The impact of surgical training on the practice of recently graduated ophthalmologists at Riyadh's ophthalmology residency program.
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ABSTRACT:
SUBMITTER: Al Saedi NG
PROVIDER: S-EPMC6950953 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Background The COVID-19 pandemic has accelerated the adoption of telemedicine in the field of ophthalmology. Despite the increasing utilization of telemedicine, there is a lack of formal training in ophthalmology residency programs to ensure ophthalmologists are prepared to conduct virtual eye exams. Objective This article aims to assess the impact of an ophthalmic telemedicine curriculum on ophthalmology residents' self-reported knowledge acquisition in conducting telemedicine eye exams, perceived ability to diagnose, manage, and triage common eye diseases, and evaluate their attitudes toward the current and future use of teleophthalmology. Methods This single-center study at Massachusetts Eye and Ear used a nonvalidated pre- and postcurriculum survey conducted during the 2020 to 2021 academic year among ophthalmology residents. Participants engaged in an ophthalmic telemedicine curriculum that consisted of interactive didactic lectures and electronic postdidactic assessments. Results Twenty-four residents (100%) completed a precurriculum survey, while 23 of 24 (95.8%) residents completed both the telemedicine curriculum and a postcurriculum survey. On a five-point Likert scale, the median interquartile range (IQR) scores for confidence with setup/logistics, history taking, examination, documentation, and education increased from 2.5 (2.0-4.0) to 4.0 (3.5-4.5) ( p = 0.001), 3.0 (3.0-4.0) to 5.0 (4.0-5.0) ( p < 0.001), 2.0 (1.8-2.0) to 4.0 (3.5-4.0) ( p < 0.001), 2.0 (1.0-2.0) to 4.0 (3.0-4.0) ( p < 0.001), and 2.5 (2.0-3.0) to 4.0 (4.0-4.0) ( p < 0.001), respectively. The median (IQR) scores for comfort with ethics/professionalism, disparities and conducting patient triage, diagnosis, and management increased from 2.0 (2.0-2.3) to 4.0 (3.0-4.0) ( p < 0.001), 2.0 (2.0-2.0) to 3.0 (3.0-4.0) ( p < 0.001) and 3.0 (2.0-3.0) to 4.0 (3.0-4.0) ( p = 0.001), 2.0 (2.0-3.0) to 3.0 (3.0-4.0) ( p < 0.001), and 3.0 (2.0-3.0) to 3.0 (3.0-4.0) ( p = 0.008), respectively. Conclusion The implementation of an ophthalmic telemedicine curriculum increased resident confidence and self-reported knowledge across all logistical and clinical components of virtual ophthalmic care. Formal telehealth curricula can address an unmet educational need of resident trainees in an era of rapid uptake and utilization of telehealth services.
| S-EPMC9927988 | biostudies-literature
Project description: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.
| S-EPMC10002549 | biostudies-literature
Project description: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.
| S-EPMC10401789 | biostudies-literature
Project description:Importance:Important metrics of residency program success include the clinical outcomes achieved by trainees after transitioning to practice. Previous studies have shown significant differences in reported training experiences of general surgery residents at nonuniversity-based residency (NUBR) and university-based residency (UBR) programs. Objective:To examine the differences in practice patterns and clinical outcomes between surgeons trained in NUBR and those trained in UBR programs. Design, Setting, and Participants:This observational cohort study linked the claims data of patients who underwent general surgery procedures in New York, Florida, and Pennsylvania between January 1, 2012, and December 31, 2013, to demographic and training information of surgeons in the American Medical Association Physician Masterfile. Patients who underwent a qualifying procedure were grouped by surgeon. Practice pattern analysis was performed on 3638 surgeons and 1 237 621 patients, representing 214 residency programs. Clinical outcomes analysis was performed on 2301 surgeons and 312 584 patients. Data analysis was conducted from February 1, 2017, to July 31, 2017. Exposures:NUBR or UBR training status. Main Outcomes and Measures:Inpatient mortality, complications, and prolonged length of stay. Results:No significant differences were observed between the NUBR-trained surgeons and UBR-trained surgeons in age (mean, 53.3 years vs 53.7 years), sex (female, 18.2% vs 16.9%), or years of clinical experience (mean, 16.5 years vs 16.5 years). Overall, NUBR-trained surgeons compared with UBR-trained surgeons performed more procedures (median interquartile range [IQR], 328 [93-661] vs 164 [49-444]; P < .001) and performed a greater proportion of procedures in the outpatient setting (risk difference, 6.5; 95% CI, 6.4 to 6.7; P < .001). Before matching, the mean proportion of patients with documented inpatient mortality was lower for NUBR-trained surgeons than for UBR-trained surgeons (risk difference, -1.01; 95% CI, -1.41 to -0.61; P < .001). The mean proportion of patients with complications (risk difference, -3.17%; 95% CI, -4.21 to -2.13; P < .001) and prolonged length of stay (risk difference, -1.89%; 95% CI, -2.79 to -0.98; P < .001) was also lower for NUBR-trained surgeons. After matching, no significant differences in patient mortality, complications, and prolonged length of stay were found between NUBR- and UBR-trained surgeons. Conclusions and Relevance:Surgeons trained in NUBR and UBR programs have distinct practice patterns. After controlling for patient, procedure, and hospital factors, no differences were observed in the inpatient outcomes between the 2 groups.
| S-EPMC5875345 | biostudies-literature
Project description:BackgroundResidency training is the basis of good clinical and surgical practice.PurposeThe aim is to know the demographics, training experience, and perception of young ophthalmologists to improve the present residency programs in India.SettingYoung ophthalmologists trained in India.MethodsA survey was conducted by the Academic and Research Committee of the All India Ophthalmology Society, in 2014-2016 of young ophthalmologists (those trained between 2002 and 2012, with 2-10 years' postresidency experience) to gauge teaching of clinical and surgical skills during the postgraduate residency program.Statistical analysisStatistical Package for Social Sciences version 16.ResultsOf the 1005 respondents, 531 fulfilled inclusion criteria. Average age was 32.6 years (standard deviation [SD] 4). On a scale of 0-10, clinical skills teaching was graded as (mean, SD): Slit lamp examination (7.2, SD 2.8), indirect ophthalmoscopy (6.2, SD 3.3), gonioscopy (5.7, SD 3.4), perimetry (6.2, SD 3.2), optical coherence tomography (4.6, SD 4), and orthoptic evaluation (4.3, SD 3.1). The mean (SD) and median of surgeries performed independently was intracapsular cataract extraction 3.0 (14.9), 0; extracapsular cataract extraction 39.9 (53.2), 18; small incision cataract surgery 75.3 (64.4), 55; phacoemulsification 30 (52.6), 1; pterygium excision 31.5 (43.5), 15; dacryocystectomy 20.3 (38.1), 4; dacryocystorhinostomy 11.7 (26.2), 2; chalazion 46.4 (48.3), 30; trabeculectomies 4 (14.9), 0; strabismus correction 1.4 (4.9), 0; laser-assisted in situ Keratomileusis 1.5 (12.2), 0; retinal detachment 1.5 (12.5), 0; vitrectomy 3.0 (17.0), 0; keratoplasty 5.2 (17.8), 0; eyelid surgery 8.6 (18.9), 2 and ocular emergencies 41.7 (52.4), 20. Observed and assisted surgeries were more common. However, the range of grading was 0-10 in all categories.ConclusionResidency training in India varies considerably from program to program. Standardization is needed to assure all graduates are competent and render consistent quality of service.
| S-EPMC5508454 | biostudies-literature
Project description:ObjectiveTo describe the self-perception of basic competencies in clinical practice and evaluate their associated factors, among recently graduated physicians from Lima, Peru.MethodsCross-sectional study. We evaluated the self-perception of the competencies in recently graduated physicians of four dimensions of the Tuning Project. Each item had six possible responses on a Likert scale: "non-existent" (1 point), "insufficient" (2 points), "sufficient" (3 points), "good" (4 points), "very good" (5 points) and "excellent" (6 points). To evaluate associated factors of the average scores for each dimension, we used linear regressions with the bootstrap method.ResultsWe analyzed data from 425 (54.9% were between 22 and 25 years old), which represent 31.1% of all physicians who graduated in 2016 from all medical schools located in Lima. The average self-perception score of the assessed dimensions was, in descending order: 4.49 for carrying out a patient consultation with a patient; 4.13 for carrying out practical procedures; 4.12 for providing immediate care of medical emergencies; and 4.04. for applying the principles, skills, and knowledge of evidence-based medicine (EBM). Regarding the factors associated with the average score per dimension, physicians from one university had higher average scores in all dimensions, and having done an externship and done an internship at social security hospitals was associated with a higer score with self-perception in two dimensions.ConclusionSelf-perception of competence was greater for the patient consultation dimension, and lower for the EBM. Only physicians from one university had higher average scores in all dimensions.
| S-EPMC7680771 | biostudies-literature
Project description:PurposeTo gauge the differences in ophthalmology residency training, academic, clinical and surgical, in the last three decades of the 20th century and the first decade of the 21st century.MethodsA survey was conducted by the Academic and Research Committee of the All India Ophthalmological Society, in 2014-2016, using a prevalidated questionnaire, which was circulated to ophthalmologists to gauge the practicality of the teaching protocols of clinical and surgical skills during postgraduate residency program.ResultsOf the 1005 respondents, 320 ophthalmologists who completed residency between 1967 and 2002 (20th century trained) and 531 who completed a residency in 2003-2012 (21st century trained) fulfilled the inclusion criteria. The average age was 49.2 years (standard deviation [SD] 4) and 32.6 years (SD 4), respectively. Twenty-first century trained ophthalmologists rated their training significantly better than the 20th century trained ophthalmologists for slit lamp examination (P = 0.001), indirect ophthalmoscopy, gonioscopy, automated perimetry, optical coherence tomography, and fundus photography (all having P < 0.001), while the 20th century trained rated their teaching of refraction, synoptophore, diplopia charting better (all P < 0.001). The range of grading was 0-10 in all categories. The median number of surgeries performed independently by 20th century and 21st century trained (during their training period) were: intracapsular cataract extraction (ICCE) 10, 0; extracapsular cataract extraction (ECCE) 43, 18; small incision cataract surgery (SICS) 5, 55; phacoemulsification (Phaco) 0, 1; pterygium excision 20, 15; dacryocystectomy 11, 4; dacryocystorhinostomy 11, 2; chalazion 35, 30; trabeculectomies 5, 0; strabismus correction 0, 0; vitrectomy 0, 0; keratoplasty 0, 0; eyelid surgery 6, 2; and ocular emergencies 18, 20.ConclusionTeaching of many clinical skills had improved over decades. Cataract surgery training has shifted from ICCE and ECCE to SICS and Phaco, but other surgeries were still taught sparingly. There was an enormous variation across the country in residency training which needs immediate attention.
| S-EPMC5989498 | biostudies-literature
Project description:ObjectiveTo investigate changes in the patterns of cumulative surgical experience for ophthalmologists in the UK following the introduction of a new national training scheme.DesignRetrospective review of all surgical training records submitted to the UK Royal College of Ophthalmologists by trainees for the award of Certificate of Completion of Training (CCT) for the period 2009-2015.SettingSecondary level care, UK.Participants539 trainees achieving CCT over the 7-year study period.InterventionsHigher specialist training or ophthalmology specialist training.Outcome measuresNumber of CCT awards by years and procedures performed for cataract surgery, strabismus, corneal grafts, vitreoretinal (VR) procedures, oculoplastics and glaucoma.ResultsCataract surgical experience showed little change with median number performed/performed?supervised (P/PS) 592, IQR: 472-738; mean: 631. Similarly, the median number of strabismus (P/PS 34), corneal grafts (assisted, 9) and VR procedures (assisted, 34) appeared constant. There was a trend towards increasing surgical numbers for oculoplastics (median 116) and glaucoma (57). Overall case numbers for ophthalmic specialist training (OST) trainees (7-year training programme) were higher than higher surgical training (HST) trainees (4.5-year programme) with the exception of squint (P/PS), corneal grafts (P/PS) and VR cases (P/PS).ConclusionsOverall case numbers reported at time of CCT application appear stable or with a marginal trend towards increasing case numbers. HST (4.5-year programme) case numbers do not include those performed before entry to HST, and although case numbers tended to be higher for OST trainees (7-year programme) compared with HST trainees, they were not proportionately so.
| S-EPMC5640272 | biostudies-literature
Project description:BACKGROUND:Physicians, particularly trainees and those in surgical subspecialties, are at risk for burnout. Mistreatment (i.e., discrimination, verbal or physical abuse, and sexual harassment) may contribute to burnout and suicidal thoughts. METHODS:A cross-sectional national survey of general surgery residents administered with the 2018 American Board of Surgery In-Training Examination assessed mistreatment, burnout (evaluated with the use of the modified Maslach Burnout Inventory), and suicidal thoughts during the past year. We used multivariable logistic-regression models to assess the association of mistreatment with burnout and suicidal thoughts. The survey asked residents to report their gender. RESULTS:Among 7409 residents (99.3% of the eligible residents) from all 262 surgical residency programs, 31.9% reported discrimination based on their self-identified gender, 16.6% reported racial discrimination, 30.3% reported verbal or physical abuse (or both), and 10.3% reported sexual harassment. Rates of all mistreatment measures were higher among women; 65.1% of the women reported gender discrimination and 19.9% reported sexual harassment. Patients and patients' families were the most frequent sources of gender discrimination (as reported by 43.6% of residents) and racial discrimination (47.4%), whereas attending surgeons were the most frequent sources of sexual harassment (27.2%) and abuse (51.9%). Proportion of residents reporting mistreatment varied considerably among residency programs (e.g., ranging from 0 to 66.7% for verbal abuse). Weekly burnout symptoms were reported by 38.5% of residents, and 4.5% reported having had suicidal thoughts during the past year. Residents who reported exposure to discrimination, abuse, or harassment at least a few times per month were more likely than residents with no reported mistreatment exposures to have symptoms of burnout (odds ratio, 2.94; 95% confidence interval [CI], 2.58 to 3.36) and suicidal thoughts (odds ratio, 3.07; 95% CI, 2.25 to 4.19). Although models that were not adjusted for mistreatment showed that women were more likely than men to report burnout symptoms (42.4% vs. 35.9%; odds ratio, 1.33; 95% CI, 1.20 to 1.48), the difference was no longer evident after the models were adjusted for mistreatment (odds ratio, 0.90; 95% CI, 0.80 to 1.00). CONCLUSIONS:Mistreatment occurs frequently among general surgery residents, especially women, and is associated with burnout and suicidal thoughts.
| S-EPMC6907686 | biostudies-literature
Project description:IntroductionSurgery and the training of young surgeons face various challenges. Work hour restrictions, demographic changes, medicolegal demands, as well as economic constraints have led to changes in patient care and thus changed surgical residency. In addition to the daily training at work, several theoretical and practical courses are offered to surgical residents. The aim of this manuscript is to provide an overview of the existing courses and programs for surgical residents in Germany. It describes the current structure of surgical training in Germany for 10 subspecialties and sets out existing approaches to implement structured surgical training by professional associations as well as by commercial providers.Materials and methodsThe official homepages of 10 surgical associations were analyzed for information on structured surgical training and a Google search for surgical training programs was conducted. Then, the websites of two commercial providers were searched for information in courses. In addition, the members of the German Young Surgeons Association were asked open questions about the existence of structured resident training and additional training opportunities in their specialty. The courses were analyzed for structural characteristics such as the price and type of course (single course, exam preparatory course, and structured program). A structured program was defined as a set of courses based on learning objectives that are designed to cover all aspects of the specialty and include some form of summative or formative assessment.ResultsSeveral courses are offered by varied providers; some of them associated with surgical associations and some commercial. Seven of 10 professional associations offer single courses and six of them offer exam preparatory courses. Commercial providers only offer single courses. All of these courses are optional; there is no requirement to take part in any of them. None of them is free of charge, but most offer discounts for members of surgical societies. Only one structured program exists for orthopedics and trauma surgery. A fixed schedule does not exist for any surgical subspecialty, but it is rather the responsibility of the trainee or his/her supervisor to pick or suggest a course that suits their personal state of knowledge.DiscussionUntil now, it depends on personal motivation and the generosity of hospitals whether or not surgical residents will receive training outside of their training hospital. Various external courses are offered in all surgical subspecialties to complement on-the-job training. It is unknown how many residents take part in them. The implementation of new, competence-based specialist training regulations in Germany in 2018 may facilitate a change in surgical education. Simulation-based education can promote the acquisition and consolidation of surgical skills. Additional training possibilities and structured programs should be implemented in surgical resident training to foster competence-based education and surgical proficiency.
| S-EPMC6754064 | biostudies-literature