Steps to standardize ophthalmology residency programs in India

Survey of Ophthalmology Training Experiences Among Young Ophthalmologists in the Asia-Pacific

PURPOSE

To describe ophthalmology training experiences across the Asia-Pacific (APAC).

DESIGN

Survey study.

METHODS

We utilized an anonymous online survey, which was previously validated and conducted in Europe, through Young Ophthalmologist leaders from the national member societies of the Asia-Pacific Academy of Ophthalmology (APAO) from September 2019 to July 2021. Responses were based on a 5-point Likert scale (where applicable) and data were analyzed using Microsoft Excel. Our main outcome measures were differences between regions, that is, Southeast Asia (SEA) and Western Pacific (WP); and seniority, that is, trainees/junior ophthalmologists and senior ophthalmologists.

RESULTS

We collated 130 responses representing 20 regions in the APAC region. The year of completion of ophthalmic training ranged from 1999 to 2024. The mean duration of training was 3.7±1.0 years. Most (98/130, 75%) indicated an interest for a common training standard across the APAC. Comparing SEA and WP trainees, both regions had similar working environments, but those in SEA reported significantly lower remuneration than their counterparts in WP ($600 vs $3000, P <0.05). WP trainees performed more phacoemulsification surgeries (76 WP vs 19 SEA), while SEA trainees conducted more manual small incision cataract surgeries (157 WP vs 1.5 SEA per duration of training). Senior ophthalmologists performed more cataract surgeries (210.9 senior ophthalmologists vs 40.1 junior ophthalmologists). Trainees had less confidence in medical competency areas such as interpreting an electroretinogram/visual evoked potential/electrooculogram (SEA=1.8, WP=2.1) and conducting an angiography (SEA=2.8, WP=3.4).

CONCLUSIONS

Our study highlighted heterogeneity among ophthalmology training experiences in the APAC region, with the majority indicating an interest in a common training standard.

An update on the novel approaches towards skills assessment of ophthalmology residents in the Indian scenario

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.

Adoption of newer teaching methods to overcome challenges of training in ophthalmology residency during the COVID-19 pandemic

The coronavirus disease 2019 (COVID-19) pandemic has disrupted training programs across all specialties. Surgical specialties, such as ophthalmology, that need continued microsurgical training are affected the most. The pandemic has resulted in ophthalmology residents being taken off their regular duties in ophthalmology and inducted into COVID duties. The focus on COVID care has de-emphasized training in ophthalmology. We highlight the challenges that teachers face in continuing the training programs of theory, clinical skill, and surgical skill transfer. Embracing technology is the need of the hour. We discuss the multiple options available to enable continued training programs and emphasize the need for all training institutes to include technology as an additional component of their training curricula.

Setting Objectives for a Competency-based Undergraduate Obstetrics and Gynecology Curriculum

INTRODUCTION

Little emphasis on standardization, less stringent outcome measurement and resource constrains can result in deteriorating competencies among medical graduates in a country with rapidly increasing number of medical institutions like India. A competency-based curriculum is where we carefully design curricular experiences to achieve pre-identified outcomes. In this study, we aimed to define the outcome objectives of a competency-based undergraduate Obstetrics and Gynaecology curriculum which is comprehensive, and is based on the present day need of our society. These objectives can serve as the basis for designing a suitable curriculum with aligned teaching learning and assessment methods.

METHODS

This is an observational study in which a Delphi technique was used to identify the outcome objectives representing competencies specific to the subject of obstetrics and gynaecology at graduate level. The six core competencies identified by Accreditation Council for Graduate Medical Council formed the framework to identify these competencies. Then, a cross-sectional countrywide survey was conducted among purposively sampled teachers and clinical experts through a postal questionnaire to know the relative importance of the identified outcome measures and need for their inclusion in a contemporary outcome-based curriculum.

RESULT

Ninety four medical teachers and clinical experts, belonging to institutes across the county, with demonstrable interest and expertise in the field of medical education identified 38 outcome objectives for the curriculum. There were twenty one "vital", fourteen "essential", two "desirable" and one "optional" outcome objectives identified. There were eighteen outcome objectives for "patient care" domain, nine for "medical knowledge", four for "Practice based learning and improvement", three for "professionalism", two for "system based practice", and two for "interpersonal and communication skills".

CONCLUSION

The outcome objectives for a competency-based obstetrics and gynaecology curriculum in an Indian context were defined.