Educators' consideration of learner motivation in ophthalmology education in medical school: Influences on teaching practice and course design.

BACKGROUND: Ophthalmology education in medical school has historically neglected the impact of autonomous motivation on student learning and wellbeing. This study aimed to understand ophthalmology educators' consideration and application of student motivation in ophthalmology medical education. MATERIAL AND METHODS: Lead ophthalmology educators from Australian and New Zealand medical schools participated in an online semi-structured in-depth interview. Interview transcripts were analysed using thematic analysis. Codes were generated and aligned into overarching themes. FINDINGS: Six educators participated in the study. Five main themes arose from the transcripts: the lack of explicit consideration of student motivation, implicit consideration of motivation in curriculum design and in teaching practices, the impact of innovation on motivation and the relationship between teacher and student motivation. Participants also commented on trends in ophthalmology education including generalists' confidence in managing ophthalmic disease, the role of fundoscopy in medical education and time pressure on ophthalmology in medical schools. CONCLUSION: There has only been an implicit instead of explicit consideration of motivation in ophthalmology education in medical school, which leaves an unfulfilled potential for teaching practices to impact the affective along with cognitive and metacognitive aspects of learning. This study highlights the need for motivation to be explicitly incorporated into the development of teaching practices and curriculum reform.

Long-term limitations and complications of trans-scleral diode laser cycloablation for refractory glaucoma.

BACKGROUND: Trans-scleral diode laser cycloablation (cyclodiode) is effective in the short-term management of refractory glaucoma where alternative treatments are not feasible. Long-term outcomes of 5-years or more are not well-documented, particularly in relation to intraocular pressure (IOP) control, need for further procedures and complications such as hypotony and phthisis. METHODS: A review was undertaken of patient medical records with refractory glaucoma who underwent cyclodiode at City Eye Centre in Brisbane from 2012 to 2016. Data included sex, age, laterality, type of glaucoma, cyclodiode parameters, number of glaucoma medications, visual acuity and treatment with acetazolamide. Data were analysed using generalised linear modelling and Kaplan-Meier analysis. RESULTS: A total of 54 eyes in 54 patients (29 M:25F) with a mean age of 66 years (range 15-85 years) with a minimum of 5 years follow up were included. The mean number of burns was 23.3 (range 12-40) over 180-270 degrees, mean power per burn was 1967 mW (range 1500-2000 mW), with a mean duration of 1981 ms (1500-2000 ms). The mean pre-treatment IOP was 31.5 mmHg (range 17-56 mmHg) and mean IOP 5 years post-treatment was 16.1 mmHg (2-42 mmHg). The mean number of pre-treatment medications was 3.6 (range 1-6) and 2.7 (range 0-5) 5 years post treatment, including 5 (8.3%) on oral acetazolamide. Complications of cyclodiode were seen in 6 (11.1%) patients, including 3 (5.0%) cases of hypotony, and 2 (3.3%) phthisis. CONCLUSION: Cyclodiode is often utilised for end-stage glaucoma when the IOP is uncontrolled on medical treatment and drainage surgery is not indicated, resulting in long-term reduction of IOP and the number of medications, including acetazolamide. Hypotony and phthisis can be significant complications.

Ophthalmology teaching in Australian medical schools: A national survey.

PURPOSE: To survey the current educational trends and methods of ophthalmology teaching in Australian undergraduate and postgraduate medical schools. MATERIALS AND METHODS: Cross-sectional survey; National online survey distributed to Australian university undergraduate and post-graduate medical schools from November 2020 to March 2021. The survey encompassed 35 questions on student demographics, teaching methods, core theoretical topics, clinical skills, and assessment methods in ophthalmology. One survey per institution completed by the relevant individual responsible for curriculum. RESULTS: Total response rate of 90.48% (19 of 21 medical schools) was received with good representation across Australia. Ophthalmology rotations were required in 63.3% (n = 12), while 36.7% (n = 7) did not have mandatory terms. This compares favourably to the USA (16%), Canada (35.7%) and equivalent to UK (65%). 74% (n = 14) state ophthalmology is not a priority in the curriculum. All respondents reported student exposure to at least one clinical day in ophthalmology, with total teaching time ranging from less than six hours (36.9%), up to greater than two weeks (10.5%). Overall, only 31.6% reported utilisation of the International Council of Ophthalmology (ICO) curriculum in curricular development. CONCLUSIONS: Ophthalmology medical school teaching in Australia remains reasonable when compared internationally, but there is significant variation amongst universities. Incorporation of the ICO curriculum and development of shared resources would enhance medical graduates' competence.