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Gutierrez LC, Ayars C. Analyzing the training of PAs in ophthalmology. JAAPA 2024; 37:34-41. [PMID: 38484292 DOI: 10.1097/01.jaa.0001007352.76363.d2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
OBJECTIVE This study sought to determine the role of physician associates/assistants (PAs) in ophthalmology, the balance between barriers and facilitators in training, and optimal training for PAs in ophthalmology. METHODS In this explanatory qualitative case study, 17 of the 94 PAs in ophthalmology in the United States participated in qualitative, semistructured interviews. Qualitative interviews were conducted using a validated interview guide. Interpretational data analysis methods helped in the development of various themes. RESULTS Themes suggest that PAs play a unique role in assisting ophthalmologists in surgery, performing procedures autonomously, and evaluating and treating patients autonomously. PAs in ophthalmology reported current training programs as unfavorable, reported satisfaction in their careers, and identified formal postgraduate training programs as optimal training for PAs. CONCLUSIONS Findings of this study suggest that formal postgraduate training programs can help PAs gain the necessary skills to successfully fulfill their roles in ophthalmology.
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Affiliation(s)
- L Carlos Gutierrez
- L. Carlos Gutierrez is vice chair of student success and an associate professor at the University of Pittsburgh in Pittsburgh, Pa. Candace Ayars is an assistant professor at A.T. Still University in Mesa, Ariz. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Khanna S, Emerson GG, Shah GK. Role of physician extenders: more regulation is necessary before full integration into practice. Curr Opin Ophthalmol 2023; 34:386-389. [PMID: 37326218 DOI: 10.1097/icu.0000000000000971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE OF REVIEW To discuss the drawbacks and propose recommendations for integrating physician extenders in ophthalmologic practice. RECENT FINDINGS In this article, the role of utilizing physician extenders in ophthalmology is discussed. A role for physician extenders has been suggested as more and more patients will require ophthalmologic care. SUMMARY Guidance is needed on how to best integrate physician extenders into eye care. However, quality of care is of the highest importance, and unless there is reliable and consistent training of extenders, using physician extenders to administer invasive procedures (e.g., intravitreal injection) should be avoided due to safety concerns.
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Bhullar PK, Venkateswaran N. Ophthalmology Residency in the United States: The Case for a National Curriculum. Semin Ophthalmol 2023; 38:167-177. [PMID: 36653736 DOI: 10.1080/08820538.2022.2152713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
To identify strategies for effective curriculum development and implementation in United States (US) ophthalmology residency training programs. A literature review was conducted for all English-language PubMed/Medline articles relating to ophthalmology residency education or curriculum/curricula. Despite ACGME-defined program requirements outlining curricular goals for US ophthalmology residency training programs, there is no comprehensive, national curriculum with detailed plans for instruction of necessary topics within the 36-month residency training period. Several articles identify a need for detailed curricula on various topics, propose ideas on how residency programs could create curricula, and explore ways of assessing resident competence. There is a paucity of literature evaluating how ophthalmology residents best learn various ophthalmology topics. We need to develop an intentional, comprehensive, and timely national curriculum for ophthalmology residency programs in the US, with detailed plans on how to meet curricular objectives and consideration of the most effective teaching strategies for different ophthalmology concepts.
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Ibragimova RR, Gilmanov II, Lopukhova EA, Lakman IA, Bilyalov AR, Mukhamadeev TR, Kutluyarov RV, Idrisova GM. Algorithm of segmentation of OCT macular images to analyze the results in patients with age-related macular degeneration. BULLETIN OF RUSSIAN STATE MEDICAL UNIVERSITY 2022. [DOI: 10.24075/brsmu.2022.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Age-related macular degeneration (AMD) is one of the main causes of loss of sight and hypovision in people over working age. Results of optical coherence tomography (OCT) are essential for diagnostics of the disease. Developing the recommendation system to analyze OCT images will reduce the time to process visual data and decrease the probability of errors while working as a doctor. The purpose of the study was to develop an algorithm of segmentation to analyze the results of macular OCT in patients with AMD. It allows to provide a correct prediction of an AMD stage based on the form of discovered pathologies. A program has been developed in the Python programming language using the Pytorch and TensorFlow libraries. Its quality was estimated using OCT macular images of 51 patients with early, intermediate, late AMD. A segmentation algorithm of OCT images was developed based on convolutional neural network. UNet network was selected as architecture of high-accuracy neural net. The neural net is trained on macular OCT images of 125 patients (197 eyes). The author algorithm displayed 98.1% of properly segmented areas on OCT images, which are the most essential for diagnostics and determination of an AMD stage. Weighted sensitivity and specificity of AMD stage classifier amounted to 83.8% and 84.9% respectively. The developed algorithm is promising as a recommendation system that implements the AMD classification based on data that promote taking decisions regarding the treatment strategy.
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Affiliation(s)
| | - II Gilmanov
- Ufa State Aviation Technical University, Ufa, Russia
| | - EA Lopukhova
- Ufa State Aviation Technical University, Ufa, Russia
| | - IA Lakman
- Bashkir State Medical University, Ufa, Russia
| | - AR Bilyalov
- Bashkir State Medical University, Ufa, Russia
| | | | - RV Kutluyarov
- Ufa State Aviation Technical University, Ufa, Russia
| | - GM Idrisova
- Bashkir State Medical University, Ufa, Russia
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Lee B, McCall TC, Smith NE, Srikumaran D. PAs' skills in providing vision and ocular care. JAAPA 2022; 35:48-55. [PMID: 35120362 DOI: 10.1097/01.jaa.0000819560.92687.c5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate characteristics, training, and self-reported skills and abilities in vision and ocular care among PAs not specializing in ophthalmology. METHODS A survey on PA practice was administered to 5,763 randomly selected US-based PAs, and 537 respondents who completed the survey were invited to complete a separate vision and ocular care survey. Of those respondents, 382 completed the vision and ocular care survey. RESULTS Among respondents, 23% of PAs were involved in eyecare by providing patient information, answering questions, and initiating discussions about vision care and ocular health more than once per month. More than 77% received vision and ocular care training in and/or outside PA training. PAs involved in eyecare had significantly greater odds of reporting higher desired and current skill and ability levels compared with PAs not involved in eyecare, in six of eight vision and ocular care domains. CONCLUSIONS PAs who do not practice in ophthalmology provide vision and ocular care but have varying amounts of training and desire higher skill and ability levels. Ophthalmologists and PA institutions may develop vision and ocular care training for PA schools and continuing medical education.
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Affiliation(s)
- Benjamin Lee
- Benjamin Lee practices in the Department of Ophthalmology at Louisiana State University Health Sciences Center in New Orleans, La. Timothy C. McCall is director of research at the National Association of County and City Health Officials and director of health sciences undergraduate courses in the Department of Clinical Research and Leadership at George Washington University, both in Washington, D.C. Noël E. Smith is senior director of PA and industry research and analysis at the American Academy of Physician Associates in Alexandria, Va. Divya Srikumaran is vice chair of education and an associate professor at Wilmer Eye Institute at Johns Hopkins University School of Medicine in Baltimore, Md. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Wang KM, Lee B, Woreta FA, Ramanathan S, Singman EL, Tian J, Srikumaran D. Parental Leave Policy for Ophthalmology Residents: Results of a Nationwide Cross-Sectional Study of Program Directors. JOURNAL OF SURGICAL EDUCATION 2021; 78:785-794. [PMID: 32948506 PMCID: PMC7960573 DOI: 10.1016/j.jsurg.2020.08.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/25/2020] [Accepted: 08/27/2020] [Indexed: 05/04/2023]
Abstract
BACKGROUND Many residents become parents during residency and the adequacy of parental leave is integrally related to resident wellness. OBJECTIVE To understand current parental leave policies in ophthalmology residency programs and program director perceptions of the impact of parental leave on trainees. DESIGN Cross-sectional study. SETTING Multicenter among all U.S. ophthalmology residency programs. PARTICIPANTS Ophthalmology residency program directors during the 2017 to 2018 academic year. RESULTS Sixty-eight percent (82/120) program directors participated in this study. The majority of programs had written maternity leave policies (89%) and partner leave policies (72%). The typical duration of maternity leave taken ranged from 4 to 6 weeks while typical partner leave duration taken ranged from 1 day to 2 weeks. Residents who take leave may need to extend training at 72% of programs. Program directors perceived that parental leave negatively impacts resident scholarly activities and surgical skills and volume. Male program directors, relative to female program directors, perceived that becoming a childbearing parent negatively impacts resident dedication to patient care. Program directors raised concerns including local support and policy, extension of residency, impact on residents, impact on programs, consistency and fairness, and desire for national policy change. CONCLUSIONS Parental leave practices vary significantly among ophthalmology training programs with residents typically taking less leave than permitted. Program directors are challenged to accommodate parental leave while balancing resident training and wellness for all trainees in their program.
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Affiliation(s)
- Kendrick M Wang
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Benjamin Lee
- Department of Ophthalmology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Saraswathy Ramanathan
- University of California San Francisco, Department of Ophthalmology, San Francisco, California
| | - Eric L Singman
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Jing Tian
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Divya Srikumaran
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Hidden Costs in Resident Training: Financial Cohort Analysis of First Assistants in Reduction Mammaplasty. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3333. [PMID: 33564574 PMCID: PMC7859249 DOI: 10.1097/gox.0000000000003333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/28/2020] [Indexed: 11/06/2022]
Abstract
Graduate medical education (GME) programs are vital to developing future plastic surgeons. However, their cost-efficiency has yet to be contextualized. This cohort quality improvement (QI) project aimed to measure the indirect costs an institution assumes in training surgical residents, by comparing the differences in operative time and procedural charges between a resident and a physician assistant (PA) first-assisting during adolescent reduction mammaplasty.
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Chadha N, Gooding H. Twelve tips for teaching ophthalmology in the undergraduate curriculum. MEDICAL TEACHER 2021; 43:80-85. [PMID: 32400234 DOI: 10.1080/0142159x.2020.1758649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Ophthalmology education in the undergraduate medical curriculum has declined, and graduating healthcare professionals express discomfort with basic evaluation and management of ophthalmic complaints. With the growing aging population, ophthalmic needs will continue to rise, underscoring the need for increased eye care. This article offers 12 tips for increasing undergraduate ophthalmic education, which can be implemented strategically within limited established curricular time, or in novel ways outside the traditional curriculum. Within the curriculum, existing ophthalmology sessions can be enhanced through use of simulation technology and partnership with ophthalmology faculty. Additional curricular time can be justified through needs assessments and alignment of content with other disciplines, and ophthalmology content on licensing examinations. Finally, ophthalmology can be reinforced in service-based initiatives and through use of online resources and social media.
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Affiliation(s)
- Nisha Chadha
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai/New York Eye and Ear Infirmary, Eye and Vision Research Institute, New York, NY, USA
| | - Holly Gooding
- Division of Pediatrics and Adolescent Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Persaud-Sharma V, Hooshmand MA. Need for Nurse Practitioner Fellowships in Ophthalmology in the USA. J Ophthalmic Vis Res 2021; 16:113-121. [PMID: 33520134 PMCID: PMC7841275 DOI: 10.18502/jovr.v16i1.8257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 12/13/2020] [Indexed: 11/24/2022] Open
Abstract
Medical attention to vision impairment and associated eye care complications are a vital component of daily living and overall well-being. In the United States today, the physician to patient deficit places great strain on the availability of medical attention tenable to patients nationwide; in terms of specialty medicine, this deficit is even more widespread. The field of ophthalmology faced the same physician to patient deficit in 2020, a grim reality that has left many states void of ophthalmic care, rending millions of aging individuals without domestic eye care. The implementation of trained, ophthalmic nurse practitioners (NPs) can fill the needs of this deficit; however, efficient, accredited, and board-approved American ophthalmic fellowships and residencies that secure proper ophthalmic NP transitions from academia to clinical practice are non-existent. Though scant, evidence-based literature presents sound findings that support the efficacy and benefit for superior patient outcomes with care provided by ophthalmic-trained NPs, offering a viable, long-term solution to the need for ophthalmic medical providers across all states without mitigating patient care, emphasizing the great need for the implementation of ophthalmic NP residencies and fellowships to ensure the continuity of impeccable ophthalmic care for all populations.
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Affiliation(s)
| | - Mary A Hooshmand
- School of Nursing and Health Studies, University of Miami, Miami, FL, USA
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Lee B, McCall TC, Smith NE, D'Souza MA, Srikumaran D. Physician Assistants in Ophthalmology: A National Survey. Am J Ophthalmol 2020; 217:261-267. [PMID: 32360345 DOI: 10.1016/j.ajo.2020.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 04/10/2020] [Accepted: 04/16/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate the scope of practice and training of current physician assistants (PAs) in ophthalmology and gauge their interest in further training and involvement in ophthalmology. DESIGN Cross-sectional survey study. METHODS An anonymous survey on vision and ocular care in the PA profession was administered to PAs in ophthalmology within the American Academy of Physician Assistants member database. All survey questions were optional. RESULTS A total response rate of 47/94 (50.0%) was obtained. Respondents reported an average of 9.8 years (SD = 9.0) of experience as a PA in ophthalmology. Over half of the respondents (59.5%) did not have previous experience in vision and ocular health before becoming a PA. Most respondents (79.5%) reported that they are able to provide their primary clinical responsibilities for ophthalmic care independently. In addition to providing clinical ophthalmic care, many of the respondents have duties that involve consenting patients for ophthalmic surgery and procedures (62.5%) and assisting in ophthalmic surgery and minor procedures (65.0%). Only a minority of respondents independently perform procedures, such as intravitreal injections (23.1%) and minor lid procedures (38.5%). Most respondents reported interest in additional training in providing vision and ocular care (69.0%), in continuing their career as a PA in ophthalmology (87.5%), and in joining a specialty organization for PAs in ophthalmology (88.1%). CONCLUSIONS The PAs participating in this survey provide a range of clinical and some procedural ophthalmic care. The development of formal PA postgraduate training programs in ophthalmology may expand the pool of PAs qualified to practice ophthalmology.
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Commentaries on health services research. JAAPA 2019; 32:52. [PMID: 31579253 PMCID: PMC6774619 DOI: 10.1097/01.jaa.0000552727.95810.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PAs and NPs have broad prescribing authority in the United States, yet little is known about how the quality of their prescribing practices compares with that of physicians. The quality of prescribing practices of physicians, PAs, and NPs was investigated through a serial cross-sectional analysis of the 2006-2012 National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS). Ambulatory care services in physician offices, hospital EDs, and outpatient departments were evaluated using a nationally representative sample of patient visits to physicians, PAs, and NPs. Main outcome measures were 13 validated outpatient quality indicators focused on pharmacologic management of chronic diseases and appropriate medication use. The study sampled 701,499 patient visits during the study period, representing about 8.3 billion visits nationwide. Physicians were the primary provider for 96.8% of all outpatient visits examined; PAs and NPs each accounted for 1.6% of these visits. The proportion of eligible visits in which quality standards were met ranged from 34.1% (angiotensin-converting enzyme inhibitor use for patients with heart failure) to 89.5% (avoidance of inappropriate medications in older adults). The median overall performance across all indicators was 58.7%. On unadjusted analyses, differences in quality of care between PAs, NPs, and physicians for each indicator did not consistently favor one practitioner type over others. After adjustment for potentially confounding patient and provider characteristics, the quality of prescribing by PAs and NPs was similar to the care delivered by physicians for 10 of the 13 indicators evaluated, and no consistent directional association was found between provider type and indicator fulfillment for the remaining measures. Although significant shortfalls exist in the quality of ambulatory prescribing across all practitioner types, the quality of care delivered by PAs, NPs, and physicians was generally comparable.1.
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