Ophthalmology Residency Training Research Articles

Perceptions of the learning environment in ophthalmology residency training: A mixed method study

Introduction: A good learning environment (LE) will affect the quality and standard of the learning process, student performance, and the outcome of the curriculum as well as predictor of the quality of health services. Our study aims to assess residents’ perception of the LE in Ophthalmology training programs for future improvement. Methods: Mixed method with an explanatory sequential design was implemented in this study using the Post-graduate Hospital Educational Environment Measure (PHEEM) as a quantitative approach and open-ended questions collaborated with focus group discussion (FGD) as a qualitative measurement. A comparison of the quantitative data was made using parametric and non-parametric analyses. Thematic analyses were performed for qualitative data. Integration of quantitative and qualitative data was done by connecting both data. Results: Fifty-three residents participated in this survey. The mean age was 30.96±2.18 years old, 64.15% were female and 77.36% are at the internship stage. The mean score of overall PHEEM was 123.40 ±12.35, indicated an excellent LE, while the mean score of perceptions of role autonomy, perceptions of teaching, and perceptions of social support were 42.57±4.62, 47.75±4.84 and 33.08±4.15, respectively. There is no significant difference between gender and study period with the perception of LE. Thematic analysis from qualitative data reveals six positive and five negative perception themes. All discovered themes confirmed concordance with the result of LE perception. Conclusion: Learning environment perception in the ophthalmology residency program was excellent and essential for the student's skills and performance quality. Some specific areas still need improvement strategies for institutional development. Keywords: Learning Environment, PHEEM, Ophthalmology, Residency, Mixed Method

Impact of the economic crisis, COVID-19 and the Beirut explosion on ophthalmology training in Lebanon: an observational cohort survey-based study

ObjectivesThe objective of the study is to investigate the effects of the COVID-19 pandemic, the economic crisis and the Beirut explosion on the training and work of ophthalmology residents and...

Comparison of Machine and Human Expert Evaluation of Capsulorrhexis Creation Performance Through Analysis of Surgical Video Recordings.

Achieving competency in cataract surgery is an essential component of ophthalmology residency training. Video-based analysis of surgery can change training through its objective, reliable, and timely assessment of resident performance. Using the Image Labeler application in MATLAB, the capsulorrhexis step of 208 surgical videos, recorded at the University of Michigan, was annotated for subjective and objective analysis. Two expert surgeons graded the creation of the capsulorrhexis based on the International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubric:Phacoemulsification (ICO-OSCAR:phaco) rating scale and a custom rubric (eccentricity, roundness, size, centration) that focuses on the objective aspects of this step. The annotated rhexis frames were run through an automated analysis to obtain objective scores for these components. The subjective scores were compared using both intra and inter-rater analyses to assess the consistency of a human-graded scale. The subjective and objective scores were compared using intraclass correlation methods to determine relative agreement. All rhexes were graded as 4/5 or 5/5 by both raters for both items 4 and 5 of the ICO-OSCAR:phaco rating scale. Only roundness scores were statistically different between the subjective graders (mean difference = -0.149, p-value = 0.0023). Subjective scores were highly correlated for all components (>0.6). Correlations between objective and subjective scores were low (0.09 to 0.39). Video-based analysis of cataract surgery presents significant opportunities, including the ability to asynchronously evaluate performance and provide longitudinal assessment. Subjective scoring between two raters was moderately correlated for each component.

Impact Of COVID-19 Pandemic On Ophthalmology Residency Training- A Cross-Sectional Survey Among Pakistani Residents

Background: The purpose of this study was to get an idea of the impact of COVID-19 on Ophthalmology post-graduate training.
 Materials & methods: This cross-sectional questionnaire-based study was conducted at the College of Ophthalmology and Allied Vision Sciences/Eye Unit III (King Edward Medical University), Lahore from 01-03-2021 to 31-08-2021. A web-based close-ended questionnaire (Google form) was developed consisting of questions related to residency training in the wake of the COVID-19 pandemic. Eighty-one Ophthalmology residents from across the country participated in this survey. Based on the responses to 21 questions, percentages of various variables in questions were calculated. Data analysis was done on SPSS version 22. Responses to questions are mainly presented as percentages. A chi-square test was applied to see the significant difference in survey questions. For categorical variables, Fisher’s Exact test was applied. P-value ≤0.05 is considered significant.
 Results: Twenty-seven ophthalmology residents were 1st year residents 23 were 2nd year residents while 3rd and 4th year residents were 14 and 17 respectively. 33% of residents thought their surgical training was affected badly due to covid-19 pandemic while 55% of them were concerned about their basic cataract surgery skills. 67% of residents were in favour of their training extension for 6-12 months. The majority of residents stated that COVID-19 affected their training adversely (p=0.000) and cataract surgery training was the most affected one (p=0.000)
 Conclusion: The COVID-19 pandemic has severely affected the clinical and surgical training of post-graduate ophthalmology residents. Formulation of institution-based & nationwide short and long-term strategies regarding web-based teaching, surgical simulation courses and necessary adjustments in curriculum are the need of the hour.

43706 Cross sectional survey study of dermatology exposure during ophthalmology residency training

43706 Cross sectional survey study of dermatology exposure during ophthalmology residency training

Standard ophthalmology residency training in China: an evaluation of resident satisfaction on training program in Guangdong Province

BackgroundNational standardized training for resident doctors (STRD) in mainland China has been formally established since 2014 as a kind of postgraduate education. The purpose of this survey was to assess the satisfaction of the training residents in Guangdong Province on the ophthalmology STRD program after a duration of 5 years.MethodA 48-item survey was sent to all postgraduate ophthalmology residents from bases in Guangdong Province to inquire about their attitude towards the program. The survey contained questions about demographic and work-related information, job satisfaction, psychological resilience, and job performance. All responses were verified, and invalid questionnaires were excluded. Statistical analyses were performed using SPSS software version 22.0 (SPSS, Inc., Chicago, IL). Multiple logistic regression analysis was used to evaluate the factors (demographic information, working environment, clinical exposure, supervision and hands-on training opportunities, and involvement in academic activities) impacting the overall satisfaction. P < 0.05 was considered statistically significant.ResultsA total of 471/635 (74.17%) valid questionnaires were returned from all the STRD bases of Guangdong Province, which included 38 hospitals. 60.3% of the respondents reported overall satisfaction with their training. The satisfaction with operative teaching (60.7%) was slightly lower than the other settings of teaching experience (above 65%). Meanwhile, the satisfaction on different secessions of operative experience was all below 70%, of which in the areas of cornea and orbit were 55.42% and 57.53%, respectively. Some potential factors were found to affect general satisfaction, including the training grade, marriage, working time, income level, the doctor-patient relationship, family members working as doctors, the time proportion spent on writing medical documents during clinical work, and the frequency of attending academic meetings. Improvement was observed in both performing and reporting clinical examinations in the last year of training in comparison to the first year. Finally, 82.8% of the residents acknowledged this training was helpful for future clinical work. The first five career preferences for residents were cataract (67.1%), refractive surgery (42.3%), vitreo-retina (36.5%), optometry (28.7%), and oculoplastic (27.2%).ConclusionOphthalmology residents in Guangdong Province expressed comparable satisfaction with the STRD program. To further improve satisfaction, factors such as resident subsidy, harmonious marriage, the patient-doctor relationship, and chances of attending academic conferences should be emphasized.

Evaluation of commitment to equity, diversity, and inclusion on Canadian ophthalmology residency program websites

ObjectiveProgram websites play a crucial role in providing information to prospective residency applicants. This research assesses the extent to which Canadian ophthalmology residency programs demonstrate their commitment to equity, diversity, and inclusion (EDI) through their websites and identifies areas for potential improvement. MethodsA cross-sectional analysis of websites affiliated with 15 accredited Canadian ophthalmology residency training programs was performed. A score was assigned based on 16 EDI elements derived from recent literature. The relationship between program website EDI elements with language, geography, and regional population diversity was explored. ResultsOf the 15 Canadian ophthalmology residency programs, 12 (80%) met at least 1 of 16 EDI elements, with a mean program score of 2.4 (SD = 1.92). The program that attained the highest score met 7 of 16 EDI elements. Anglophone programs had a higher mean score (2.92; SD = 1.78) when compared with their Francophone counterparts (0.33; SD = 0.58; p = 0.023). No significant difference was found between programs in western, central, and eastern Canada (p = 0.86). The regional minorities proportion associated with each program was not found to influence scores (p = 0.088). ConclusionsEDI elements were seldom addressed on Canadian ophthalmology residency program affiliated websites. We propose recommendations in 4 domains: showcasing team diversity, clear discourse in recruitment, inclusive resources, and program organization. Improving EDI visibility on program websites through revisions of existing websites or through creation of new promotional websites may foster recruitment of a diverse resident body.

Artificial Intelligence for Personalised Ophthalmology Residency Training.

Residency training in medicine lays the foundation for future medical doctors. In real-world settings, training centers face challenges in trying to create balanced residency programs, with cases encountered by residents not always being fairly distributed among them. In recent years, there has been a tremendous advancement in developing artificial intelligence (AI)-based algorithms with human expert guidance for medical imaging segmentation, classification, and prediction. In this paper, we turned our attention from training machines to letting them train us and developed an AI framework for personalised case-based ophthalmology residency training. The framework is built on two components: (1) a deep learning (DL) model and (2) an expert-system-powered case allocation algorithm. The DL model is trained on publicly available datasets by means of contrastive learning and can classify retinal diseases from color fundus photographs (CFPs). Patients visiting the retina clinic will have a CFP performed and afterward, the image will be interpreted by the DL model, which will give a presumptive diagnosis. This diagnosis is then passed to a case allocation algorithm which selects the resident who would most benefit from the specific case, based on their case history and performance. At the end of each case, the attending expert physician assesses the resident's performance based on standardised examination files, and the results are immediately updated in their portfolio. Our approach provides a structure for future precision medical education in ophthalmology.

Ophthalmology residency training in Nigeria: The trainers' perspective.

Periodic evaluations are an indispensable part of any training programme. This study assessed ophthalmology residency training in Nigeria from the perspective of ophthalmology trainers. This was a nationwide web-based survey of ophthalmology trainers at the 30 institutions accredited by the National Postgraduate Medical College of Nigeria from April 2021 to June 2021. Trainers were invited to complete a Google form via E-mail and WhatsApp. Data were collected on the characteristics of trainers and the training programme. One hundred and fifty-eight (71.2%) out of 222 trainers responded to the survey comprising 67 (42.4%) males and 91 (57.6%) females, amongst whom were 97 (61.4%) subspecialists. The mean age (±standard deviation) was 51.47 ± 8.61 years (range, 38-75 years). Most respondents rated human resources (trainers and support staff) as 'much more' than adequate (n = 30, 19%), the volume of surgery as 'less or much less' than adequate (n = 82, 51.9%), the conduct of examinations as 'good' or better than good (n = 120, 75.9%) and impact of emigration of ophthalmologists on training as 'very negative' (n = 36, 22.8%). Overall, 94 (59.4%) respondents rated the quality of training as 'good' or better than good. Respondents recommended improving funding and training resources, revising the current conduct of examinations, increasing the use of appropriate technology and improving remunerations and national security. The majority of ophthalmology trainers rated ophthalmology residency training in Nigeria as 'good' but rated 'volume of surgery' as inadequate for training. Recommendations were made to improve the quality of training, revise examination practices and reduce the negative impact of emigration.

Impact of COVID-19 on ophthalmology residency training - can it be swept under the rug?

Dear Editor, The COVID-19 pandemic has impacted and altered the way residency training is imparted. Online webinars to substitute clinical learning and wet labs to substitute surgical training have been adopted by institutions to mitigate the losses from hands-on clinical and surgical exposure for residents.[1,2] Amongst this, the losses incurred by the 2019 batch of admitted residents, in particular, have arguably been the most detrimental with 18 months of a 36-month training period clashing with the pandemic (March 2020 to September 2021, the waning of the second wave).[3] With this forethought, we circulated an online questionnaire via Google Forms to all the 2019 batch of Ophthalmology residents (who have taken their final MS/DNB examinations between April and June 2022) with relevant questions about their perception of their current clinical and surgical training status, the effect of COVID-19 on their residency training and overall mental health. The questionnaire was distributed in the eight medical colleges and training institutes in Pondicherry. No personal details or identity were asked to ensure accurate reporting. Out of a total of 38 residents, 35 responded to the questionnaire. Among the respondees, 71% (n = 25) were females, while 29% (n = 10) were males. A staggering 80% (n = 28) and 75% (n = 26) of residents felt that COVID-19 affected their clinical and surgical training respectively in some way. Meanwhile, 88.5% (n = 31) felt that mitigative measures like online webinars were of benefit to them [Figure 1]. However, in this regard, a considerable 57.5% (n = 20) residents are fearful of a prolonged training period post-residency and 71.5% (n = 25) feel a dip in their confidence owing to a loss in clinical and surgical exposure, 51.5% (n = 18) attributing it solely to the pandemic.Figure 1: (a) Residents response to COVID 19 affecting clinical and surgical training. (b) Pie chart representation of benefits with online webinar in residency trainingThough the limitations of a self-reported questionnaire are applicable, the aftermath of COVID-19 and its domino effect, particularly impacting the mental health of residents cannot be overlooked. Institutions conducting further training, are urged to consider this aspect and incorporate facilities and opportunities for further teaching to continue the high standard of Ophthalmic care. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Application of Mind Mapping Combined with PBL Teaching Method in Standardized Training of Ophthalmology Residents

Application of Mind Mapping Combined with PBL Teaching Method in Standardized Training of Ophthalmology Residents

Accuracy and Utility of Internet Image Search as a Learning Tool for Retinal Pathology.

Purpose Ophthalmology residency training heavily relies on visual and pattern recognition-based learning. In parallel with traditional reference texts, online internet search via Google Image Search (GIS) is commonly used and offers an accessible fund of reference images for ophthalmology trainees seeking rapid exposure to images of retinal pathology. However, the accuracy and quality of this tool within this context is unknown. We aim to evaluate the accuracy and quality of GIS images of selected retinal pathologies. Methods A cross-sectional study was performed of GIS of 15 common and 15 rare retinal diseases drawn from the American Academy of Ophthalmology residency textbook series. A total of 300 evaluable image results were assessed for accuracy of images and image source accountability in consultation with a vitreoretinal surgeon. Results A total of 377 images were reviewed with 77 excluded prior to final analysis. A total of 288 (96%) search results accurately portrayed the retinal disease being searched, whereas 12 (4%) were of an erroneous diagnosis. More images of common retinal diseases were from patient education Web sites than were images of rare diseases ( p < 0.01). Significantly more images of rare retinal diseases were found in peer-reviewed sources ( p = 0.01). Conclusions GIS search results yielded a modest level of accuracy for the purposes of ophthalmic education. Despite the ease and rapidity of accessing multimodal retinal imaging examples, this tool may best be suited as a supplementary resource for learning among residents due to limited accuracy, lack of sufficient supporting information, and the source Web site's focus on patient education.

Artificial intelligence-based pathologic myopia identification system in the ophthalmology residency training program

Background: Artificial intelligence (AI) has been successfully applied to the screening tasks of fundus diseases. However, few studies focused on the potential of AI to aid medical teaching in the residency training program. This study aimed to evaluate the effectiveness of the AI-based pathologic myopia (PM) identification system in the ophthalmology residency training program and assess the residents' feedback on this system. Materials and Methods: Ninety residents in the ophthalmology department at the Second Affiliated Hospital of Zhejiang University were randomly assigned to three groups. In group A, residents learned PM through an AI-based PM identification system. In group B and group C, residents learned PM through a traditional lecture given by two senior specialists independently. The improvement in resident performance was evaluated by comparing the pre-and post-lecture scores of a specifically designed test using a paired t-test. The difference among the three groups was evaluated by one-way ANOVA. Residents' evaluations of the AI-based PM identification system were measured by a 17-item questionnaire. Results: The post-lecture scores were significantly higher than the pre-lecture scores in group A (p < 0.0001). However, there was no difference between pre-and post-lecture scores in group B (p = 0.628) and group C (p = 0.158). Overall, all participants were satisfied and agreed that the AI-based PM identification system was effective and helpful to acquire PM identification, myopic maculopathy (MM) classification, and "Plus" lesion localization. Conclusion: It is still difficult for ophthalmic residents to promptly grasp the knowledge of identification of PM through a single traditional lecture, while the AI-based PM identification system effectively improved residents' performance in PM identification and received satisfactory feedback from residents. The application of the AI-based PM identification system showed advantages in promoting the efficiency of the ophthalmology residency training program.

EFFECT OF COVID-19 PANDEMIC ON OPHTHALMOLOGY RESIDENTS IN NORTH INDIA

Purpose: Ongoing COVID-19 pandemic has globally affected training, skills and mental health of ophthalmology residents. This prospective, population based observational study was done to study the effect of COVID-19 on ophthalmology resident's education and mental health. Methods and Materials: 37-questions web-based survey was circulated amongst ophthalmology residents studying in North India between 1st to 30th April 2021. Questions comprised of their demographic prole, concerns regarding their training and skills and effect of COVID -19 on their mental health. The statistical analysis was performed using SPSS 27.0 for MAC (SPSS Inc.) Chi-square test was used to determine the level of signicance. Ap value of &lt; 0.05 was considered statistically signicant. Results: 52.1% of residents believed that COVID-19 had a severe impact on Post Graduate teaching program. 77.3% believed that appropriate measures were not taken to preserve effectiveness of their training. 94.7% of the residents opined that there was decrease in surgical exposure. 86.08% of residents thought there would be a dip in opportunities for international fellowships after nishing their course. 67.6% residents reported their deployment in COVID care wards out of which 73.9% residents had fear of getting infected with COVID-19. Conclusion: COVID-19 pandemic has signicantly affected the personal and professional life of the ophthalmology residents. Their mental stress on variable issues needs to be addressed and solved on priority basis so that a healthier workforce is formed to ght against a pandemic like situation in future.

Impact of the second wave of COVID-19 pandemic on the mental health and training of ophthalmology residents doing COVID duties in Gujarat.

Background: To study the impact of the second wave of the COVID-19 pandemic on the attitude and practice of vaccination, mental health and training of the ophthalmology residents doing COVID duties in Gujarat. Materials and methods: In this prospective study, online survey (Google Forms) was conducted during the second wave of COVID-19 pandemic from May 13 to May 17 2021 amongst the ophthalmology residents doing COVID duties in Gujarat. It was designed to understand their attitudes and practices towards COVID-19 vaccination, their mental health using the Patient Health Questionnaire (PHQ-9) and their perceived impact of the second wave of the pandemic on their ophthalmology training. Results: 148 residents responded to the survey. Mean age was 25.86 ± 1.4years and 73 (49.32%) were males. 112/148 (75.67%) had been vaccinated against COVID-19. The mean PHQ-9 score was 10.61 ± 4.5 (range of 1 to 24).130(87.83%) participants had some degree of depression. Depression was significantly more in students from government medical colleges (p=0.013). Mean duration of covid duty performed was 26.54 ± 17.63 days. 83/101 (82.18%) residents who had done COVID duties during both waves of the pandemic, found the second wave more stressful. 109/148 (73.65%) residents found COVID duties during the second wave had hampered their training in ophthalmology. Conclusion: With the constant threat of ongoing COVID-19 pandemic, an accessible psychological support system and effective e-learning process amongst the ophthalmology trainees, thereby boosting their self-confidence should be encouraged. Key words: second wave, ophthalmology residents, vaccination, mental health, training, COVID 19

Using artificial intelligence reading label system in diabetic retinopathy grading training of junior ophthalmology residents and medical students

PurposeEvaluate the efficiency of using an artificial intelligence reading label system in the diabetic retinopathy grading training of junior ophthalmology resident doctors and medical students.MethodsLoading 520 diabetic retinopathy patients’ colour fundus images into the artificial intelligence reading label system. Thirteen participants, including six junior ophthalmology residents and seven medical students, read the images randomly for eight rounds. They evaluated the grading of images and labeled the typical lesions. The sensitivity, specificity, and kappa scores were determined by comparison with the participants’ results and diagnosis gold standards.ResultsThrough eight rounds of reading, the average kappa score was elevated from 0.67 to 0.81. The average kappa score for rounds 1 to 4 was 0.77, and the average kappa score for rounds 5 to 8 was 0.81. The participants were divided into two groups. The participants in Group 1 were junior ophthalmology resident doctors, and the participants in Group 2 were medical students. The average kappa score of Group 1 was elevated from 0.71 to 0.76. The average kappa score of Group 2 was elevated from 0.63 to 0.84.ConclusionThe artificial intelligence reading label system is a valuable tool for training resident doctors and medical students in performing diabetic retinopathy grading.

Eyes in Sight: Embodiment, Affect, and Learning to See in Ophthalmology

Vision is central to the apprenticeship of ophthalmology residency training. As clinicians who diagnose and treat diseases of the eye, ophthalmologists build their professional identities around the mission of safeguarding their patients’ sight. At the same time, ophthalmologists rely on their own vision as they peer into the eye to detect subtle signs of disease. Based on an extended ethnography of an ophthalmology residency programme, as well as autoethnographic analysis of ophthalmology training, this article explores how novice trainees learn to view the eye by considering two fundamental examination techniques. The first is slit lamp biomicroscopy, where a table-mounted microscope is used to view ocular structures in fine detail. The second is binocular indirect ophthalmoscopy, where examiners view the retina using a head-mounted instrument in conjunction with handheld lenses. Rather than framing visual interpretation as a cognitive exercise in identifying pathology, I instead consider these techniques as embodied practices where trainees must discipline their movement, attention, and use of instrumentation to make the eye visible. This process of embodiment, in turn, unfolds within a broader terrain of affects as trainees marvel at what they behold, yearn to see more, and fear the limitations of their own vision while they learn to perform challenging examination manoeuvres. Situating the ophthalmic examination in its embodied and affective contexts illustrates the sensibilities that ophthalmology residents come to inhabit during their apprenticeship and which undergird the visual expertise of ophthalmologists.

Shortening Training Duration to Address the Insufficiency of Ophthalmologists: A Deeper Look at the China Experience

The availability of ophthalmologists is vital to making eyecare accessible to everyone. Medical education and ophthalmology residency training in China was reduced to address the high demand for ophthalmologists. This is something the Philippines can consider to increase the number of ophthalmologists in the country. However, decreasing the duration, together with insufficient monitoring of medical education and ophthalmology residency training, were not without consequences in eyecare in China.

The Impact of COVID-19 Pandemic on Ophthalmology Residency Education.

Objectives:The aim of this study is to investigate the theoretical, practical, and academic effects of the Coronavirus disease 2019 (COVID-19) pandemic on ophthalmology residents.Methods:The web-based survey consisting of 28 questions was sent through Email to 37 educators who provides resident training. We divided the pandemic period into three, according to the severity of the pandemic and the measures, compared with pre-pandemic period (PreP), separately. Between March 2020 and June 2020 was named as P1, June 2020–October 2020 was named as P2, and October 2020–March 2021 was named as P3.Results:Responses received from 35 centers (17 university hospitals, 18 training and research state hospitals). There were totally 458 residents in the hospitals. Two hundred and forty-six of them (53.71%) worked on COVID-19 duties, with an average working time of 69.57 days. There were significant decreases in the number of patients examined by resident doctors and theoretical training time in the P1, P2, and P3 periods compared to PreP (p<0.05 for all). Furthermore, in terms of the total number of surgeries in clinics and surgeries performed by residents, there were significant decreases in P1 and P2 compared to PreP (p<0.001 for both), but there was no significant difference in P3 (p=0.109). In the examinations held in the clinic, in the 1st year of the pandemic, the grade average was lower than before the pandemic (p<0.05). Seventeen residents (3.74%) resigned or moved to another hospital.Conclusion:The COVID-19 pandemic has severely affected the theoretical, practical, and academic training of ophthalmology residents.

Renaissance of a new era of ophthalmology residency training: Silver linings after three waves of COVID-19

Renaissance of a new era of ophthalmology residency training: Silver linings after three waves of COVID-19