Background  The ophthalmology residency matching program is the first successful medical specialty match, dating back to 1979. This article reviews the impetus for starting the match and the roles that ophthalmologists Bruce Spivey, MD, and August Colenbrander, MD, PhD, played in establishing the match and developing the machinery to make it possible. Challenges to the match's operations over the years have improved the process. Objective  This article aims to research the roles of key individuals and institutions in establishing and maintaining the ophthalmology residency matching program. Methods  Oral and written interviews with key participants in establishing and maintaining the match were conducted. Primary and secondary written materials were reviewed. Results  Two physicians played key roles in establishing the ophthalmology residency matching program. Bruce Spivey, MD, spearheaded the drive to persuade the Association of University Professors of Ophthalmology (AUPO) to support and sponsor the match. August Colenbrander, MD, PhD, created the original match algorithm and single-handedly ran the match process in the early years. Obstacles were overcome, including resistance from the Association of American Medical College's National Resident Matching Program, a challenge to the validity of the algorithm, and the threat that antitrust laws might prohibit all graduate medical education residency match programs. The ophthalmology match evolved over time to become a more formal entity, the San Francisco Matching Program (SF Match). With continued support of the AUPO, the process of matching applicants to residency programs has flourished despite contemporary challenges related to electronic applications and social media. Conclusion  The ophthalmology residency matching program has benefited applicants and teaching programs for more than four decades due to visionary founders, ongoing support of the AUPO, and strong leadership within SF Match.

Purpose  The aim of this study was to determine whether the coronavirus disease 2019 (COVID-19) pandemic influenced the presence of ophthalmology residency programs on social media platforms. Methods  The presence of all accredited ophthalmology residency programs on Twitter and Instagram was assessed for January 2020 and August through March 2021 through an online search. The number of followers and posts per month during these periods was collected for each program. The presence of programs on social media was compared between the two time periods. Results  The percentage of programs on Instagram rose from 18% in January of 2020 to 57% in March of 2021 ( p  < 0.001). On Twitter, the percentage of programs rose from 24 to 37% ( p  < 0.001). From January 2020 to March 2021, the mean number of Instagram followers increased from 265 to 649 ( p  < 0.0001), while the mean number of Twitter followers increased from 421 to 532 ( p  < 0.0001). The top ten ophthalmology residency programs in 2021 according to Doximity all had Instagram pages, while 57 (53%) of remaining programs had pages ( p  = 0.005). Meanwhile, 7 top ten programs (70%) were on Twitter compared with 36 (34%) of the remaining programs ( p  = 0.036). Conclusions  The presence of ophthalmology residency programs on Instagram and Twitter increased significantly after the onset of the COVID-19 pandemic. Social media represents an evolving platform through which programs can connect with prospective residents.

Introduction  Ophthalmology departments have been stated to be among the least diverse clinical departments at United States medical schools. Improvement requires recruiting a pipeline of diverse trainees. Residency program Web sites represent a potential diversity and inclusion recruitment tool. This study assesses how ophthalmology residency program Web sites demonstrate a commitment to diversity and inclusion. Methods  We analyzed the diversity and inclusion content of 116 ophthalmology residency program Web sites in April 2021. Main outcome measures were the presence of 12 diversity and inclusion elements on program Web sites, based on prior work and Accreditation Council for Graduate Medical Education guidelines: nondiscrimination statement, diversity and inclusion message, community resources, extended faculty or resident biographies (including hobbies, etc.), faculty photos, resident photos, additional financial resources for trainees, wellness resources, mental health resources, health disparities/community engagement, and diversity council. We used Mann-Whitney U and Kruskal-Wallis tests to assess whether residency program characteristics such as rank, size, university affiliation, and geographic location were associated with commitment to diversity and inclusion on affiliated residency Web sites. Results  Ophthalmology residency program Web sites included a mean of 4.4 ± 2.1 diversity elements. Sixteen percent of programs featured more than half (7 + ) of the evaluated diversity elements. The most featured common diversity elements included resident photos (85.3%), faculty photos (78.4%), and community resources (64.3%). Extended faculty biographies (2.6%), mental health resources (9.5%), and diversity council information (11.2%) were less commonly showcased. Top-ranked programs (7.6 ± 1.8, p  < 0.0001) and university-based/-affiliated programs (4.7 ± 2.8, p  = 0.0039) displayed more diversity elements than lower-ranked (4.1 ± 1.8) and community-based programs (2.8 ± 1.7). Conclusion  Most ophthalmology residency program Web sites feature less than half of the 12 diversity and inclusion elements included in this study, suggesting room for improvement. By drawing attention to program diversity and inclusion efforts, Web sites offer a potential tool for residency programs to consider in their recruitment efforts for diverse trainees. Incorporating the diversity and inclusion elements analyzed in this study represents a low-burden way to signal a greater commitment to diversity that could help programs recruit diverse applicants.

Objective  The aim of the study is to describe an inexpensive and easily-constructed model eye for the purpose of teaching laser peripheral iridotomy (LPI) and selective laser trabeculoplasty (SLT) to ophthalmology residents. Methods  Easily constructed, inexpensive model eyes were utilized to teach residents SLT and LPI utilizing a remote self-study module. A teaching microscope attachment allowed for video-based instruction and feedback. Results  This model eye, used in conjunction with video modules is an effective low-cost teaching tool for laser surgery among ophthalmology residents. Attending ophthalmologists rated the use of these model eyes using surveys and found them to be appropriate teaching tools that could lead to improved knowledge and translate to better patient care. Conclusion  Our novel method for teaching glaucoma laser surgery allows residents to learn the principles and theory behind common laser procedures while having the opportunity to practice repetitive procedures on low-cost model eyes.

Purpose  The purpose of this study is to characterize the influence of a new night float rotation on resident wellness and performance in the Duke University Eye Center Ophthalmology Residency Program. Methods  We analyzed three classes of ophthalmology residents: one class ( n  = 4) utilized the new night float rotation with no daytime clinical duties, while two senior classes ( n  = 12) utilized the traditional call system wherein they had daytime and nighttime responsibilities. Residents completed a questionnaire regarding their perceptions of the night float rotation. Supervising attendings ( n  = 15) were also surveyed about their perceptions of the new rotation. Results  Zero of the four residents on the night float rotation reported burnout compared with 6 of 11 residents in the traditional call system. Most residents supported the adoption of the night float rotation, but this trend was less apparent among fellows and attendings. Most respondents believed the new night float rotation reduced burnout, fatigue, and work hours while increasing time for nonclinical activities. Perceived skills gained while on call were felt to be similar between the two call systems. Fellows and attendings believed residents in the night float system performed similarly or better than residents in the traditional system in indicators such as knowledge and enthusiasm. There was no significant difference in the average number of patient encounters (290.8 ± 30.5 vs. 310.7 ± 25.4, p  = 0.163), phone encounters (430.8 ± 20.2 vs. 357.1 ± 90.0, p  = 0.068), or average hours worked per week (57.3 ± 4.6 vs. 58.0 ± 5.7 p  = 0.797) per resident between night float residents and traditional call residents. Conclusions  This study shows resident support for a night float rotation in ophthalmology residency at Duke, with reductions in burnout and more time for nonclinical activities without affecting perceived clinical performance. We hope this study serves as an impetus for other ophthalmology programs considering a transition to a night float system.

Introduction  This study aimed to describe the difference in operative time during strabismus surgery in the presence and absence of a trainee with the operating physician. Methods  This is a retrospective chart review of pediatric patients who underwent strabismus surgery by three surgeons from January 2016 through September 2019. Electronic medical records were reviewed and noted for operative times as well as the presence or absence of a trainee (postgraduate year [PGY]-3 ophthalmology resident, PGY-5 pediatric ophthalmology fellow, or both). Results  The average time needed for a two-horizontal muscle recession by all the three surgeons in the absence of a trainee averaged at 35.7 minutes (range: 24-48). This is increased by 34% in the presence of a trainee with an average of 47.88 minutes (range: 20-81) with a p -value < 0.001. Similar comparisons were performed for a two-horizontal muscle recession in addition to bilateral inferior oblique weakening procedures for two surgeons. On average, in the absence of a trainee, this required an average of 61.9 minutes for completion with an increase of 31.8% with the participation of a trainee requiring 81.56 minutes. Discussion  The presence of trainees, whether residents or fellows, is a crucial component of medical education and training. It is important for their learning and helps develop strong future surgeons. However, this may increase surgical procedure times and affect the efficiency of the primary surgeon. This has important implications for surgical scheduling, surgical time utilization, and surgical productivity of those involved in trainee education. Conclusion  The presence of a trainee with a primary surgeon, although crucial to surgical training, may result in significant prolongation of strabismus surgical times.

Purpose  To determine if a structured surgical wet laboratory curriculum for ophthalmology residents reduced the rate of posterior capsule rupture (PCR) in phacoemulsification cataract surgery. Setting  James A. Haley Veterans' Hospital, Tampa, FL. Design  Retrospective cohort study. Methods  The study assessed resident-performed phacoemulsification cataract cases from 2011 to 2017, after the creation of a wet laboratory course. Primary outcome measure was PCR. If present, timing of complication, dropped lens fragments, and the need for anterior vitrectomies were noted. Self-reported rates of PCR prior to institution of a wet laboratory course (2010-2011) were compared with cases done by residents who completed the course (2011-2017). Results  A total of 3,445 cases were reviewed of which 2.44% (84 cases) noted PCR. Of these, 19% (16) had dropped lens fragments, and 60.7% (51) required anterior vitrectomy. Sixty-nine cases documented timing of PCR with the majority, 58%, occurring during phacoemulsification. When comparing rates of PCR in cases done prior to the presence of a wet laboratory course versus after, there was a significant reduction observed (5.20% before vs. 2.44% after). Conclusion  In the presence of a wet laboratory curriculum, the rate of PCR decreased dramatically. The average rate was lower than those reported at other training programs (2.6-9.9%). Most PCR occurred during phacoemulsification, suggesting need for further focused instruction in this step.

Introduction  During a time of increased interest in physician well-being, this study benchmarks current work life, home life, and burnout scores for ophthalmology medical student directors (MSD), associate program directors (APD), and program directors (PD). Methods  An anonymous cross-sectional survey was disseminated through the Association of University Professors of Ophthalmology (AUPO) listserve, with queries regarding leadership positions, work time allotment, extracurricular activities, family life, and burnout. Answers were analyzed descriptively through Fisher's exact test, Kruskal-Wallis test, and Poisson regression models. Results  Nineteen percent of listed MSD, 15% of APD, and 29% of PD queried responded to the survey. MSD, APD, and PD are statistically similar in terms of work and home life, with the exception of time spent performing administrative tasks for the position. PD spend more time on administrative tasks, and are paid more. All groups score positively on burnout surveys. Conclusion  This benchmarking survey demonstrates that MSD, APD, and PD are intensively involved in both their work and home lives, with a seemingly high correlation of sense of worth both personally and in their careers.

Ophthalmology is one of the most rewarding and fulfilling medical careers in medicine due to the broad practice scope (including a combination of medicine and surgery); patient population (treatment of pediatric and adult patients); diverse patient and pathology mix (healthy eye exams, refractions, and pathology); high patient and provider satisfaction rates; and highly specialized technology and treatments. Unfortunately, academic exposure to ophthalmology as a career in medical school curricula has had a global decline for decades. While most of the evidence-based interventions found in the literature have resulted in enhanced educational outcomes, ophthalmology exposure should be initiated earlier which provided an impetus for developing and implementing a structured curriculum for introducing preprofessional students to careers in ophthalmology. Educational programs offered in the pipeline from high school to college can reach students who are still undecided about higher education and career choices, thus providing an opportunity for increasing the numbers of students in medical and health professions. We describe a structured, academic curriculum model for pregraduate and undergraduate students to enhance interest and to increase academic exposure to basic clinical, research, and educational domains in ophthalmology. The Houston Methodist Hospital (HMH) Academic Institute offers an unparalleled 10-week summer student research program that matches HMH faculty members with students from multiple levels (e.g., high school, college undergraduates, and medical school). Students undergo prerequisite virtual training; attend weekly didactic lectures given by mentors, invited speakers, and other local leaders; shadow health care providers in active clinical settings as observers; participate in active research projects; present at local conferences; and are encouraged to eventually publish their work. We describe the structured curriculum from our first Summer Internship Program for High Schoolers in ophthalmology. To our knowledge an ophthalmology internship program for preprofessional students has not been previously published in the literature.

Objective  The aim of this study was to understand the factors that ophthalmology trainees consider in pursuing vitreoretinal surgery (VRS) fellowship training. Methods  This is a prospective observational survey study. Survey invitations were disseminated to postgraduate year 4 (PGY)-4 ophthalmology residents at Accreditation Council for Graduate Medical Education-accredited residency programs and surgical retina fellows at Association of University Professors of Ophthalmology Fellowship Compliance Committee-compliant fellowship programs in the United States. Survey questions on factors related to VRS were administered employing a 5-point Likert scale. Responses from ophthalmology residents pursuing surgical retina were combined with surgical retina fellows' responses and compared with responses from PGY-4 residents not pursuing vitreoretinal surgery. Results  Eighty-one resident surveys were completed. Forty-three fellow surveys were completed. Fifty-seven out of eighty-one (70.4%) residents were not pursuing surgical retina, and a total of 67 trainees (24 residents, 43 fellows) were pursuing surgical retina. The following factors were associated with pursuing VRS training: male gender ( p  = 0.031); having performed retina research during residency ( p ≤ 0.001); enjoying surgical retina procedures ( p ≤ 0.001), enjoying surgical retina patient outcomes ( p ≤ 0.001), and working with vitreoretinal surgeons ( p ≤ 0.001); finding surgical retina prestigious ( p ≤ 0.001); perceiving their residency having a strong record of matching surgical retina ( p  = 0.039); liking the potential financial income from surgical retina ( p ≤ 0.001); and having vitreoretinal mentors during residency ( p  = 0.014). A majority of trainees (31/57, 54.4%) not pursuing surgical retina disagreed or strongly disagreed with enjoying the patient outcomes in surgical retina. A third of female residents not pursuing surgical retina felt having a female surgical retina mentor would have made them more likely to pursue the field. Conclusion  Longer retina rotations, encouraging resident participation in retina research, and increasing mentorship opportunities of female trainees from female retina specialists may increase resident interest in pursuing surgical retina fellowship.