Which is the best method to learn
ophthalmology? Resident doctors′
perspective of ophthalmology
training

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Abstract

The study aimed to gauge ophthalmology resident doctors′ perception of their teaching programs and various methods used in it and to formulate a well structured program for teaching ophthalmology. Closed ended and open-ended questionnaires were used for survey of ophthalmology residents in West Maharashtra, India. Sixty-seven out of 69 residents of seven residency programs completed the questionnaire. On a scale of 0 (most unsatisfactory) to 4 (best), lectures with power point presentation had a median score of 4, didactic lectures 2, seminar 3, case presentation 4, wet lab 3 and journal club 3. There was a discrepancy in the actual number of surgeries performed by the resident doctors and their perception of the number needed to master those surgeries. Phacoemulsification and non-cataract surgery training was neglected in most programs. The residents wanted to be evaluated regularly and taught basic ophthalmic examination, use of equipments and procedures in greater depth.

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An evaluation of medical college departments of ophthalmology in India and change following provision of modern instrumentation and training

Ravi Thomas, Mangat Dogra (2008)

Aim: To evaluate teaching and practice in medical college ophthalmology departments in a representative Indian state and changes following provision of modern instrumentation and training. Study Type: Prospective qualitative study. Materials and Methods: Teaching and practice in all medical colleges in the state assessed on two separate occasions by external evaluators. Preferred criteria for training and care were pre-specified. Methodology included site visits to document functioning and conduct interviews. Assessments included resident teaching, use of instrumentation provided specifically for training and standard of eye care. The first evaluation (1998) was followed by provision of modern instrumentation and training on two separate occasions, estimated at Rupees 34 crores. The follow-up evaluation in 2006 used the same methodology as the first. Results: Eight departments were evaluated on the first occasion; there were 11 at the second. On the first assessment, none of the programs met the criteria for training or care. Following the provision of modern instrumentation and training, intraocular lens usage increased dramatically; but the overall situation remained essentially unchanged in the 8 departments evaluated 8 years later. Routine comprehensive eye examination was neither taught nor practiced. Individually supervised surgical training using beam splitters was not practiced in any program; neither was modern management of complications or its teaching. Phacoemulsification was not taught, and residents were not confident of setting up practice. Instruments provided specifically for training were not used for that purpose. Students reported that theoretical teaching was good. Conclusions: Drastic changes in training, patient care and accountability are needed in most medical college ophthalmology departments.

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A novel 3-year longitudinal pilot study of medical students' acquisition and retention of screening eye examination skills.

L Mottow-Lippa, Onyeabochukwu Duke, John R Boker … (2005)

To assess the acquisition and retention of screening ophthalmic clinical skills over 3 years of medical school. Observational, longitudinal, multiple skills measures. All 96 students enrolled in a single graduating class at a public medical school in California. Immediately after the second-year ophthalmic clinical skills course, all students were evaluated by their preceptors and self-rated for competence in defined skills. Follow-up assessments were done during 2 required third-year clerkships without additional formal ophthalmic clinical exposure. Three complete history and physical examination chart notes routinely submitted for course grading in third-year clerkships were selected randomly for each student by clerkship directors in family medicine and internal medicine, masked for identity, and then scored for appropriateness. Funduscopic skills were assessed objectively with a simulator in the third-year Clinical Performance Examination. During a fourth-year 4-day ophthalmology clerkship, students were trained and reassessed with the same simulator. Just before graduation, a self-assessment questionnaire was administered to the entire class. Twelve skills were assessed: ability to evaluate visual acuity (VA); pupils; extraocular muscles; confrontation fields; lids; cornea; conjunctiva/sclera; anterior chamber depth; and, funduscopically, the disc, macula, vessels, and retina. Faculty rated 88% to 90% of students as able to assess acuity, pupils, ductions, and fields, and 72% to 82% as able to visualize various parts of the fundus. Seventy-six percent of students felt comfortable after funduscopic training. In 364 analyzed chart notes, one VA was measured, and pupils were examined in 66% of notes, ductions in 54%, and fields in 3%. Only 11% of notes documented attempted funduscopy; <2% suggested actual visualization. In the Clinical Performance Examination, 32% of students accurately described some aspect of the disc, with an improvement to 84% of 38 students retested after brief ophthalmology training in year 4. Of 54 (56%) respondents to the exit questionnaire, 59% felt comfortable visualizing some aspect of the fundus. There is worrisome erosion of students' acquired screening skills across the third-year clerkships. Skill reinforcement in the fourth year yielded improved performance. Attention must be directed to reinforcing basic ophthalmology skills training within medical school curricula to assure competence of graduates.

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Ophthalmology resident surgical competency: a national survey.

Gil Binenbaum, Nicholas J Volpe (2006)

To describe the prevalence, management, and career outcomes of ophthalmology residents who struggle with surgical competency and to explore related educational issues. Fourteen-question written survey. Fifty-eight program directors at Accreditation Council on Graduate Medical Education-accredited, United States ophthalmology residency programs, representing a total of 2179 resident graduates, between 1991 and 2000. Study participants completed a mailed, anonymous survey whose format combined multiple choice and free comment questions. Number of surgically challenged residents, types of problems identified, types of remediation, final departmental decision at the end of residency, known career outcomes, and residency program use of microsurgical skills laboratories and applicant screening tests. One hundred ninety-nine residents (9% overall; 10% mean per program) were labeled as having trouble mastering surgical skills. All of the programs except 2 had encountered such residents. The most frequently cited problems were poor hand-eye coordination (24%) and poor intraoperative judgment (22%). Most programs were supportive and used educational rather than punitive measures, the most common being extra practice-laboratory time (32%), scheduling cases with the best teaching surgeon (23%), and counseling (21%). Nearly one third (31%) of residents were believed to have overcome their difficulties before graduation. Other residents were encouraged to pursue medical ophthalmology (22%) or to obtain further surgical training through a fellowship (21%) or a supervised practice setting (12%); these residents were granted a departmental statement of satisfactory completion of residency for Board eligibility. Twelve percent were asked to leave residency. Of reported career outcomes, 92% of residents were practicing ophthalmology, 65% as surgical and 27% as medical ophthalmologists. Ninety-eight percent of residency programs had microsurgical practice facilities, 64% had a formal teaching course, and 36% had mandatory practice time. Most programs (76%) did not perform applicant vision or dexterity screening tests; questions existed about the legality and validity of such tests. The issue of ophthalmology residents who struggle to develop surgical competency appears common. Although many problems appear to be remediable with time, practice, and dedicated, patient teachers, more specific guidelines for a statement of surgical competency are likely necessary to standardize the Board certification process.

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Author and article information

Journal

Journal ID (nlm-ta): Indian J Ophthalmol

Journal ID (publisher-id): Indian Journal of Ophthalmology

Title: Indian Journal of Ophthalmology

Publisher: Medknow Publications (India )

ISSN (Print): 0301-4738

ISSN (Electronic): 1998-3689

Publication date (Print): Sep-Oct 2008

Volume: 56

Issue: 5

Pages: 409-412

Affiliations

H.V. Desai Eye Hospital, Pune, India

Author notes

Correspondence to Dr. Parikshit Gogate, Department of Community Eye Care, H.V. Desai Eye Hospital, S. No. 93, Tarawade Vasti, Mohammadwadi, Hadapsar, Pune - 411 028, India. Email: parikshitgogate@ 123456hotmail.com

Article

Publisher ID: IndianJOphthalmol_2008_56_5_409_42419

PMC ID: 2636136

PubMed ID: 18711271

SO-VID: 634fc40a-3382-49dc-b0b1-c9556f361c50

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Which is the best method to learn ophthalmology? Resident doctors′ perspective of ophthalmology training

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Abstract

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Karger: Ophthalmology

Most cited references 13

An evaluation of medical college departments of ophthalmology in India and change following provision of modern instrumentation and training

A novel 3-year longitudinal pilot study of medical students' acquisition and retention of screening eye examination skills.

Ophthalmology resident surgical competency: a national survey.

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