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1.
Eur J Ophthalmol ; 30(1): 81-87, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30426767

RESUMO

INTRODUCTION: To evaluate the adverse event rate following pars plana vitrectomy as a function of surgical start time and the presence of a vitreoretinal fellow. METHODS: Single-institution retrospective cohort study of patients undergoing pars plana vitrectomy from 1 January 2016 to 31 December 2016 at Stanford University School of Medicine (Palo Alto, CA, USA). Records were reviewed for surgical start time, the presence of vitreoretinal fellow, and postoperative adverse events defined as any finding deviating from the expected postoperative course requiring observation or intervention. RESULTS: A total of 310 pars plana vitrectomies were performed. There was no statistical difference in the rate of any adverse event when comparing cases starting after 16:01 (9/13, 69.2%) and after 12:01 (42/99, 42.4%) to a morning start time (69/198, 34.9%, adjusted p = 0.083). There was a statistically significant increase in the risk of postoperative vitreous hemorrhage with afternoon and evening cases as compared to morning cases (adjusted p = 0.021). In addition, there was no difference in any adverse event with a fellow present (93/244, 38.1%) compared to without (27/66, 40.9%, adjusted p = 0.163). There was a higher risk of postoperative hypotony when a fellow was involved (6.6% vs 0%, p = 0.028), though this difference disappeared after adjusting for confounders (adjusted p = 0.252). There was no difference in the length of surgery with and without a fellow (49 vs 54 min, respectively; p = 0.990). DISCUSSION: Afternoon start time and the presence of a fellow were not independent risk factors for postoperative adverse events.


Assuntos
Competência Clínica , Bolsas de Estudo , Duração da Cirurgia , Oftalmologia/educação , Complicações Pós-Operatórias , Doenças Retinianas/cirurgia , Vitrectomia/efeitos adversos , Idoso , Educação de Pós-Graduação em Medicina , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acuidade Visual/fisiologia
3.
J Pediatr Ophthalmol Strabismus ; 56(5): 282-287, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31545861

RESUMO

PURPOSE: To characterize retinopathy of prematurity (ROP) training practices in international residency and fellowship programs. METHODS: A publicly available online-based platform (http://www.SurveyMonkey.com) was used to develop a 28-question multiple-choice survey that targeted ROP screening and treatment methods. The authors solicited training programs in the Philippines, Thailand, and Taiwan. RESULTS: Programs from three countries participated in the survey, and a total of 95 responses collected from residents, fellows, and attending ophthalmologists were analyzed. A descriptive analysis demonstrated that 45 participants (47%) reported 1% to 33% of ROP screenings were performed under direct supervision of attending ophthalmologists, and 35 (37%) reported the use of formal assessments. The majority of participants (Country A: 87%, Country B: 71%, and Country C: 75%) estimated 1% to 33% of their practice was spent screening for ROP. Notably, 44 participants (46%) reported performing zero laser photocoagulation treatments for ROP during training (Country A: 65%, Country B: 38%, and Country C: 38%). CONCLUSIONS: International ophthalmology trainees perform a limited number of ROP examinations and laser interventions. ROP screenings are often unsupervised and lead to no formal evaluation by an attending ophthalmologist. Limited ROP training among ophthalmologists may lead to misdiagnosis and ultimately mismanagement of a patient. Loss of vision and exposure to unwarranted treatments are among the implications of such errors. The findings highlight the need to improve ROP training in international ophthalmology residency and fellowship programs. [J Pediatr Ophthalmol Strabismus. 2019;56(5):282-287.].


Assuntos
Competência Clínica , Educação de Pós-Graduação em Medicina/métodos , Internet , Internato e Residência/métodos , Oftalmologia/educação , Humanos , Filipinas , Retinopatia da Prematuridade/diagnóstico , Taiwan , Tailândia
4.
Indian J Ophthalmol ; 67(9): 1455-1458, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31436191

RESUMO

Purpose: The sub-retinal injections are not very commonly performed procedures in vitreoretina, but form a crucial step in any cell replacement therapy for retinal diseases. The purpose of this study is to describe the learning curve of a trained vitreo-retinal surgeon in sub-retinal injections in a rat model and its implications in future clinical trials. Methods: This is an in-vivo retrospective animal study using Wistar rats. All ARVO guidelines regarding animal handling were followed. After anesthetization, aspectic preparation and dilating the pupils with 1% tropicamide eye drops, subretinal injection of 10 µl saline was done via a limbal entry. Data recorded included time taken for the procedure, success of injection, associated complications, post-operative infections and complications. The rats were followed up for 1 month post procedure. A trend analysis was done for the above factors to look for improvement in ease of procedure, reduction in procedure time and reduction in complications for the clinician using a novel objective scale. Results: About 20 eyes were studied. Mean weight of the rats was 188 ± 12.82 gram. Mean time taken for the procedure was 14.1 ± 5.07 minutes. There was a significant inverse co-relation between the serial number of the eye and time taken for the procedure (r = -0.89, P < 0.0001). Comparative complications noted between the first ten and the last ten eyes were: conjunctival tear 30% versus 10% (P = 0.27), lens touch 50% versus 10% (P = 0.05), subretinal hemorrhage 40% versus 0% (P = 0.13), vitreous loss 30% versus 0% (P = 0.06). The successful subretinal injection without intraocular complications was achieved in 40% versus 90% (P = 0.02). There was a significant co-relation between the serial number of the eye and ease of the procedure (r = 0.87, P < 0.0001). Post operatively none of the eyes had any infection. Six eyes (12%) developed cataract and 3 eyes (6%) had non-resolving retinal detachment at the last examination visit. Conclusion: Subretinal injections in rats have a definite learning curve even for a trained vitreoretinal surgeon. This should be accounted for and resources allocated accordingly to achieve good technical comfort and negate confounding by the surgeon factor in the results of future clinical trials.


Assuntos
Educação de Pós-Graduação em Medicina/métodos , Curva de Aprendizado , Oftalmologia/educação , Hemorragia Retiniana/cirurgia , Cirurgiões/educação , Gravação em Vídeo , Animais , Modelos Animais de Doenças , Humanos , Injeções , Ratos , Ratos Wistar , Hemorragia Retiniana/tratamento farmacológico , Estudos Retrospectivos
5.
Indian J Ophthalmol ; 67(9): 1460-1462, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31436193

RESUMO

Recording surgical procedures is of value for teaching and training in residency and fellowship programs. Operating external ophthalmic surgeries is not as easy as recording intraocular surgeries. In this communication, we describe the use of a video recorder mounted on a flexible tripod (Gorillapod®), a commonly available photography accessory; which is fixed to an IV fluid stand. This set up was used to record external ophthalmic surgeries and the recorded videos were of high quality in terms of stability and required no change in surgical technique to ensure that the area of interest was in focus. In our experience, early results show that a flexible tripod offers an economical mount for recording external surgeries with reproducible results.


Assuntos
Educação de Pós-Graduação em Medicina/métodos , Internato e Residência , Procedimentos Cirúrgicos Oftalmológicos/educação , Oftalmologia/educação , Procedimentos Cirúrgicos Reconstrutivos/educação , Gravação em Vídeo/instrumentação , Desenho de Equipamento , Humanos
6.
Indian J Ophthalmol ; 67(8): 1327-1328, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31332123

RESUMO

Buckling surgery is one of the common procedures performed by the retinal surgeons for visual rehabilitation at the earliest in cases of retinal detachment. The optimal surgical skill in this section can only be achieved with repeated practices and clinical experiences. Here, we describe an easy and inexpensive way to perform, practice, and refine surgical skills by demonstrating this complicated surgery in a simple manner on goat's eyes. The advantages of this technique are real-tissue handling experiences and repeatability of the procedure with almost similar practical implications. Thus, whenever feasible, every attempt should be made to refine the residents or budding ophthalmologists surgical skills by undertaking this technique in their routine curriculum.


Assuntos
Competência Clínica , Modelos Animais de Doenças , Internato e Residência , Oftalmologia/educação , Descolamento Retiniano/cirurgia , Recurvamento da Esclera/educação , Animais , Cabras , Recurvamento da Esclera/métodos
7.
Healthc Q ; 22(1): 6-10, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31244461

RESUMO

Cataract surgery is the most common operation performed in most developed countries, including Canada. Nuanced, evidence-driven policies are needed to ensure appropriate access to this sight-saving operation while maintaining the highest standards in quality of care. The Vision Health Services Research Program at Queen's University, in partnership with members of the Ontario Provincial Vision Task Force, has developed evidence to inform policies aimed at optimizing both access and quality across the eye care spectrum.


Assuntos
Extração de Catarata/normas , Cirurgiões/provisão & distribução , Mobilidade Ocupacional , Extração de Catarata/efeitos adversos , Extração de Catarata/estatística & dados numéricos , Política de Saúde , Humanos , Ontário , Salas Cirúrgicas/provisão & distribução , Oftalmologia/educação , Oftalmologia/normas , Complicações Pós-Operatórias/epidemiologia
8.
BMC Med Educ ; 19(1): 201, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196068

RESUMO

BACKGROUND: Direct ophthalmoscopy (DO) is an essential skill for medical graduates but there are multiple barriers to learning this. Medical students and junior doctors typically lack confidence in DO. Most students do not own an ophthalmoscope and learn via ward devices that vary in design and usability. The Arclight ophthalmoscope (AO) is an easy to use, low-cost and portable device that could help address device access. This study aimed to assess the impact of personal ownership of an AO on DO skill acquisition and competency amongst medical students in the clinical environment. METHODS: Method comparison study with 42 medical students randomised to either traditional device ophthalmoscope (TDO) control or AO intervention group during an 18-week medical placement. Three objective assessments of DO competency were performed at the beginning and end of the placement: vertical cup to disc ratio (VCDR) measurement, fundus photo multiple-choice questions (F-MCQ) and model slide examination (MSE). DO examinations performed during the placement were recorded via an electronic logbook. RESULTS: Students in both groups recorded a median number of six examinations each during an eighteen-week placement. There was no statistically significant difference between the groups in any of the objective assessment measures (VCDR p = 0.561, MCQ p = 0.872, Model p = 0.772). Both groups demonstrated a minor improvement in VCDR measurement but a negative performance change in F-MCQ and MSE assessments. CONCLUSIONS: Students do not practice ophthalmoscopy often, even with constant access to their own portable device. The lack of significant difference between the groups suggests that device access alone is not the major factor affecting frequency of DO performance and consequent skill acquisition. Improving student engagement with ophthalmoscopy will require a more wide-ranging approach.


Assuntos
Competência Clínica , Educação de Graduação em Medicina , Oftalmologia/educação , Oftalmoscópios , Avaliação Educacional , Feminino , Humanos , Masculino
9.
BMC Med Educ ; 19(1): 202, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31196084

RESUMO

BACKGROUND: A balance between autonomy and supervision can be difficult to obtain in medical education. In this study, we sought to determine whether the presence and level of supervision of ophthalmology resident outpatient clinic correlates with metrics of resident success, professionalism and stress. METHODS: A survey was emailed to all US ophthalmology program directors requesting it be forwarded to PGY4 residents. Questions included whether their program provided a resident-hosted outpatient clinic, and if so, whether residents were mandated to discuss every patient with faculty. Residents were assigned to three categories based on this question (0: no clinic, 1: mandated faculty input, 2: discretionary faculty input). Success metrics included numbers of manuscripts submitted, OKAP scores and success in obtaining fellowships. Professionalism metrics included rating comfort obtaining informed consent, breaking bad news, managing time in clinic, and confidence in providing care in various settings. Residents affirming participation in a continuity clinic also provided perceptions of the level of supervision and how the clinic affected stress. RESULTS: Category 1 residents perceived somewhat too much supervision, while category 2 residents felt that they had somewhat insufficient supervision. The majority of residents in either category did not feel that the continuity clinic affected their overall stress, although those who reported a change in stress usually indicated that the presence of the clinic increased stress. There were no other statistically significant differences between the responses from any category. CONCLUSIONS: The presence of a resident-hosted continuity clinic neither adds nor detracts from the success or sense of professionalism of ophthalmology residents. However, when such a clinic is present, the degree of supervision appears to correlate inversely with resident perception of autonomy. These results suggest that the decision of a training program to offer a clinic hosted by residents offering comprehensive continuity care can be informed primarily by faculty and trainee philosophy and personal preferences without comprising education quality, clinical efficiency, residents' perception of stress or their success in fellowship matching.


Assuntos
Instituições de Assistência Ambulatorial , Internato e Residência/organização & administração , Oftalmologia/educação , Autonomia Profissional , Humanos , Inquéritos e Questionários
10.
Asia Pac J Ophthalmol (Phila) ; 8(3): 264-272, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31149787

RESUMO

The lifestyle of modern society has changed significantly with the emergence of artificial intelligence (AI), machine learning (ML), and deep learning (DL) technologies in recent years. Artificial intelligence is a multidimensional technology with various components such as advanced algorithms, ML and DL. Together, AI, ML, and DL are expected to provide automated devices to ophthalmologists for early diagnosis and timely treatment of ocular disorders in the near future. In fact, AI, ML, and DL have been used in ophthalmic setting to validate the diagnosis of diseases, read images, perform corneal topographic mapping and intraocular lens calculations. Diabetic retinopathy (DR), age-related macular degeneration (AMD), and glaucoma are the 3 most common causes of irreversible blindness on a global scale. Ophthalmic imaging provides a way to diagnose and objectively detect the progression of a number of pathologies including DR, AMD, glaucoma, and other ophthalmic disorders. There are 2 methods of imaging used as diagnostic methods in ophthalmic practice: fundus digital photography and optical coherence tomography (OCT). Of note, OCT has become the most widely used imaging modality in ophthalmology settings in the developed world. Changes in population demographics and lifestyle, extension of average lifespan, and the changing pattern of chronic diseases such as obesity, diabetes, DR, AMD, and glaucoma create a rising demand for such images. Furthermore, the limitation of availability of retina specialists and trained human graders is a major problem in many countries. Consequently, given the current population growth trends, it is inevitable that analyzing such images is time-consuming, costly, and prone to human error. Therefore, the detection and treatment of DR, AMD, glaucoma, and other ophthalmic disorders through unmanned automated applications system in the near future will be inevitable. We provide an overview of the potential impact of the current AI, ML, and DL methods and their applications on the early detection and treatment of DR, AMD, glaucoma, and other ophthalmic diseases.


Assuntos
Algoritmos , Inteligência Artificial , Aprendizado Profundo , Técnicas de Diagnóstico Oftalmológico , Oftalmopatias/diagnóstico , Aprendizado de Máquina , Oftalmologia/educação , Humanos
11.
BMC Med Educ ; 19(1): 190, 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31174525

RESUMO

BACKGROUND: To determine which resident and program characteristics correlate with ophthalmic knowledge, as assessed by resident Ophthalmic Knowledge Assessment Program (OKAP) performance. METHODS: An online survey was sent in June 2017 to all US ophthalmology residents who took the OKAP in April 2017. RESULTS: The survey response rate was 13.8% (192/1387 residents). The mean respondent age was 30.4 years, and 57.3% were male. The mean [SD] self-reported 2017 OKAP percentile was 61.9 [26.7]. OKAP performance was found to have a significant positive correlation with greater number of hours spent/week studying for the OKAPs (p = 0.007), with use of online question banks (p < 0.001), with review sessions and/or lectures arranged by residency programs (p < 0.001), and with OKAP-specific didactics (p = 0.002). On multivariable analysis, factors most predictive of residents scoring ≥75th percentile were, higher step 1 scores (OR = 2.48, [95% CI: 1.68-3.64, p < 0.001]), presence of incentives (OR = 2.75, [95% CI: 1.16-6.56, p = 0.022]), greater number of hours/week spent studying (OR = 1.09, [95% CI:1.01-1.17, p = 0.026]) and fewer hours spent in research 3 months prior to examination (OR = 1.08, [95% CI: 1.01-1.15, p = 0.020]. Lastly, residents less likely to depend on group study sessions as a learning method tended to score higher (OR = 3.40, [95% CI: 1.16-9.94, p = 0.026]). CONCLUSIONS: Programs wishing to improve resident OKAP scores might consider offering incentives, providing effective access to learning content e.g. online question banks, and adjusting the curriculum to highlight OKAP material. Step 1 scores may help educators identify residents who might be at risk of not performing as well on the OKAP.


Assuntos
Avaliação Educacional , Internato e Residência/estatística & dados numéricos , Oftalmologia/educação , Adulto , Avaliação Educacional/métodos , Feminino , Humanos , Internato e Residência/métodos , Masculino , Inquéritos e Questionários
14.
Arq Bras Oftalmol ; 82(4): 289-294, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30970123

RESUMO

PURPOSE: To evaluate whether training medical residents with the Eyesi® cataract surgery simulator reduces the occurrence of intraoperative complications. METHODS: This was a retrospective study in which the first 10 phacoemulsification surgeries performed by two groups of second-year ophthalmology residents were evaluated, during 2014 and 2015. The first Group consisted of seven residents from 2014 who had not had previous training with the simulator. The second Group was formed of seven residents in 2015, who had completed the C-level (intermediate) training with the simulator before beginning surgery on patients. We then compared these two groups regarding the frequency of occurrence of the four main intraoperative surgical complications: posterior capsule rupture, aphakia, and nucleus fragment dislocation into the vitreous, and extracapsular conversion. RESULTS: A total of 140 surgeries were performed, 70 by Group 1 and 70 by Group 2. The total number of complications was 19 (27.14%) in Group 1 and nine (12.86%) in Group 2, and this reduction was significant (p=0.031). Fourteen (20%) surgeries in Group 1 and seven (10%) in Group 2 had complications. The complications were 13 posterior capsule ruptures (18.57%) in Group 1 and seven (10%) in Group 2; three eyes had nucleus fragment dislocations (4.29%) in Group 1, but only one (1.43%) in Group 2; two extracapsular conversions (2.86%) occurred in Group 1 and one (1.43%) in Group 2; and there was one aphakia (1.43%) in Group 1. CONCLUSIONS: The training with the Eyesi® cataract surgery simulator significantly reduced the total number of intraoperative complications in the first 10 phacoemulsification cataract surgeries performed by ophthalmology residents.


Assuntos
Complicações Intraoperatórias/prevenção & controle , Corpo Clínico Hospitalar/educação , Facoemulsificação/efeitos adversos , Facoemulsificação/educação , Treinamento por Simulação/métodos , Humanos , Internato e Residência/métodos , Oftalmologia/educação , Reprodutibilidade dos Testes , Estudos Retrospectivos , Resultado do Tratamento
15.
BMC Ophthalmol ; 19(1): 90, 2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30975112

RESUMO

BACKGROUND: The purpose of this study was to perform a systematic review of the current literature on simulator-based training in vitreoretinal surgery (VRS). We examined the results regarding simulated VRS and provided an overview of how the current results may be employed in VRS training. Lastly, we evaluated the quality of these results. METHODS: The databases of Pubmed, Embase and Cochrane Library were searched for articles in English involving simulated VRS training. A qualitative analysis was performed, since the studies which met our inclusion criteria did not allow for a quantitative meta-analysis. RESULTS: We identified 203 articles of which seven met the inclusion criteria. Of these, six studies investigated simulation with EyeSi® Surgical (VRMagic, Mannheim, Germany). Six studies reported positive performance curves. Four studies showed construct validity. One study attempted to show skill transfer from simulator to vitrectomies performed on cadavers. Methodological quality of the included studies was moderate but lacking in instrument validation. CONCLUSION: Simulator-based training in VRS can assess and possibly assist acquisition of a variety of VRS skills. Further research is needed to support transfer from simulator to operating room. Future studies should strive to follow established validation frameworks and streamline study designs.


Assuntos
Competência Clínica , Educação de Pós-Graduação em Medicina/métodos , Internato e Residência , Oftalmologia/educação , Treinamento por Simulação/métodos , Cirurgia Vitreorretiniana/educação , Humanos , Doenças Retinianas/cirurgia
16.
Can J Ophthalmol ; 54(2): 150-154, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30975335

RESUMO

OBJECTIVE: Clerkship at the University of British Columbia (UBC) Medical School encompasses a variety of models: traditional rotation-based clerkship; distributed rotation-based clerkship at sites across the province; and a longitudinal integrated community clerkship. The purpose of this study was to: (i) Evaluate the undergraduate ophthalmology clerkship experience at UBC to compare outcomes and experiences across the various sites and models; and (ii) Apply educational theories to evaluation outcomes in order to improve curriculum design for clerkship programs. DESIGN: Cross-sectional evaluation of the ophthalmology clerkship program at UBC. METHODS: Using a logic model, we identified inputs, activities, and outputs of the ophthalmology clerkship experience at each site at UBC. Site directors and administrators were contacted for information regarding program curriculum and delivery, and outcomes were described using written exam and clinical assessment scores as well as student and instructor feedback (questionnaires with narrative responses). RESULTS: Site directors and administrators from all clerkship sites participated in the study. Clerkship experiences across all sites (rotation-based and integrated community clerkship) were found to be unique in contexts and clinical activities. There were no significant differences noted between outcomes in the rotation-based sites. CONCLUSION: Clerkship experiences can be delivered in various contexts and through varied clinical settings, yet provide an equivalent student learning experience. As longitudinal and distributed clerkship models gain traction in medical education around the world, there are lessons for undergraduate medical education both in ophthalmology and in other areas.


Assuntos
Estágio Clínico/organização & administração , Competência Clínica , Currículo , Educação de Graduação em Medicina/métodos , Oftalmologia/educação , Avaliação de Programas e Projetos de Saúde , Universidades , Colúmbia Britânica , Estudos Transversais , Avaliação Educacional , Humanos
17.
Can J Ophthalmol ; 54(2): 155-158, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30975336

RESUMO

OBJECTIVE: The Royal College of Physicians and Surgeons of Canada has mandated a shift in post-graduate residency education in Canada towards a competency-based model. Within this context, it is unclear how resident's competence in cataract surgery is currently being assessed for both formative and summative purposes. Therefore, we conducted a national survey to evaluate the current landscape of cataract surgery teaching in Canadian Ophthalmology programs. METHODS: The opportunity to participate in an online survey was extended to all Canadian ophthalmology program directors and residents. Between July and September 2017, data was collected on demographics (name of program, levels of training), current framework of assessment, and any other contexts for cataract surgery assessments being used (e.g., wetlabs or surgical simulators). RESULTS: We had a total of 32 responses including 7 program directors (22%), 14 senior residents (44%), and 10 junior residents (34%). The assessments used varied greatly; none of the residency programs used a published assessment tool for assessing skill in cataract surgery. The majority of programs (9 of 11; 82%) used locally-designed assessments and two programs (18%) did not use any standardized forms or tools. All schools were using a wet lab to augment surgical teaching and simulators were being used by 5 of 11 programs (45%). CONCLUSION: There are a variety of approaches being used to assess competence in cataract surgery. Many programs share some similarities, and a framework for designing assessment is suggested to guide future efforts at competency-based training and assessment.


Assuntos
Extração de Catarata/educação , Competência Clínica , Currículo , Educação de Pós-Graduação em Medicina/métodos , Internato e Residência/métodos , Oftalmologia/educação , Ensino/organização & administração , Canadá , Humanos , Inquéritos e Questionários
18.
Can J Ophthalmol ; 54(2): 159-163, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30975337

RESUMO

OBJECTIVE: To characterize changes in body positioning while performing a standardized slit lamp examination after exposure to an educational module on ergonomics. DESIGN: Prospective interventional pilot study. PARTICIPANTS: Ten ophthalmology residents. METHODS: An educational module discussing ergonomic issues in ophthalmology was created. In a standardized examination lane, participants were recorded performing 3 trials of an indirect slit lamp examination of a volunteer patient, adjusting equipment as they saw fit. Participants were then sent the module and within 2 weeks repeated the trial process. Data were processed using biomechanical software to obtain the Rapid Upper Limb Assessment (RULA) injury risk score, elbow and shoulder joint reaction moments, neck and trunk flexion angles, and spinal curvature magnitudes. RESULTS: The RULA injury risk scores decreased after completion of the module (95% CI 2.10-2.77), indicating a lesser risk for injury to the resident. Shoulder flexion and elbow abduction moments also decreased (95% CI -3.2 to -1.5 and -0.44 to -0.04, respectively), suggesting a more neutral body posture. The trunk flexion angle increased after completion of the module (95% CI -5.1 to -1.6), signifying a more upright trunk posture; this was confirmed by the lumbar spine curvature, which flattened postmodule (95% CI 6.6-940). CONCLUSIONS: These results suggest a promising ability for an educational module to mitigate some injury risk in this population during indirect slit lamp examination. It also delineated some awkward postures that persisted despite the module. These results will be reintegrated into the module to optimize its educational utility.


Assuntos
Educação de Pós-Graduação em Medicina , Ergonomia/métodos , Internato e Residência , Doenças Profissionais/prevenção & controle , Oftalmologia/educação , Postura/fisiologia , Microscopia com Lâmpada de Fenda/normas , Feminino , Humanos , Masculino , Doenças Profissionais/etiologia , Exposição Ocupacional/prevenção & controle , Projetos Piloto , Estudos Prospectivos
19.
J Pediatr Ophthalmol Strabismus ; 56(2): 83-87, 2019 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-30889261

RESUMO

PURPOSE: To compare intraoperative technique and quality of surgical steps in pediatric cataract surgery between pediatric ophthalmology consultants and fellows in training. METHODS: In a video-based analysis by two fellowship-trained pediatric ophthalmologists, 42 surgical videos of pediatric ophthalmology consultants and 34 videos of fellows in training were graded based on the International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubrics (ICO-OSCAR). Six steps in surgery were analyzed: wound construction, anterior continuous curvilinear capsulorrhexis, irrigation and aspiration, intraocular lens implantation, primary posterior capsulorrhexis with anterior vitrectomy, and wound suturing. Cohen's Kappa was used to rate inter-observer agreement. RESULTS: Cohen's Kappa scores ranged from 0.6 to 0.8. The median scores for surgical steps for both analyzed groups were similar. The mean duration of surgery was shorter for consultants (24 minutes, range: 10 to 45 minutes) than for fellows (40 minutes, range: 15 to 70 minutes). The median age of patients operated on by consultants was younger (24 months, range: 2 to 180 months) than fellows (58 months, range: 10 to 150 months). CONCLUSIONS: The quality of the surgical steps performed by pediatric ophthalmology consultants and fellows in training was similar. [J Pediatr Ophthalmol Strabismus. 2019;56(2):83-87.].


Assuntos
Extração de Catarata/métodos , Catarata/fisiopatologia , Competência Clínica , Consultores , Educação de Pós-Graduação em Medicina/métodos , Internato e Residência/métodos , Oftalmologia/educação , Extração de Catarata/educação , Pré-Escolar , Avaliação Educacional , Feminino , Humanos , Lactente , Masculino , Curva ROC , Acuidade Visual , Adulto Jovem
20.
J Vet Med Educ ; 46(4): 518-522, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30920947

RESUMO

Ophthalmoscopy is an important examination technique in the diagnosis of disease. Although it is difficult to learn, practice increases confidence and proficiency. Practicing ophthalmoscopy on live animals presents an additional level of complexity, so we sought to evaluate how students would respond to practicing ophthalmoscopy on an ocular fundus model. We constructed a simple and inexpensive model and allowed half of the students (49/100) in a first-year veterinary medicine class to practice ophthalmoscopy (direct, PanOptic, and indirect) for 20 minutes using the model. Students completed a questionnaire regarding ease of use, enjoyment, and recommendations for future use of the model immediately after the practice session. Six weeks later, we tested students' ability to correctly match a fundus to a photograph using indirect ophthalmoscopy. All students who used the model rated it as 'easy' or 'somewhat easy' to use. All students reported that they 'enjoyed' (93.9%) or 'somewhat enjoyed' (6.1%) using the model. Also, all students who used the model stated the models should continue to be used to aid student learning. Students who used the model were significantly more likely (p = .013) to correctly match a fundus photograph to the fundus being observed than students who had not used the model. These findings demonstrate that the model used in this study is well received by students and results in discernible gains in proficiency.


Assuntos
Educação em Veterinária , Oftalmologia , Estudantes de Medicina , Animais , Fundo de Olho , Humanos , Oftalmologia/educação , Oftalmoscopia , Ensino
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