Psychomotor vigilance and visual field test performance.

INTRODUCTION: Visual field test is an invaluable tool to evaluate the detection and progression of glaucoma. On the other hand, as a subjective test, reliable results depend on patients' optimum performance including vigilance during the test. The purpose of this study was to understand patient's attitude and preferences about the visual field test taking, and in addition to assess the relationship between the reliability indices of visual field testing (VFT) and the Walter Reed Psychomotor Vigilance Test (PVT). MATERIAL AND METHODS: In this cross-sectional, non-interventional study, VFT reliability indices were recorded for all 140 patients. In the 46 patients who completed the PVT, average reaction time and minimum reaction times were recorded. All 140 patients completed a survey about their VFT experience. RESULTS: Based on the survey results, most subjects found VFT to be difficult. Subjects who rated their VFT performance excellent/good had similar VFT reliability rates compared to the ones with fair/poor self-assessments. The average reaction time (RT) was 0.6 seconds (0.3-1.9 seconds). Higher average RT was associated with increased age and less formal education (p < 0.001 and 0.03, respectively). There was a marginally significant correlation between average RT and the VFT "reliability" status (p = 0.045). CONCLUSIONS: While VFT is the least favorable part of the work-up for glaucoma patients, their self-assessment about VFT performance did not correlate with current VF reliability indicators. Although reliability of the VFT was not strongly affected by slower reaction times when tested by the PVT, the effect of psychomotor reaction time on other aspects of test outcomes is unknown and warrants further investigation.

Diphenhydramine as a topical ocular anesthetic.

OBJECTIVE: To determine whether 5% diphenhydramine solution has an anesthetic effect when administered topically to rabbit corneas. DESIGN: Experimental study. PARTICIPANTS: Twenty white New Zealand rabbits. METHODS: Twenty rabbits at the University of Arkansas for Medical Sciences received 1 drop of 5% diphenhydramine solution in the left eye and 1 drop of balanced salt solution in the right eye. Corneal sensation was then measured with a Cochet-Bonnet esthesiometer at 30-, 60-, and 90-minute intervals. Rabbits were observed for conjunctival reaction. Follow-up fluorescein and Rose Bengal slit-lamp examinations were then performed to assess toxicity. RESULTS: Diphenhydramine solution at a 5% concentration demonstrated a significant anesthetic effect 30, 60, and 90 minutes after instillation (p < 0.0001, p = 0.0001, p = 0.0164, respectively). Mild conjunctival injection occurred in all diphenhydramine-treated eyes. No toxic effects on the corneal epithelium were observed. CONCLUSIONS: When applied topically to rabbit corneas, 5% diphenhydramine solution has a significant anesthetizing effect compared with salt solution (control eyes). Topical diphenhydramine may be a safe alternative in patients requiring topical anesthesia who have multiple allergies to topical anesthetics. Additional studies are needed to determine a dose-response curve and to further evaluate corneal toxicity prior to use in humans.

Implementing a structured oral examination into a residency program: getting started.

BACKGROUND AND OBJECTIVE: To describe the steps involved in implementing a structured oral examination into a residency program PATIENTS AND METHODS: Existing oral examination format was evaluated and deficiencies addressed by creating a structured examination and increasing the frequency of administration to ophthalmology residents at the University of Arkansas for Medical Sciences. RESULTS: A structured oral examination was implemented. It provided both a realistic simulation of the board certification examination and a process that was a useful teaching method and assessment tool. It was valuable in addressing the Accreditation Council for Graduate Medical Education (ACGME) competencies. CONCLUSIONS: Oral examinations can be a versatile means of teaching and assessing resident physicians. Although the implementation process can be onerous, once in place, it can become an efficient tool for assessing all categories of the ACGME competencies and can provide valuable training in oral examination performance.

An institutional system to monitor and improve the quality of residency education.

PURPOSE: This study sought to investigate whether an institution's Graduate Medical Education Committee (GMEC) could develop a system of continuous quality improvement of its residency programs using an annual survey provided by the institution for all residents. METHOD: Beginning in 2000, residents were surveyed annually about their educational and work environments. The GMEC determined standards of performance for the items on the survey based on four areas commonly cited by the Accreditation Council for Graduate Medical Education: supervision, feedback/evaluation, scholarly time, and duty hours. Residency program directors submitted action plans to improve those areas rated below the standard by the residents in the program. RESULTS: The 2000 survey served as baseline. In 2001, residency programs met the standard for 55.2% of the items, and 18 programs submitted 67 action plans. In 2002, programs met the standard for 80.6% of the items. For the items below standard, programs showed improvement in 14.9% and declined in 4.5% of the items compared with baseline. Six of the 18 programs had accreditation site visits during the study period. Five received no citations in the targeted areas. The sixth program was visited three months after it developed action plans for its six deficient areas. It received citations for two of the six areas. CONCLUSION: An institution that sponsors residency programs can develop and sustain an effective system to continuously monitor and evaluate its programs and improve the educational quality as evidenced by successful accreditation decisions.