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Huang JJ, Waldner D, Huang JJ, Huang JM, Huang P, Teichman JC, Darvish-Zargar M, Gooi P. Comparison of 3D heads-up display system with conventional surgical microscopy for minimally invasive glaucoma surgery on an artificial eye model. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024; 59:e338-e342. [PMID: 37369358 DOI: 10.1016/j.jcjo.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 05/14/2023] [Accepted: 06/05/2023] [Indexed: 06/29/2023]
Abstract
OBJECTIVE To survey ophthalmic surgeons' opinions comparing a novel three-dimensional (3D) heads-up display system with a conventional surgical microscopy for minimally invasive glaucoma surgery (MIGS) on an artificial eye model. MATERIALS AND METHODS Twenty-one ophthalmologists at the 2021 Canadian Ophthalmological Society Annual Meeting in Halifax, Nova Scotia, underwent a 90-minute skills-transfer course on MIGS. Using an artificial eye model (SimulEYE iTrack Model; InsEYE LLC, Westlake Village, Calif.), participants engaged in hands-on practice of MIGS via both a 3D heads-up display system (3D HUDS) (Zeiss Artevo 800; Carl Zeiss Meditec, Jena, Germany) and a conventional surgical microscope. Following completion, participants and instructors answered a 16-question survey comparing the 2 systems (3D HUDS vs conventional surgical microscope). Survey responses were recorded on a 9-point double-headed Likert scale ranging from strongly favour 3D HUDS (1) to strongly favour conventional surgical microscopy (9). Mann-Whitney U nonparametric analysis was used to compare instructor versus participants and experts versus nonexperts. RESULTS Survey ratings favoured the 3D HUDS over the conventional surgical microscopy, with respondent ratings for all survey questions ranging from a response of 1 (strongly favour 3D HUDS) to 5 (equal). Mann-Whitney U statistical analysis revealed no significant difference between instructor versus participant as well as between expert versus nonexpert. Most ratings for the 3D HUDS were received for ergonomic setup of the surgical modality, depth of field (or) field of view, and usefulness in training residents for MIGS. Equal ratings for the 3D HUDS and conventional surgical microscope were received for system malfunctions and lag during surgery. CONCLUSIONS The 3D HUDS was favoured over conventional microscopy for the performance of simulated MIGS by ophthalmologists with varying levels of experience. The survey results suggest that the 3D HUDS in an artificial eye model is useful for teaching minimally invasive glaucoma surgery, particularly with the advent of competency-based ophthalmology education programs.
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Affiliation(s)
- Jordan J Huang
- Cumming School of Medicine, University of Calgary, Calgary, AB.
| | - Derek Waldner
- Cumming School of Medicine, University of Calgary, Calgary, AB; Division of Ophthalmology, University of Calgary, Calgary, AB
| | - Jaxon J Huang
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI
| | - Joshua M Huang
- Cumming School of Medicine, University of Calgary, Calgary, AB
| | - Paul Huang
- Cumming School of Medicine, University of Calgary, Calgary, AB; Division of Ophthalmology, University of Calgary, Calgary, AB
| | - Joshua C Teichman
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON; Division of Ophthalmology, Trillium Health Partners, Mississauga, ON
| | | | - Patrick Gooi
- Division of Ophthalmology, University of Calgary, Calgary, AB
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Carr L, McKechnie T, Hatamnejad A, Chan J, Beattie A. Effectiveness of the Eyesi Surgical Simulator for ophthalmology trainees: systematic review and meta-analysis. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024; 59:172-180. [PMID: 37088102 DOI: 10.1016/j.jcjo.2023.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVE The Eyesi Surgical Simulator (VRmagic, Mannheim, Germany) is the most commonly used ophthalmic virtual reality surgical simulator. While studies have demonstrated improved trainee skill acquisition with simulation-based training tools, a systematic review and meta-analysis evaluating Eyesi specifically has yet to be conducted. The aim of this study was to meta-analyze studies comparing Eyesi with other methods of technical skill teaching for trainees. METHODS MEDLINE, Embase, and CENTRAL databases were searched. Articles included compared Eyesi Surgical Simulator use with alternative methods of technical skill training for medical students or residents. A pairwise meta-analysis using inverse variance random effects was performed. Standardized mean differences (SMDs) were used as the primary outcome measure to account for differences in surgical skill evaluation tools. RESULTS From 207 citations, 8 studies with 108 learners using Eyesi and 123 learners not using Eyesi were included. Improvements in technical skill scores were significantly greater with the use of Eyesi (3 studies; SMD = 2.02; 95% CI, 1.47-2.57; p < 0.001; I2 = 0%). There was a significant reduction in the number of learners experiencing post-training technical errors in the Eyesi group (5 studies: odds ratio = 0.43; 95% CI, 0.20-0.90; p = 0.03; I2 = 30%). There were no significant differences in post-training time to task completion between groups (3 studies; SMD = 1.96; 95% CI, -1.96-5.88; p = 0.33; I2 = 97%). CONCLUSIONS The Eyesi Surgical Simulator may improve technical skill acquisition (grade: low certainty of evidence) and decrease technical errors (grade: very low certainty of evidence) during cataract surgery among trainees. Further prospective studies evaluating Eyesi modules with standardized scoring systems is warranted.
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Affiliation(s)
- Lauren Carr
- Department of Surgery, Division of Ophthalmology, McMaster University, Hamilton, ON
| | - Tyler McKechnie
- Department of Surgery, Division of General Surgery, McMaster University, Hamilton, ON
| | - Amin Hatamnejad
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON
| | - Jenny Chan
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON
| | - Anne Beattie
- Department of Surgery, Division of Ophthalmology, McMaster University, Hamilton, ON.
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Birman NA, Vashdi DR, Miller-Mor Atias R, Riskin A, Zangen S, Litmanovitz I, Sagi D. Unveiling the paradoxes of implementing post graduate competency based medical education programs. MEDICAL TEACHER 2024:1-8. [PMID: 38803298 DOI: 10.1080/0142159x.2024.2356826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 05/14/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE Competency-based medical education (CBME) has gained prominence as an innovative model for post-graduate medical education, yet its implementation poses significant challenges, especially with regard to its sustainability. Drawing on paradox theory, we suggest that revealing the paradoxes underlying these challenges may contribute to our understanding of post graduate competency-based medical education (PGCBME) implementation processes and serve as a first-step in enhancing better implementation. Thus, the purpose of the current study is to identify the paradoxes associated with PGCBME implementation. METHOD A qualitative study was conducted, as part of a larger action research, using in-depth semi-structured interviews with fellows and educators in eight Neonatal wards. RESULTS Analysis revealed that the PGCBME program examined in this study involves three different levels of standardization, each serving as one side of paradoxical tensions; (1) a paradox between the need for standardized assessment tools and for free-flow flexible assessment tools, (2) a paradox between the need for a standardized implementation process across all wards and the need for unique implementation protocols in each ward; and 3) a paradox between the need for a standardized meaning of competency proficiency and the need for flexible and personal competency achievement indicators. CONCLUSIONS Implementing PGCBME programs involves many challenges, some of which are paradoxical, i.e. two contradictory challenges in which solving one challenge exacerbates another. Revealing these paradoxes is important in navigating them successfully.
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Affiliation(s)
- Noa A Birman
- University of Haifa, The Herta and Paul Amir Faculty of Social Sciences, School of Political Science, Department of Public Administration, Haifa, Israel
| | - Dana R Vashdi
- University of Haifa, The Herta and Paul Amir Faculty of Social Sciences, School of Political Science, Department of Public Administration, Haifa, Israel
| | - Rotem Miller-Mor Atias
- University of Haifa, The Herta and Paul Amir Faculty of Social Sciences, School of Political Science, Department of Public Administration, Haifa, Israel
| | - Arieh Riskin
- Technion Israel Institute of Technology, The Ruth and Bruce Rappaport Faculty of Medicine, Haifa, Israel
| | - Shmuel Zangen
- Ben- Gurion University of the Negev, Faculty of Health Sciences, Be'er-Sheva, Israel
| | - Ita Litmanovitz
- Tel Aviv University, Faculty of Medicine & Health Sciences, Tel-Aviv, Israel
| | - Doron Sagi
- The Israel Center for Medical Simulation, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
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de Heer MH, Driessen EW, Teunissen PW, Scheele F. Lessons learned spanning 17 years of experience with three consecutive nationwide competency based medical education training plans. Front Med (Lausanne) 2024; 11:1339857. [PMID: 38455473 PMCID: PMC10917951 DOI: 10.3389/fmed.2024.1339857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/31/2024] [Indexed: 03/09/2024] Open
Abstract
Introduction Curricula for postgraduate medical education have transformed since the introduction of competency based medical education (CBME). Postgraduate training plans offer broader training with different competencies and an outcome-based approach, in addition to the medical technical aspects of training. However, CBME also has its challenges. Over the past years, critical views have been shared on the potential drawbacks of CBME, such as assessment burden and conflicts with practicality in the workplace. Recent studies identified a need for a better understanding of how the evolving concept of CBME has been translated to curriculum design and implemented in the practice of postgraduate training. The aim of this study was to describe the development of CBME translations to curriculum design, based on three consecutive postgraduate training programs spanning 17 years. Method We performed a document analysis of three consecutive Dutch gynecology and obstetrics training plans that were implemented in 2005, 2013, and 2021. We used template analysis to identify changes over time. Results Over time, CBME-based curriculum design changed in several domains. Assessment changed from a model with a focus on summative decision to one with an emphasis on formative, low-stakes assessments aimed at supporting learning. The training plans evolved in parallel to evolving educational insights, e.g., by placing increasing emphasis on personal development. The curricula focused on a competency-based concept by introducing training modules and personalized authorization based on feedback rather than on a set duration of internships. There was increasing freedom in personalized training trajectories in the training plans, together with increasing trust towards the resident. Conclusion The way CBME was translated into training plans has evolved in the course of 17 years of experience with CMBE-based education. The main areas of change were the structure of the training plans, which became increasingly open, the degree to which learning outcomes were mandatory or not, and the way these outcomes were assessed.
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Affiliation(s)
- Merel H. de Heer
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Research in Education, Amsterdam, Netherlands
| | - Erik W. Driessen
- School of Health Professions Education (SHE), Faculty of Health Medicine and Life Sciences (FHML), Maastricht University, Maastricht, Netherlands
| | - Pim W. Teunissen
- School of Health Professions Education (SHE), Faculty of Health Medicine and Life Sciences (FHML), Maastricht University, Maastricht, Netherlands
- Department of Obstetrics and Gynecology, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| | - Fedde Scheele
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Research in Education, Amsterdam, Netherlands
- Athena Institute, Faculty of Science, VU, Amsterdam, Netherlands
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Braund H, Hanmore T, Dalgarno N, Baxter S. Using a rapid-cycle approach to evaluate implementation of competency-based medical education in ophthalmology. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024; 59:40-45. [PMID: 36372134 DOI: 10.1016/j.jcjo.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 08/15/2022] [Accepted: 10/15/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE As competency-based medical education is being implemented across Canada, there is an increasing need to evaluate the progress to date, including identification of strengths and weaknesses, to inform program development. Ophthalmology is preparing for a national launch in coming years. The purpose of this study was to describe key stakeholders' lived experiences in the competency-based medical education foundation-of-discipline stage in one ophthalmology department. DESIGN Using a case-study approach, a qualitative rapid-cycle evaluation was conducted during the 2018-2019 academic year. PARTICIPANTS Residents, faculty, academic advisors, competence committee members, the program director, the program administrator, and the educational consultant were invited to participate in the program evaluation. METHODS The rapid-cycle evaluation consisted of 2 evaluation cycles, with the first round of interviews and focus groups occurring in October 2018 and the second round in March 2019. Recommendations were implemented in November 2019 and June 2019. All data were analyzed thematically using NVivo. RESULTS Three main themes emerged across all data sets: developing a shared understanding (e.g., role expectations and changes to assessment), refining assessment processes and tools (e.g., the need for streamlining and clarification), and feedback (e.g., perceived benefits and value of narrative comments). CONCLUSIONS Exploring lived experiences in this study resulted in positive and immediate improvements to the residency program. The recommendations and approach will be useful to other Canadian departments and institutions as they prepare for Competence by Design.
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Affiliation(s)
- Heather Braund
- Office of Professional Development and Educational Scholarship, Faculty of Health Sciences, Queen's University, Kingston, ON
| | - Tessa Hanmore
- Departments of Ophthalmology, Physical Medicine and Rehabilitation, and Psychiatry, Queen's University, Kingston, ON
| | - Nancy Dalgarno
- Office of Professional Development and Educational Scholarship, Faculty of Health Sciences, Queen's University, Kingston, ON
| | - Stephanie Baxter
- Department of Ophthalmology, Queen's University and Kingston Health Sciences Centre, Kingston, ON.
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Ní Dhubhghaill S, Sanogo M, Lefebvre F, Aclimandos W, Asoklis R, Atilla H, Creuzot-Garcher C, Curtin D, Cvenkel B, Flanagan L, Kivelä TT, Maino A, Martinez Costa R, Priglinger S, Prior Filipe H, Stopa M, Strong B, Sturmer J, Tassignon MJ, Ivekovic R, Bourcier T. Cataract surgical training in Europe: European Board of Ophthalmology survey. J Cataract Refract Surg 2023; 49:1120-1127. [PMID: 37867285 DOI: 10.1097/j.jcrs.0000000000001280] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/02/2023] [Indexed: 10/24/2023]
Abstract
PURPOSE To survey recently graduated European ophthalmologists concerning cataract surgery (CS) training opportunities. SETTING Countries affiliated to the European Board of Ophthalmology (EBO). DESIGN Cross-sectional study of anonymous survey results. METHODS A 23-question online survey was emailed to candidates who sat the EBO Diploma Examination as residents between 2018 and 2022. RESULTS 821 ophthalmologists from 30 countries completed the survey. The mean residency duration was 4.73 (SD 0.9) years. The mean reported number of entire CS procedures performed was 80.7 (SD 100.6) at the end of residency, but more than 25% of respondents (n = 210) had received no live CS training during their residency. The self-confidence (scale, 1 to 10) to perform a simple case or challenging case, manage posterior capsular rupture, and realize a corneal stitch were rated 4.1, 3.2, 4.2, 2.4, respectively. We observed extensive variation in clinical exposure to CS and self-reported confidence to perform CS between European trainees. Females reported a mean of 18% fewer entire procedures than their male colleagues and were also less confident in their surgical skills (P < .05). Trainees in residency programs longer than 5 years performed fewer procedures and were less confident than trainees in residences of shorter duration (P < .001). The importance of fellowships to complete surgical education was rated 7.7 out of 10. CONCLUSIONS CS training across European countries lacks harmony. Female ophthalmology trainees continue, as in other specialties, to experience apparent gender bias. European level recommendations seem necessary to raise and harmonize competency-based CS training programs and promote post-residency fellowship training programs.
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Affiliation(s)
- Sorcha Ní Dhubhghaill
- From the Department of Ophthalmology, Antwerp University and University Hospital of Antwerp, Antwerp, Belgium (Ní Dhubhghaill, Tassignon); Department of Ophthalmology, Strasbourg University Hospital, NHC, FMTS, University of Strasbourg, Strasbourg, France (Sanogo, Bourcier); Department of Biostatistics, Strasbourg University Hospital, Civil Hospital, FMTS, University of Strasbourg, Strasbourg, France (Lefebvre); King's College Hospital, London, United Kingdom (Aclimandos); Department of Ophthalmology, Center of Eye Diseases, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania (Asoklis); Department of Ophthalmology, Ankara University, School of Medicine, Ankara, Turkey (Atilla); Department of Ophthalmology, Dijon University Hospital, University of Dijon, Dijon, France (Creuzot-Garcher); Consultant Ophthalmologist, Clinical Lecturer, Royal College of Surgeons in Ireland, Dublin, Ireland (Curtin); Department of Ophthalmology, University Medical Centre Ljubljana, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia (Cvenkel); EBO Secretariat Office, Agenda Communications and Conference Services, Ltd., Dublin, Ireland (Flanagan, Strong); Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland (Kivelä); Manchester Royal Eye Hospital, Manchester, United Kingdom (Maino); Department of Ophthalmology, Hospital Universitario y Politécnico La Fe, University of Valencia, Valencia, Spain (Martinez Costa); Department of Ophthalmology, LMU Munich, Germany (Priglinger); Department of Ophthalmology, West Lisbon Hospitals Center, Hospital Egas Moniz, Portugal (Prior Filipe); Department of Ophthalmology, Poznan University Hospital, Poznan University of Medical Sciences, Poland (Stopa); Department of Ophthalmology, Cantonal Hospital Winterthur, University of Zurich, Switzerland (Sturmer); Department of Ophthalmology, University Medical Centre Sestre Milosrdnice, Zagreb, Croatia (Ivekovic)
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Yang X, Zheng D, Wan P, Luo X, Zhang M, Zhang L, Zhang S, Huang J, Zhuo Y. Standard ophthalmology residency training in China: an evaluation of resident satisfaction on training program in Guangdong Province. BMC MEDICAL EDUCATION 2023; 23:550. [PMID: 37537562 PMCID: PMC10401789 DOI: 10.1186/s12909-023-04527-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 07/21/2023] [Indexed: 08/05/2023]
Abstract
BACKGROUND National 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. METHOD A 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. RESULTS A 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%). CONCLUSION Ophthalmology 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.
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Affiliation(s)
- Xiaonan Yang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, No.7, Jinsui Road, Guangzhou, China
- Department of Ophthalmology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China
| | - Danying Zheng
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, No.7, Jinsui Road, Guangzhou, China
| | - Pengxia Wan
- Department of Ophthalmology, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, Guangdong Province, China
| | - Xiaoling Luo
- Department of Ophthalmology, Shenzhen People's Hospital Second Clinical Medical College of Jinan University, Shenzhen, China
| | - Mingzhi Zhang
- Joint Shantou International Eye Center, Shantou University & the Chinese University of Hong Kong, Shantou, 515041, China
| | - Liang Zhang
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, No. 106, Zhongshan Er Road, Yuexiu District, Guangzhou, Guangdong, China
| | - Shaochong Zhang
- Shenzhen Eye Hospital affiliated to Jinan University, Shenzhen, China
| | - Jingjing Huang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, No.7, Jinsui Road, Guangzhou, China.
| | - Yehong Zhuo
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, No.7, Jinsui Road, Guangzhou, China.
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Huang JJ, Waldner D, Huang JJ, Huang JM, Huang P, Teichman JC, Darvish-Zargar M, Gooi P. Face and Content Validity of an Artificial Eye Model for Secondary Intraocular Lens Fixation via Yamane Technique. Clin Ophthalmol 2023; 17:2063-2069. [PMID: 37496849 PMCID: PMC10368112 DOI: 10.2147/opth.s419464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/10/2023] [Indexed: 07/28/2023] Open
Abstract
Purpose To assess the face and content validity of an artificial eye model for secondary intraocular lens (IOL) fixation via the Yamane technique. Methods Ophthalmologists and residents participated in a 90-minute simulation session on secondary IOL fixation via the Yamane technique. Hands-on practice of this technique was performed on an artificial eye, the Bioniko Okulo BR8. After, all ophthalmologists answered an 18-question survey assessing the face and content validity of the model. Survey responses were recorded on a 5-point double-headed Likert scale, ranging from strongly agree (1)-to-strongly disagree (5) (Figure 1). Results Twenty-three surveys were completed. Respondents rated the survey with a median response of 1 (strongly agree)-to-3 (neutral). Highest ratings for the model were received for "usefulness for training residents", and "easier to set up and clean-up compared to a cadaver". Lowest ratings were received for realism of the model compared to cadaveric eyes. Statistical analysis revealed no significant difference among identified groups. Ratings for face and content validity were viewed favorably, both with an overall median response of 2.00 (agree). Conclusion The Bioniko Okulo BR8 shows promise as a valid tool for practicing secondary IOL fixation via the Yamane technique. Considering recent guidelines in competency-based ophthalmology education programs, this model may be a valuable tool over traditional techniques for teaching and improving surgical skill amongst trainees.
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Affiliation(s)
- Jordan J Huang
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Derek Waldner
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Division of Ophthalmology, University of Calgary, Calgary, Alberta, Canada
| | - Jaxon J Huang
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, USA
| | - Joshua M Huang
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Paul Huang
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Division of Ophthalmology, University of Calgary, Calgary, Alberta, Canada
| | - Joshua C Teichman
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Division of Ophthalmology, Trillium Health Partners, Mississauga, Ontario, Canada
| | | | - Patrick Gooi
- Division of Ophthalmology, University of Calgary, Calgary, Alberta, Canada
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Helliwell LA, Hyland CJ, Gonte MR, Malapati SH, Bain PA, Ranganathan K, Pusic AL. Bias in Surgical Residency Evaluations: A Scoping Review. JOURNAL OF SURGICAL EDUCATION 2023; 80:922-947. [PMID: 37142488 DOI: 10.1016/j.jsurg.2023.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/21/2023] [Accepted: 04/13/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE Given widespread disparities in the surgical workforce and the advent of competency-based training models that rely on objective evaluations of resident performance, this review aims to describe the landscape of bias in the evaluation methods of residents in surgical training programs in the United States. DESIGN A scoping review was conducted within PubMed, Embase, Web of Science, and ERIC in May 2022, without a date restriction. Studies were screened and reviewed in duplicate by 3 reviewers. Data were described descriptively. SETTING/PARTICIPANTS English-language studies conducted in the United States that assessed bias in the evaluation of surgical residents were included. RESULTS The search yielded 1641 studies, of which 53 met inclusion criteria. Of the included studies, 26 (49.1%) were retrospective cohort studies, 25 (47.2%) were cross-sectional studies, and 2 (3.8%) were prospective cohort studies. The majority included general surgery residents (n = 30, 56.6%) and nonstandardized examination modalities (n = 38, 71.7%), such as video-based skills evaluations (n = 5, 13.2%). The most common performance metric evaluated was operative skill (n = 22, 41.5%). Overall, the majority of studies demonstrated bias (n = 38, 73.6%) and most investigated gender bias (n = 46, 86.8%). Most studies reported disadvantages for female trainees regarding standardized examinations (80.0%), self-evaluations (73.7%), and program-level evaluations (71.4%). Four studies (7.6%) assessed racial bias, of which all reported disadvantages for trainees underrepresented in surgery. CONCLUSIONS Evaluation methods for surgery residents may be prone to bias, particularly with regard to female trainees. Research is warranted regarding other implicit and explicit biases, such as racial bias, as well as for nongeneral surgery subspecialties.
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Affiliation(s)
| | | | - Madeleine R Gonte
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Wayne State University School of Medicine, Detroit, Michigan
| | | | - Paul A Bain
- Countway Library, Harvard Medical School, Boston, Massachusetts
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Guimarães ABC, Amaral E, Carvalho KM. Curriculum satisfaction of graduates of medical residency in ophthalmology. BMC MEDICAL EDUCATION 2023; 23:403. [PMID: 37268934 PMCID: PMC10239158 DOI: 10.1186/s12909-023-04410-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 05/29/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND The number of ophthalmologists trained in Brazil has increased, but their satisfaction with the medical residency curriculum is unclear. The purpose of this study is to evaluate the satisfaction and self-confidence of graduates of a reference ophthalmology residency program in Brazil and to analyze whether there is a difference in these parameters among those who graduated in different decades. METHODS This is a cross-sectional web-based study conducted in 2022 with 379 ophthalmologists who graduated from the Faculty of Medical Sciences of the State University of Campinas (UNICAMP), Brazil. We aim to obtain data on satisfaction and self-confidence in clinical and surgical practices. RESULTS In total, 158 questionnaires were completed (41.68% response rate); 104 respondents completed their medical residency between 2010 and 2022, 34 between 2000 and 2009, and only 20 before 2000. Most respondents were satisfied or very satisfied with their programs (98.7%). Respondents reported insufficient exposure to low vision rehabilitation (62.7%), toric intraocular implants (60.8%), refractive surgery (55.7%), and orbital trauma surgery (84.8%), particularly among graduates before 2010. They also reported insufficient training in certain non-clinical areas, such as office management (61.4%), health insurance management (88.6%), and personnel and administration skills (74.1%). We found that respondents who graduated a long time ago had higher confidence in clinical and surgical practices. CONCLUSIONS Brazilian ophthalmology residents and UNICAMP graduates expressed high levels of satisfaction with their residency training programs. Those who completed the program a long time ago appear to have more confidence in clinical and surgical practices. There were clinical and non-clinical areas with insufficient training identified for improvement.
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Affiliation(s)
- A B C Guimarães
- Faculty of Medical Sciences, State University of Campinas, Rua Vital Brasil, 80. CidadeUniversitária Zeferino Vaz, Campinas, SP, 13083-888, Brazil
| | - E Amaral
- Faculty of Medical Sciences, State University of Campinas, Rua Vital Brasil, 80. CidadeUniversitária Zeferino Vaz, Campinas, SP, 13083-888, Brazil
| | - K M Carvalho
- Faculty of Medical Sciences, State University of Campinas, Rua Vital Brasil, 80. CidadeUniversitária Zeferino Vaz, Campinas, SP, 13083-888, Brazil.
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Anaya-Alaminos R, Rassmussen ML, Fung SSM, Potic J, González-Andrades M. Comparative analysis of European residency programs: benchmarking and harmonizing ophthalmology training in Europe. Eye (Lond) 2023; 37:725-731. [PMID: 35354947 PMCID: PMC9998389 DOI: 10.1038/s41433-022-02040-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 03/06/2022] [Accepted: 03/15/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND/OBJECTIVES This study aims to benchmark the training programs of European ophthalmology residents. SUBJECTS/METHODS An online survey, aimed at European ophthalmology residents in training and those within two years of completion, was sent through the national representatives of the European Society of Ophthalmology, Young Ophthalmologists section (SOE-YO). The study involved 214 subjects representing 36 of the 44 European countries offering ophthalmology training programs. RESULTS Among the surveyed, 74.8% of participants had an official national curriculum; 55.8% had a national specialty examination to accredit their training as ophthalmologists. 45.8% were satisfied or very satisfied with the clinical skills acquired, while 42.1% were completely dissatisfied with the surgical skills achieved. Considering the 4th year residents (mean duration of the residency), many of them did not perform phacoemulsification surgery (34%), pterygium excision (46.9%), or repair of eyelid laceration (31.3%). CONCLUSIONS There is great heterogeneity in the competencies achieved by residents in training according to their country of origin, especially in terms of surgical competences.
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Affiliation(s)
- Roberto Anaya-Alaminos
- Department of Ophthalmology, San Cecilio University Hospital, Granada, Spain
- VISIOON Ophthalmic Clinic, Granada, Spain
| | | | - Simon S M Fung
- Department of Ophthalmology, University of California Los Angeles, Los Angeles, CA, USA
| | - Jelena Potic
- Clinic for Eye Diseases, Clinical Center of Serbia, School of Medicine, University of Belgrade, Belgrade, Serbia
- Jules-Gonin Eye Hospital, Fondation Asile des Aveugles, Department of Ophthalmology, University of Lausanne, Lausanne, Switzerland
| | - Miguel González-Andrades
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Department of Ophthalmology, Reina Sofia University Hospital and University of Cordoba, Cordoba, Spain.
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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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Bentley H, Darras KE, Forster BB, Sedlic A, Hague CJ. Review of Challenges to the Implementation of Competence by Design in Post-Graduate Medical Education: What Can Diagnostic Radiology Learn from the Experience of Other Specialty Disciplines? Acad Radiol 2022; 29:1887-1896. [PMID: 35094947 DOI: 10.1016/j.acra.2021.11.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/27/2021] [Accepted: 11/30/2021] [Indexed: 01/26/2023]
Abstract
Competence by Design (CBD) is a medical education initiative instituted by the Royal College of Physicians and Surgeons of Canada to improve the training of resident physicians in specialty disciplines. CBD integrates Competency Based Medical Education with traditional specialty discipline post-graduate medical education (PGME) training through the application of an organizational framework of competencies. Various specialty disciplines in Canada have transitioned to CBD since 2017 in a staggered approach. Diagnostic radiology PGME programs in Canada are expected to transition to CBD in 2022 for the incoming resident physician cohort. This article reviews potential challenges to the implementation of CBD in diagnostic radiology PGME programs and proposes evidence-informed targeted strategies and solutions to address these challenges. It is important for diagnostic radiology PGME programs to understand the challenges pertaining to the implementation of CBD so that they may be able to successfully implement this or similar medical education initiatives in their programs. Moreover, as radiology subspecialty PGME programs, such as nuclear medicine, interventional radiology, neuroradiology, and pediatric radiology, likewise transition to CBD and diagnostic radiology PGME programs internationally increasingly implement other Competency Based Medical Education models, the implications of the challenges pertaining to the implementation of CBD will further become of increasing importance.
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Affiliation(s)
- Helena Bentley
- Department of Radiology, Faculty of Medicine, Gordon & Leslie Diamond Health Care Centre, University of British Columbia, 11th Floor, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada.
| | - Kathryn E Darras
- Department of Radiology, Faculty of Medicine, Gordon & Leslie Diamond Health Care Centre, University of British Columbia, 11th Floor, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada; Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Bruce B Forster
- Department of Radiology, Faculty of Medicine, Gordon & Leslie Diamond Health Care Centre, University of British Columbia, 11th Floor, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada; Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Anto Sedlic
- Department of Radiology, Faculty of Medicine, Gordon & Leslie Diamond Health Care Centre, University of British Columbia, 11th Floor, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada; Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Cameron J Hague
- Department of Radiology, Faculty of Medicine, Gordon & Leslie Diamond Health Care Centre, University of British Columbia, 11th Floor, 2775 Laurel Street, Vancouver, BC V5Z 1M9, Canada; Department of Radiology, St Paul's Hospital, Vancouver, BC, Canada
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Sud R, Khanduja S. Implementing competency-based medical education in post-graduate ophthalmology training: Understanding key concepts and methodologies and overcoming challenges. Indian J Ophthalmol 2022; 70:3701-3706. [PMID: 36190077 PMCID: PMC9789853 DOI: 10.4103/ijo.ijo_417_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The National Medical Council (NMC) has mandated that all post-graduate training shall be competency-based, following the principles of Competency. Based Medical Education (CBME). This aims to serve the dual purpose of standardizing ophthalmology post-graduate training and to overcome the shortcomings of the traditional curriculum by employing innovative and interactive teaching-learning and assessment techniques to produce competent ophthalmologists well equipped with clinical, surgical, and professional skills relevant to current times. CBME marks a paradigm shift from traditional curriculum methodologies and involves the introduction of several new concepts. This article aims to highlight the key principles of CBME and the various teaching-learning and assessment technique methodologies which can be employed for post-graduate training. It also highlights the various challenges that are likely to be faced in its implementation and measures to overcome them.
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Affiliation(s)
- Rouli Sud
- Department of Ophthalmology, Kalpana Chawla Government Medical College and Hospital, Karnal, Haryana, India
| | - Sumeet Khanduja
- Department of Ophthalmology, Kalpana Chawla Government Medical College and Hospital, Karnal, Haryana, India,Correspondence to: Dr. Sumeet Khanduja, Department of Ophthalmology, Kalpana Chawla Government Medical College and Hospital, Karnal, Haryana, India. E-mail:
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Han SY, Lee SH, Chae H. Developing a best practice framework for clinical competency education in the traditional East-Asian medicine curriculum. BMC MEDICAL EDUCATION 2022; 22:352. [PMID: 35538517 PMCID: PMC9088070 DOI: 10.1186/s12909-022-03398-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 04/21/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND While clinical competency is crucial for traditional East-Asian medical education, available studies on the educational system for fostering clinical performance are scarce. This study aimed to review the educational system, curriculum, facilities, and management of current traditional East-Asian medicine in a well-established university of Korea and develop a Best Practice Framework (BPF) of clinical competency education. METHODS The clinical competency education system in Pusan National University School of Korean Medicine was systematically described through 5 steps of governance of the educational system, competency of the graduates, educational resources, assessment strategies and tools, and gaps in the curriculum. We also reviewed the experiences in education and the points to be improved. RESULTS The Office of Traditional Korean Medicine Education governs the development, implementation, and evaluation of the educational curriculum for cultivating students' clinical competency. Medical students have undertaken 39 modules of clinical biomedicine and 21 of traditional medicine during the clinical clerkship courses in an affiliated hospital, Clinical Skill Practice Center, clinical research center, practice lab for medical herb, and other locations. After training, 15 modules of simulated clinical training using standardized patients, students' clinical competency are evaluated by a Clinical Performance Test using a Clinical Performance Examination (CPX) and an Objective Structured Clinical Examination (OSCE) for biomedical and traditional medical skills. CONCLUSIONS A clinical competency framework is required for a qualified physician of traditional East-Asian medicine. This study reviewed the current well-organized educational system of Korean traditional medicine in detail, which can be used for the BPF of competency-based clinical education. We expect the current study to be a representative reference for establishing an educational system of traditional medicine such as acupuncture and medical herbs in other countries.
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Affiliation(s)
- Sang Yun Han
- College of Korean Medicine, Daejeon University, Daejeon, 34520, South Korea
- Department of Medical Education, Seoul National University College of Medicine, Seoul, 03080, Korea
| | - Seung-Hee Lee
- Department of Medical Education, Seoul National University College of Medicine, Seoul, 03080, Korea
| | - Han Chae
- School of Korean Medicine, Pusan National University, 49 Busandaehak-ro, Mulgeum-eup, Yangsan-si, Gyeongnam, 50612, Korea.
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Ramani S, Pradeep TG, Sundaresh DD. An update on the novel approaches towards skills assessment of ophthalmology residents in the Indian scenario. Indian J Ophthalmol 2022; 70:1092-1098. [PMID: 35325993 PMCID: PMC9240543 DOI: 10.4103/ijo.ijo_1034_21] [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] [Indexed: 11/23/2022] Open
Abstract
An essential part of the teaching-learning paradigm is assessment. It is one of the ways to achieve feedback for the various methods that have been used to impart a particular skill. This is true of ophthalmology training, where various clinical and surgical skills are learned as part of the residency program. In preparation for residents to become proficient ophthalmologists, both formative and summative assessments are of paramount importance. At present, assessment is primarily summative in the form of a university examination, including theory and practical examinations that are conducted at the end of the three years of residency. A formative assessment can make course corrections early on, allowing for an improved understanding of the subject and the acquisition of clinical and surgical skills. Formative assessments also allow us to customize the teaching methodology considering individual residents’ learning capabilities. In addition, formative assessments have the advantage of alleviating the stress of a “final” examination, which could sometimes result in a less-than-optimum performance by the residents. The COVID-19 pandemic has forced us to adopt new teaching methods, which has led to the adoption of changes in assessment. In this regard, we discuss the different assessment tools available, their pros and cons, and how best these tools can be made applicable in the setting of an ophthalmology residency program.
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Affiliation(s)
- Soumya Ramani
- Department of Ophthalmology, M.S. Ramaiah Medical College, Bangalore, Karnataka, India
| | - Thanuja G Pradeep
- Department of Ophthalmology, M.S. Ramaiah Medical College, Bangalore, Karnataka, India
| | - Divya D Sundaresh
- Department of Ophthalmology, M.S. Ramaiah Medical College, Bangalore, Karnataka, India
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Waldner DM, Gorner AT, Swift AJ, Ahmed Y, Chung H, Gooi P. Face and content validity of the SimulEYE A-Vit model for anterior vitrectomy. Can J Ophthalmol 2020; 55:458-460. [PMID: 32471649 DOI: 10.1016/j.jcjo.2020.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/13/2020] [Accepted: 04/13/2020] [Indexed: 10/24/2022]
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