Journal of academic ophthalmology (2017)最新文献

Objective  This study aimed to evaluate the impact of an ophthalmic microsurgery laboratory on medical students' intrinsic motivation, explicit interest in ophthalmology, and comfort with microsurgical skills. Design  In this noncontrolled trial, medical students attended a Zoom-based lecture on corneal suturing, watched an instructional video on operating microscopes, and attended a wet laboratory on corneal suturing. Participants completed pre- and posttest surveys assessing comfort with microsurgical skills and explicit interest in ophthalmology. Additionally, the posttest survey included items from the Intrinsic Motivation Inventory (IMI). Setting  This study was conducted at a single academic medical center. Participants  A total of 20 students enrolled in the MD program at the University of California, San Francisco School of Medicine. Results  Pre- and posttest response rates were 100% ( n  = 20) and 90% ( n  = 18), respectively. Comfort with microsurgical skills increased significantly between pre- and posttest surveys with large effect sizes (95% confidence interval [CI]; p -value): loading a needle, 1.67 (1.04-2.29; p  < 0.001); passing a suture, 1.72 (1.04-2.40; p  < 0.001); knot tying, 1.05 (0.34-1.76; p  = 0.004); using a microscope, 0.83 (0.04-1.63; p  = 0.040); and suturing under a microscope, 1.44 (0.88-2.00; p  < 0.001). Comparing pre- and posttest surveys, students reporting moderate to extreme interest in ophthalmology increased from 44 to 61%. Intrinsic motivation was high, indicated by the mean IMI Interest score reaching 93% of the maximum score. Multiple linear regression analyses predicted that IMI Interest scores increased with higher scores of familiarity ( p  = 0.002), explicit interest in ophthalmology ( p  = 0.042), and comfort with microscopes ( p  = 0.005), knot tying ( p  = 0.026), and performing surgical maneuvers under a microscope ( p  = 0.032). Conclusion  Ophthalmic microsurgery laboratories may increase medical students' explicit interest in ophthalmology, comfort with microsurgical skills, and intrinsic motivation. Future studies are needed to evaluate the impact of microsurgical electives on students' objective skills and specialty selection.

Objective  This study aimed to evaluate the experiences and preferences of ophthalmology fellowship applicants utilizing a virtual interview format. Design  Present study is a cross-sectional study. Subjects  All fellowship applicants to Wills Eye Hospital during 2020 to 2021 application cycle were included. Methods  A nonvalidated, online survey was conducted, and surveys were distributed at the conclusion of the interview process after rank list submission. Main Outcome Measures  Applicant demographics, application submissions, interview experiences, financial considerations, and suggestions for improvement of the virtual interview process were the primary outcomes of this cross-sectional study. Results  Survey responses were received from 68 fellowship applicants (34% response rate). Thirty (44%) applicants preferred in-person interviews, 25 (36%) preferred virtual interviews, and 13 (19%) would like to prefer the option to choose either. Fifty-five of 68 (80%) applicants attended the same range of interviews for which they received interview invitations. Reduced costs were reported as the highest ranked strength of virtual interviews in 44 (65%) applicants, with a majority of respondents (68%) spending less than U.S. $250 throughout the entire process. The highest ranked limitation for virtual interviews was limited exposure to the culture/environment of the program in 20 (29%) respondents. On a scale of 0 to 100, the mean (standard deviation [SD]) satisfaction level with the fellowship application process was 74.6 (18.3) and mean (SD) perceived effectiveness levels of virtual interviews was 67.4 (20.4). Conclusion  Respondents were generally satisfied with virtual interviews and noted reduced costs and increased ability to attend more fellowship interviews as the strengths of the virtual interview format. Limited exposure to the culture/environment of the program was cited as the most important limitation.

Purpose: To investigate emerging trends and increasing costs in the National Residency Matching Program (NRMP) and San Francisco Residency and Fellowship Match Services (SF Match) associated with the current applicant/program Gale-Shapley-type matching algorithms.

Design: A longitudinal observational study of behavioral trends in national residency matching systems with modeling of match results with alternative parameters.

Methods: We analyzed publicly available data from the SF Match and NRMP websites from 1985 to 2020 for trends in the total number of applicants and available positions, as well the average number of applications and interviews per applicant for multiple specialties. To understand these trends and the algorithms' effect on the residency programs and applicants, we analyzed anonymized rank list and match data for ophthalmology from the SF Match between 2011 to 2019. Match results using current match parameters, as well as under conditions in which applicant and/or program rank lists were truncated, were analyzed.

Results: Both the number of applications and length of programs' rank lists have increased steadily throughout residency programs, particularly those with competitive specialities. Capping student rank lists at 7 programs, or less than 80% of the average 8.9 programs currently ranked, results in a 0.71% decrease in the total number of positions filled. Similarly, capping program rank lists at 7 applicants per spot, or less than 60% of the average 11.5 applicants ranked per spot, results in a 5% decrease in the total number of positions filled.

Conclusion: While the number of ophthalmology positions in the US has increased only modestly, the number of applications under consideration has increased substantially over the past two decades. The current study suggests that both programs and applicants rank more choices than are required for a nearly-complete and stable match, creating excess cost and work for both applicants and programs. "Stable-marriage"-type algorithms induce applicants and programs to rank as many counter-parties as possible to maximize individual chances of optimizing the match.

Objective  The aim of the study is to compare performance and ease-of-use (EOU) of optic disk assessment using a smartphone direct ophthalmoscope attachment (D-EYE) to the gold standard direct ophthalmoscope (DO). Design  The type of study involved is prospective, randomized, crossover, and educational trial. Participants  The participants involved were first year medical students inexperienced in ophthalmoscopy. Methods  Optic disks of standardized and volunteer patients were examined using the D-EYE and a conventional DO. Optic disk identification, EOU ratings of the devices, self-reported confidence level in their examination with the devices, and estimation of vertical cup-to-disk ratio (VCDR) were compared. Analyses included Chi-square tests, independent samples t -tests, correlations, and multivariable linear regression. Results  Forty-four medical students voluntarily participated in the study. Students using the DO required more attempts (3.57 vs. 2.69, p  = 0.010) and time (197.00 vs. 168.02 seconds, p  = 0.043) to match the patient's fundus to the correct photograph. Overall EOU between the devices (6.40 vs. 4.79, p  < 0.001) and overall confidence in examination (5.65 vs. 4.49, p  = 0.003) were greater when using the D-EYE. There were no statistically significant differences in accuracy of VCDR estimations between the two ophthalmoscopes. Conclusion  Smartphone ophthalmoscopy could offer additional learning opportunities in medical education and may be considered in clinical practice by non-specialist physicians given its greater EOU and increased success in visualizing the optic disk.

Objective  This study attempts to use the Myers-Briggs Type Indicator (MBTI) to analyze personality types among current and recent ophthalmology residents. We aimed to evaluate the prevalence rates of each specific personality type in ophthalmology, and whether these changed by level of training, training program, or fellowship selection. The study aimed to evaluate whether certain personality types are more prevalent in ophthalmology as a unique medical specialty. This can help understand specialty choice and potentially predict trends in specialty selection. Study Design  After obtaining institutional review board approval from Howard University Hospital, an electronic version of the MBTI questionnaire, form M, was sent to participants. In addition to the questionnaire, participants responded to four questions inquiring about home program, postgraduate training level, subspecialty interest, and work environment (if applicable). The anonymous responses of the surveys were automatically scored on google forms, and the results were analyzed by using StatView statistical analysis. Setting  This study was conducted at Howard University, Georgetown University, George Washington University, University of Texas Medical Branch at Galveston, and Kresge Eye Institute. Participants  A total of 66 current residents and recent graduates of five residency programs were involved in this study. Main Outcomes and Measures  This study evaluated four-letter personality type from each participant. Results  Ophthalmology residents were statistically more likely to be identified in the categories of extroversion (E) than introversion (I) ( p  = 0.049), thinking (T) than feeling (F) ( p  = 0.027), and judging (J) than perceiving (P) ( p  = 0.007), with no statistically significant difference between sensing (S) and intuition (N). ENTP, ESTJ, and ISTJ were the most common personality types, each comprising 13.6% of the sample population. The ratio of J:P was found to increase as training level increased, beginning with postgraduate 2nd year until graduate level. Conclusion  Certain personality types are more common among ophthalmology residents in our cohort from five different training programs. It is possible that individual types change over the course of residency training and career. Understanding that these findings exist can be used as a baseline for future research in terms of potential predictors for applicants, of resident knowledge base, and personality changes over the course of one's training.

Background  The coronavirus disease 2019 pandemic has significantly impacted medical education, notably the mandate for all residency programs to implement virtual (rather than in-person) residency interviews. Understanding residency applicants' perceptions and approach to this novel virtual interview season will be beneficial as potential future interview formats are considered. Objective  The aim of this study was to examine perceptions of the 2020 to 2021 ophthalmology residency match applicants regarding the virtual interview season prior to the start of the interview season. Patients and Methods  Ophthalmology residency applicants during the 2020 to 2021 cycle were invited to complete the survey between October 20 and 29, 2020. Respondent demographic information, perceived importance of various application details in a normal versus virtual interview season, strengths and limitations of virtual interviews, and preferences for optimal virtual interview format were obtained. Results  There were 337 survey respondents, with at least 50% of the survey completed by 190 applicants (56%). Of these, 73% of respondents applied to more than 60 ophthalmology residency programs, and 78% felt that the evaluation of candidates would be impacted by the virtual interview format. Regardless of interview format, United States Medical Licensing Examination Step 1 score and letters of recommendation were perceived to be the two most important factors related to matching at an applicant's top ranked programs. The primary limitation of a virtual interview season was the inability to experience a program's culture in person, while largest strength was cost savings. Conclusion  The ophthalmology residency match is a competitive process made potentially more complex by a novel virtual interview format. A detailed postcycle analysis will be important to optimize future interview seasons.

Purpose  The aim of this article is to investigate the impact of a 1-minute video describing resident training with a cataract surgical simulator on patients' perceptions regarding resident involvement in cataract surgery and to identify factors associated with patient willingness to have cataract surgery performed by a resident. Design  Cross-sectional survey. Methods  An anonymous Likert-style survey was conducted among 430 consecutive adult patients who presented for eye examination at the Penn State Health Eye Center. The survey included questions regarding demographics, understanding of the medical training hierarchy, and patient willingness to have a resident perform their cataract surgery. There were six questions regarding patient willingness to have residents perform their cataract surgery and the second question in this set informs the patient that residents are supervised by an experienced cataract surgeon. Patients were randomly assigned to one of two groups: patients in Group 1 completed the survey only, while patients in Group 2 watched a 1-minute video describing resident training with a cataract surgical simulator prior to completing the survey. Results  Four hundred fourteen of the 430 patients (96.3%) completed the survey. Overall, 24.7% ( n  = 102) of respondents expressed willingness to allow an ophthalmology resident to perform their cataract surgery, and that proportion increased to 54.0% ( n  = 223) if the patient was informed that the resident would be supervised by an experienced cataract surgeon. Patients in Group 2 were twice as likely compared with patients in Group 1 to express willingness to allow an ophthalmology resident to perform their cataract surgery (odds ratio 1.92 [1.18-3.11], p  = 0.009). Conclusions  A thorough informed consent process including information regarding attending supervision and a brief video detailing resident training with a cataract surgery simulator may increase patient willingness to allow resident participation in cataract surgery.

Objective  To describe the utilization of online resources by patients prior to presentation to an ophthalmic emergency department (ED) and to assess the accuracy of online resources for ophthalmic diagnoses. Methods  This is a prospective survey of patients presenting to an ophthalmic ED for initial evaluation of ocular symptoms. Prior to evaluation, patients completed surveys assessing ocular symptoms, Internet usage, and presumed self-diagnoses. Demographics and characteristics of Internet usage were determined. Accuracy of self-diagnoses was compared between Internet users and nonusers. Diagnoses were classified as high or low acuity based on agreement between senior authors. Results  A total of 144 patients completed surveys. Mean (standard deviation) age was 53.2 years (18.0). One-third of patients used the Internet for health-related searches prior to presentation. Internet users were younger compared with nonusers (48.2 years [16.5] vs. 55.5 years [18.3], p  = 0.02). There were no differences in sex, ethnicity, or race. Overall, there was a threefold difference in proportion of patients correctly predicting their diagnoses, with Internet users correctly predicting their diagnoses more often than nonusers (41 vs. 13%, p  < 0.001). When excluding cases of known trauma, the difference in proportion increased to fivefold (Internet users 40% vs. nonusers 8%, p  < 0.001). Upon classification by acuity level, Internet users demonstrated greater accuracy than nonusers for both high- (42 vs. 17%, p  = 0.03) and low (41 vs. 10%, p  = 0.001)-acuity diagnoses. Greatest accuracy was in cases of external lid conditions such as chalazia and hordeola (100% [4/4] of Internet users vs. 40% (2/5) of nonusers), conjunctivitis (43% [3/7] of Internet users vs. 25% [2/8] of nonusers), and retinal traction or detachments (57% [4/7] of Internet users vs. 0% [0/4] of nonusers). The most frequently visited Web sites were Google (82%) and WebMD (40%). Patient accuracy did not change according to the number of Web sites visited, but patients who visited the Mayo Clinic Web site had greater accuracy compared with those who visited other Web sites (89 vs. 30%, p  = 0.003). Conclusion  Patients with ocular symptoms may seek medical information on the Internet before evaluation by a physician in an ophthalmic ED. Online resources may improve the accuracy of patient self-diagnosis for low- and high-acuity diagnoses.

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.