Demographics, clinical interests, and ophthalmology skills confidence of medical student volunteers and non-volunteers in an extracurricular community vision screening service-learning program.

BACKGROUND: Medical school curricular hours dedicated to ophthalmology are low and declining. Extracurricular ophthalmology activities, such as participation in community vision screenings, may serve an important adjunctive role in medical school curricula. The Johns Hopkins University (JHU) Vision Screening In Our Neighborhoods (ViSION) Program is an example of a voluntary medical student-directed community service-learning program. METHODS: We used a mixed-methods cross-sectional approach, including an online survey and semi-structured interviews. JHU School of Medicine students enrolled in MD or MD/PhD programs during the 2019-2020 academic year were surveyed regarding demographics, career and service interests, involvement in ophthalmology-related activities, and confidence in their ophthalmology-related skills. Survey responses were compared between ViSION volunteers and non-volunteers using Fisher's exact chi-square tests. Semi-structured interviews were conducted via webconference with 8 prior or current ViSION volunteers and responses analyzed using inductive thematic analysis. Data were collected when ViSION volunteers were in variable stages of their medical education and involvement with the ViSION program. RESULTS: A total of 118 medical students were included, representing an overall response rate of 24.6% of JHU medical students. ViSION volunteers reported greater involvement in ophthalmology-related research (42% vs. 4%, p < 0.001), intent to apply to ophthalmology residency programs (35% vs. 1%, p = 0.001), and confidence with multiple ophthalmology knowledge and clinical skill domains. In particular, ViSION volunteers were more likely to feel confident estimating cup-to-disc ratio using direct ophthalmoscopy (20% vs. 0%, p < 0.001). In open-ended survey and interview questions, most volunteers attributed at least some degree of their ophthalmology skill development and desire to pursue ophthalmology and public health careers to their ViSION experience. CONCLUSIONS: Medical students who volunteered with a student-led community vision screening program were more likely to have a prior interest in ophthalmology than those who did not volunteer, but only 1/3 of volunteers planned to pursue a career in ophthalmology. Overall, volunteers reported higher confidence performing ophthalmology-related clinical skills, suggesting that student-led community vision screening programs may provide an important avenue for medical students to explore public health aspects of ophthalmology, while practicing ophthalmology exam skills and learning about common ophthalmic pathologies, regardless of their career intentions.

Endogenous Fungal Endophthalmitis: A Single-Center Retrospective Study and Review of the Literature.

PURPOSE: To evaluate factors that inform systemic antifungal choices in patients with endogenous fungal endophthalmitis (EFE). DESIGN: Single-institution retrospective case series. METHODS: Charts of EFE patients from 2010 to 2023 were reviewed. Patients treated systemically for EFE with a minimum of 14 days of follow-up were included. Outcome measures included time to improvement in vitritis or chorioretinitis, systemic therapy modification, and need for surgical intervention. RESULTS: A total of 20 eyes of 16 patients were included. Candida species were most common (43.8%), followed by culture-negative EFE (37.5%) and Aspergillus species (18.8%). In all, 90% of eyes had vitritis and/or macula-involving chorioretinitis. The majority of Candida infections (60%) or culture-negative EFE (75%) were treated initially with oral antifungals. Patients with a history of immune compromise, positive fungal culture, or positive Fungitell assay were more likely to be treated with early intravenous (IV) antifungal therapy. Two patients required systemic antifungal therapy modification because of worsening chorioretinitis, in 1 case due to voriconazole-resistant Aspergillosis that demonstrated chorioretinal lesion growth despite intravitreal amphotericin B injections and systemic voriconazole, and in the second case due to worsening chorioretinitis from Candida dubliniensis infection that regressed upon switch from oral to IV fluconazole. CONCLUSIONS: Initial systemic treatment decisions in patients with EFE were driven by systemic culture positivity, systemic symptoms, or comorbidities. Intravitreal antifungal therapy may be insufficient to arrest progression of chorioretinal lesions in some cases. Larger studies are needed to determine whether visible end-organ damage in the form of chorioretinitis may be useful for guiding systemic therapy changes.

Applicant Characteristics Associated with Glaucoma Fellowship Match from 2010 to 2017.

PURPOSE: To describe trends in the glaucoma fellowship match results, glaucoma applicant characteristics, and applicant characteristics associated with matching. DESIGN: Retrospective study. PARTICIPANTS: Ophthalmology fellowship applicants participating in the San Francisco (SF) Match between 2010 and 2017. METHODS: De-identified, individual applicant data provided by the San Francisco (SF) Match were used to describe glaucoma fellowship match trends and applicant characteristics between 2010 and 2017. Publicly available, conglomerate SF Match data were used to determine trends in the number of programs participating in the glaucoma fellowship match, as well as the number of positions offered and filled from 2014 to 2019. All trends analyses were performed using linear regression models on log-transformed response variables. Summary statistics for applicants who matched in glaucoma were compared with those who did not match. A multivariable logistic regression model was used to evaluate factors associated with matching in glaucoma fellowship. MAIN OUTCOME MEASURES: Fellowship match status (matched in glaucoma vs. did not match in any ophthalmology subspecialty). RESULTS: From 2010 to 2019, the number of matched glaucoma fellowship applicants increased from 54 to 77 (mean 3.3% per year, P = 0.001), and the proportion of applicants to any ophthalmology fellowship who matched in glaucoma increased from 13% to 15.5% (mean, 3% per year; P = 0.041). Compared with applicants who did not match in any specialty between 2010 and 2017, matched glaucoma applicants were more likely to have graduated from a top 10 residency program (10.7% vs. 4.5%, P < 0.001), U.S. medical school (93.1% vs. 39.1%, P < 0.001), or U.S. residency program (95.0% vs. 42.2%, P < 0.001), and complete more interviews (9 vs. 1, P < 0.001). After controlling for potential covariates, factors associated with increased odds of matching in glaucoma included graduating from a U.S. residency program (odds ratio [OR], 9.91; 95% confidence interval [CI], 5.45-18.03), applying to fewer programs (OR, 0.91; 95% CI, 0.88-0.93), and completing a greater number of interviews (OR, 1.49; CI, 1.39-1.60). United States Medical Licensing Examination (USMLE) Step scores were not associated with matching in glaucoma. CONCLUSIONS: The number of applicants who matched in glaucoma fellowship increased from 2010 to 2019. Factors associated with matching in glaucoma were graduating from a U.S. residency program and completing more interviews.

Gender Representation Among Presenters in Ophthalmology Subspecialties in 2019: A Retrospective Review.

PURPOSE: To describe gender representation at 8 national ophthalmology conferences, stratified by role, session category, and subspecialty. DESIGN: Retrospective cross-sectional study. METHODS: Data were examined on 3817 presenters at the 2019 American Academy of Ophthalmology subspecialty days, American Society of Cataract and Refractive Surgery, American Glaucoma Society, American Society of Retina Specialists, American Society of Ophthalmic Plastic and Reconstructive Surgery, American Association for Pediatric Ophthalmology and Strabismus, North American Neuro-Ophthalmology Society, and American Uveitis Society meetings. The main outcome measure was the gender of presenters in 7 subspecialties, stratified by category and role. RESULTS: The proportion of female presenters was less than the American Board of Ophthalmology (ABO)-estimated proportion of women in their respective fields in glaucoma (28.0% vs 39.8%), neuro-ophthalmology (35.3% vs 45.3%), and pediatrics (42.1% vs 53.3%) and greater than expected in retina (24.6% vs 19.8%). Overall, the proportion of female presenters exceeded the ABO-estimated proportion of women in ophthalmology (24.5%) for clinical (mean = 38.5%, 95% CI [35.8%, 41.4%]) and scientific (39.4% [30.3%, 49.2%]) sessions. For clinical subspecialty sessions, the proportion of female leaders exceeded the overall proportion of female leaders in the respective subspecialty in cornea (35.1% [30.4%, 40.1%] vs 24.6% all sessions). Females represented fewer than the expected number of surgical session leaders in cornea (22.0% [19.9%, 24.3%]), glaucoma (18.0% [13.2%, 24.1%]), pediatrics (22.0% [14.4%, 32.1%]), and retina (18.6% [14.2%, 24.1%]). CONCLUSIONS: Gender representation varied, with fewer than expected female presenters in glaucoma, neuro-ophthalmology, and pediatrics. Women led relatively more clinical sessions but were underrepresented in surgical sessions in most subspecialties.

COBALT: Supporting the mental well-being of the health care workforce with technology-facilitated care during Covid-19 and beyond.

Two-thirds of health professionals facing the clinical demands of responding to the Covid-19 pandemic experience psychiatric symptoms, including post-traumatic stress, anxiety, substance use, depression, insomnia, and suicide.1,2 Compounding matters, access to mental health services is poor, quality is variable, and stigma is prevalent. COBALT, a digital mental health and wellness platform developed at Penn Medicine, was designed to support health care workers, offering a combination of self-directed resources, virtual group sessions, and individual appointments with a stepped care model of providers, including peers, resilience coaches, psychotherapists, and psychiatrists. In COBALT's first 11 months, the platform saw approximately 10,000 users, 200,000 page views, 1,400 one-on-one appointment bookings, over 1,000 group appointment reservations, and 158 interceptions of employees contemplating self-harm. COBALT reveals the unmet demand for mental health support among health professionals and provides a model for both expanding the supply of and streamlining access to services.

Applicant Characteristics Associated with Retina Fellowship Match from 2010-2019.

OBJECTIVE: To describe trends in the surgical and medical retina fellowship match and applicant characteristics associated with matching in retina fellowship. DESIGN: Retrospective study. SUBJECTS: Ophthalmology fellowship applicants who applied through the San Francisco (SF) Match. METHODS: Publicly available SF Match data were used to describe trends in the number of programs participating and positions offered, filled, and left vacant in the retina fellowship match from 2014 to 2019. Deidentified applicant data for match cycles from 2010 to 2017 were stratified by match status, and characteristics were compared across groups. Trends in matched applicant characteristics were evaluated using linear regression on log-transformed variables. Multivariable logistic regression was used to determine applicant characteristics that were associated with a successful match. MAIN OUTCOME MEASURES: Match status. RESULTS: From 2014 to 2019, the number of programs participating, positions filled, and positions left vacant in the retina fellowship match increased from 101 to 119 (P = 0.010), 118 to 123 (P = 0.078), and 18 to 37 (P = 0.045), respectively. Compared with unmatched applicants, matched applicants were more likely to have graduated from a top 10 residency program, US residency, or medical school; hold a United States (US) visa (J-1, H-1B, or O1); distribute more applications; complete more interviews; rank more programs; and score higher on the United States Medical Licensing Examination (USMLE) Step examinations 1-3. Matched applicants completed a median of 10 interviews. After controlling for potential covariates, graduating from a US residency (odds ratio [OR], 2.08; 95% confidence interval [CI], 1.48-2.92), a top 10 residency (OR, 1.74; 95% CI, 1.07-2.84), having an allopathic medical degree (MD; OR, 2.39; 95% CI, 1.08-5.33), completing more interviews (OR, 1.28; 95% CI, 1.23-1.33), and scoring higher on USMLE Step 3 (OR, 1.01; 95% CI, 1.01-1.03) were associated with matching into a retina fellowship. CONCLUSIONS: Although the number of programs participating and positions offered in the retina fellowship match are increasing, the number of positions filled remained relatively stagnant. Factors associated with matching in both medical and surgical retina included graduating from a US and top 10-ranked residency program, having an MD, completing more interviews, and scoring higher on USMLE Step 3.

Trends in Cornea Fellowship Applications and Applicant Characteristics: A San Francisco Match Analysis.

Purpose We investigate trends in cornea fellowship positions filled over time and applicant characteristics associated with matching into cornea fellowship. Methods Characteristics of cornea fellowship applicants were assessed using deidentified 2010 to 2017 San Francisco (SF) Match data. Publicly available SF Match cornea fellowship data including the number of participating programs, number of positions offered, number of positions filled, percentage of positions filled, and number of vacancies from 2014 to 2019 were also analyzed as data from 2010 to 2013 were unavailable. Results From 2014 to 2019, the number of cornea fellowship programs increased by 11.3% (mean 2.3% per year, p = 0.006) and the number of positions offered increased by 7.7% (mean 1.4% per year, p = 0.065). Of 1,390 applicants from 2010 to 2017, 589 (42.4%) matched into cornea. After controlling for potential covariates, graduation from a U.S residency program (odds ratio [OR]: 6.15, 95% confidence interval [CI]: 4.05-9.35, p < 0.001) and a greater number of interviews completed (OR: 1.35, 95% CI: 1.29-1.42, p < 0.001) were associated with increased odds of cornea fellowship match. A greater number of applied programs (OR: 0.97, 95% CI: 0.95-0.98, p < 0.001) was associated with decreased odds of matching into cornea fellowship. The proportion of applicants matching into cornea fellowship increased until 30 applications. Conclusions The number of cornea fellowship programs and positions increased from 2014 to 2019. Graduation from a U.S residency program and a greater number of interviews completed were associated with an increased likelihood of cornea fellowship match. Unlike applying to any ophthalmology subspecialty fellowship, applying to greater than 30 cornea fellowship programs was associated with decreased odds of matching.