Relationship between long-term visual function and the ratio of foveal avascular zone area in eyes with macular hole and healthy fellow eyes.

PURPOSE: This study is to investigate the relationship between long-term changes in the foveal avascular zone (FAZ) and visual function of eyes with macular hole (MH) and compare the relationship between the FAZ of MH eyes and fellow eyes. METHODS: This study included 31 patients with unilateral MH who underwent vitrectomy and their fellow eyes. Best-corrected visual acuity (BCVA) and metamorphopsia were measured preoperatively and at 1, 3, 6, and 12 months postoperatively. We evaluated retinal parameters using optical coherence tomography (OCT) and the superficial FAZ using OCT angiography. The FAZ ratio was defined as follows: (preoperative FAZ area of the MH eye)/(FAZ area of the fellow eye). RESULTS: The preoperative FAZ area of MH eyes was 0.42 ± 0.08 mm2, which decreased to 0.24 ± 0.07 mm2 1 month postoperatively (p < 0.001) and slightly increased to 0.25 ± 0.06 mm2 12 months postoperatively (p = 1.000). The FAZ area did not differ significantly from that of fellow eyes (0.39 ± 0.06 mm2, p = 0.281). The FAZ area of MH eyes was not associated with visual function at any time point. The FAZ ratio showed a correlation with the preoperative, 6-month, and 12-month BCVA (r = 0.604, p < 0.001; r = 0.510, p = 0.003; and r = 0.475, p = 0.007, respectively). CONCLUSIONS: A larger FAZ in the MH eye than that in the fellow eye is associated with poorer long-term visual acuity. The preoperative comparison of the FAZ of the MH eye with that of the fellow eye may be a biomarker for predicting long-term visual acuity.

Outcomes of oocyte retrievals completed by reproductive endocrinology and infertility fellows versus faculty: a 7-year retrospective review.

PURPOSE: To examine outcomes of oocyte retrievals completed by Reproductive Endocrinology and Infertility (REI) fellows versus faculty physicians. METHODS: This retrospective cohort study examined patients who underwent oocyte retrievals at Mayo Clinic from July 15, 2009, to December 15, 2016. The primary outcome was the oocyte retrieval rate (ORR) calculated per retrieval as the number of oocytes retrieved per follicles aspirated. The Wilcoxon signed-rank test was used to compare follicle and oocyte counts and ORR between fellows and faculty during the same bilateral retrieval. RESULTS: The study cohort included the first bilateral retrieval from 845 unique patients completed by 11 fellows and seven faculty. The median ORR was not statistically different for fellows and faculty (0.79 versus 0.80, p = 0.46). To assess for a learning curve, the outcomes of seven fellows who completed at least 80 retrievals in their first year were examined as four chronologically ordered sets of 20. When these sets were compared to the faculty physician mean ORR, no significant differences were found (p-values of 0.69, 0.69, 0.81, and 0.81, respectively). CONCLUSION: There were no significant differences in oocyte retrieval rates between fellows versus faculty over a 7-year period, with no significant learning curve observed. These findings suggest that fellows possess the requisite skills for successful oocyte retrieval upon entering REI fellowship following their OB/GYN residency. However, this does not diminish the critical role of comprehensive fellowship training and close supervision, especially in initial and complex cases.

The current state of training in pain medicine fellowships: An Association of Pain Program Directors (APPD) survey of program directors.

INTRODUCTION: The Accreditation Council for Graduate Medical Education (ACGME) approved the first pain medicine fellowship programs over three decades ago, designed around a pharmacological philosophy. Following that, there has been a rise in the transition of pain medicine education toward a multidisciplinary interventional model based on a tremendous surge of contemporaneous literature in these areas. This trend has created variability in clinical experience and education amongst accredited pain medicine programs with minimal literature evaluating the differences and commonalities in education and experience of different pain medicine fellowships through Program Director (PD) experiences. This study aims to gather insight from pain medicine fellowship program directors across the country to assess clinical and interventional training, providing valuable perspectives on the future of pain medicine education. METHODS: This study involved 56 PDs of ACGME-accredited pain fellowship programs in the United States. The recruitment process included three phases: advanced notification, invitation, and follow-up to maximize response rate. Participants completed a standard online questionnaire, covering various topics such as subcategory fields, online platforms for supplemental education, clinical experience, postgraduate practice success, and training adequacy. RESULTS: Surveys were completed by 39/56 (69%) standing members of the Association of Pain Program Directors (APPD). All PDs allowed fellows to participate in industry-related and professional society-related procedural workshops, with 59% encouraging these workshops. PDs emphasized the importance of integrity, professionalism, and diligence for long-term success. Fifty-four percent of PDs expressed the need for extension of fellowship training to avoid supplemental education by industry or pain/spine societies. CONCLUSION: This study highlights the challenge of providing adequate training in all Pain Medicine subtopics within a 12-month pain medicine fellowship. PDs suggest the need for additional training for fellows and discuss the importance of curriculum standardization.

Risk of Pseudophakic Cystoid Macular Edema in Fellow-Eye Cataract Surgeries: A Multicenter Database Study.

PURPOSE: To quantify the risk of pseudophakic cystoid macular edema (pCME) in fellow-eye cataract surgery and to determine risk factors, including prior first-eye pCME. DESIGN: Retrospective, clinical database study. PARTICIPANTS: Patients undergoing bilateral nonsimultaneous cataract surgeries in 8 UK National Health Service clinical centers between July 2003 and March 2015. METHODS: We excluded patients with a history of diabetic macular edema (DME) or CME and perioperative topical nonsteroidal anti-inflammatory drug use in either eye. We calculated the overall risk of pCME and used Poisson model with robust estimation of standard error to identify potential risk factors for pCME in the fellow eye. MAIN OUTCOME MEASURE: The risk of postoperative clinical pCME in the fellow eye. RESULTS: A total of 54 209 patients were included. The mean age was 74.6 ± 10.4 years, and 38.8% were male. The fellow eye developed pCME in 544 patients (1%). The risk of fellow-eye pCME among patients without first-eye pCME was 0.9%. However, the risk of fellow-eye pCME among those with first-eye pCME was 10.7%. In the fully adjusted model, we found that the risk factors for the development of fellow-eye pCME were first-eye pCME (RR, 8.55, 95% confidence interval [CI], 6.19-11.8), epiretinal membrane (ERM) (RR, 4.1, CI, 2.63-6.19), history of retinal vein occlusion (RR, 2.94, CI, 1.75-4.93), diabetes without history of DME (RR, 2.08, CI, 1.73-2.5), advanced cataract (RR, 1.75, CI, 1.16-2.65), prostaglandin analogue use preoperatively (RR, 1.49, CI, 1.13-1.97), and male sex (RR, 1.19, CI, 1.0-1.41). CONCLUSIONS: History of pCME in the first-operated eye is the strongest independent risk factor for the development of pCME in the fellow eye. Our findings may guide clinicians in counseling patients on the risk of pCME before performing cataract surgery in the fellow eye and help in identifying high-risk patients who may benefit from prophylactic therapy. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Where the Sidewalk Ends: Parenting as a Trainee during COVID-19.

Physicians who are also parents have faced significant difficulties during the COVID-19 pandemic. However, most studies of the physician-parent workforce have focused on the experiences of attending physicians. In this commentary, we highlight the ways that trainee parents have uniquely experienced three major stressors during the pandemic: (1) childcare challenges, (2) scheduling difficulties, and (3) career uncertainties. We discuss potential solutions to mitigate these challenges for the future hematology/oncology workforce. As the pandemic continues, we hope that these steps can improve the ability of trainee parents to care both for their patients and their families.

The impact of a dedicated operating room team on robotic transplant program growth and fellowship training.

INTRODUCTION: Despite considerable interest in robotic surgery, successful incorporation of robotics into transplant programs has been challenging. Lack of a dedicated OR team with expertise in both robotics and transplant is felt to be a major barrier. This paper assesses the impact of a dedicated robotic transplant team (DART) on program growth and fellowship training at one of the largest robotic transplant programs in North America. METHODS: This is a single center, retrospective review of all robotic operations performed on the transplant surgery service from October 2017 to October 2022. DART was incorporated in February 2020 and included transplant first assists (RFAs), scrub technologists and circulating nurses who received robotic training. Robotic experience before and after DART was compared to assess its impact on program growth and training. RESULTS: Four hundred and two robotic cases were performed by five transplant surgeons: 63 pre-DART and 339 post-DART. 40% of cases were transplant-related and 59.5%, HPB. There was a significant increase in case volume (2.5-10.6 cases/month, p < .0001) and complexity (36.5% vs. 70.3% high complexity cases, p < .0001) post-DART. RFA case coverage increased from 17% to 95%, and participation of transplant fellows as primary surgeons increased from 17% to 95% post-DART period (both p < .05). Conversion rates (9.5% vs. 4.1%) and room turn-around-times (TAT) (58.4 vs. 40.3 min) were lower post-DART (p < .05). There were no emergent conversions, conversions in transplant patients, or robot-related complications in either group. CONCLUSION: OR teams with expertise in robotics and transplant surgery can accelerate growth of robotic transplant programs while maintaining patient safety.

Entrust Me: Embedding Entrustable Professional Activities in a Gastroenterology Residency Program.

Entrustable Professional Activities (EPAs) are defined as a process of gradually entrusting key tasks to specialty fellows during their training. EPAs are an important component of competency-based medical education; the concept of entrustment is also familiar and intuitive to clinical faculty, even inexperienced evaluators even if not termed as such. In this paper, we describe the process of how the authors adopted an established EPA framework for gastroenterology training, using EPAs to guide curriculum and faculty development and assessment in ten steps: (1) adopting an established framework, (2) mapping EPAs to relevant competencies, (3) specifying expected behaviors for competency of each EPA, (4) training faculty and fellows to have a shared mental model, (5) designing the training curriculum and educational strategies based on EPAs, (6) determining the assessment strategy, (7) designing the assessment tool, (8) ensuring clarity in how assessment data are used to make summative decisions, (9) changing feedback culture of fellows, and (10) using a longitudinal coaching system to improve EPA performance.

Second eyes to develop neovascular age-related macular degeneration have fewer symptoms and better one-year visual outcomes.

BACKGROUND: This study compares the visual and anatomical outcomes for the eyes of patients who developed sequential neovascular age-related macular degeneration (nAMD), both at the time of diagnosis and at one year after treatment. METHODS: The study comprised a retrospective case series of 52 patients whose eyes were diagnosed sequentially with nAMD. All eyes were treated with three monthly loading doses of anti-vascular endothelial growth factor agents, followed by further intravitreal injections, as required. Baseline characteristics and outcomes at one year after diagnosis and initial treatment were compared between first and second eyes and included visual acuity (VA), central macular thickness (CMT), and pigment epithelial detachment (PED) height on optical coherence tomography (OCT) imaging. RESULTS: VA at diagnosis was better for second eyes compared with first eyes to develop nAMD (logMAR 0.68 ± 0.51 versus logMAR 0.41 ± 0.34, P = 0.002) and remained so at one year (logMAR 0.61 ± 0.60 versus logMAR 0.42 ± 0.37, P = 0.041). Similarly, PED height at diagnosis was higher in first eyes (225 ± 176 µm versus 155 ± 144 µm, P = 0.003) and also at one year (188 ± 137 µm versus 140 ± 112 µm, P = 0.019). Whereas most patients reported symptoms at first eye diagnosis (71.2%), half as many second eyes were symptomatic (28.8%, P < 0.001). Significantly more symptomatic first eyes experienced visual distortions (32.4% versus 13.3%) or scotomas (29.4% versus 6.7%), compared with a less specific visual complaint of blurry vision (38.2% versus 80.0%, P = 0.006). CONCLUSIONS: Compared with first eyes to develop nAMD, second eyes tended to have better vision, smaller PED heights, and fewer symptoms likely because monitoring permitted earlier diagnosis.

Characteristics of Bilateral Retinal Detachment.

INTRODUCTION: Rhegmatogenous retinal detachment (RD) is still a sight-threatening and potentially blinding disease, especially if both eyes are affected. The purpose of this study is analysing the specific characteristics of bilateral rhegmatogenous RD. METHODS: The files of all 5,791 consecutive eyes undergoing vitreoretinal surgery for uncomplicated RD in a single tertiary retinal centre between January 2005 and June 2021 were retrospectively reviewed. RESULTS: A total of 300 patients (600 eyes) had bilateral retinal detachment. Interval between initial and subsequent RD surgery was 2.6 ± 2.8 (mean ± SD, median 1.5) years. Symptoms were reported by the patients for 20 ± 75 (median 5) days before presentation in the initial eye and 12 ± 32 (median 4) days in the subsequent eye. 220 patients were male (73%), and mean age at initial RD was 55 years. 183 (61%) of the initial RD eyes were phakic. In the initial eye, more patients had a detached macula, worse visual acuity, and more quadrants involved. Primary anatomic success rate was higher in the subsequent eye (90%) compared to the initial eye (83%). There was no difference in the reattachment rate of fellow eyes with primary failure in the first eye (91%) compared to those with primary success in the first eye (90%). There was a high symmetry between the eyes in terms of type of retinal break, number of breaks, and presumed localization of the causative retinal break. CONCLUSION: Patients with bilateral RD were more commonly male and younger than the group of all RD patients. The proportion of pseudophakia was not different. The majority of fellow eye RD occurred within 2 years after the RD in the first eye. Second eye RD was less advanced and had a better anatomical repair rate. Despite their experience in the first eye and despite typical symptoms, patients presented only after a mean of 12 days with RD in the second eye. RD in the initial and the subsequent eye showed a high symmetry. The anatomic result in the first eye is not a predictor for the anatomic result in the subsequent eye.

Impact of the COVID-19 pandemic on internal medicine training in the United States: results from a national survey.

BACKGROUND: Internal medicine (IM) residency is a notoriously challenging time generally characterized by long work hours and adjustment to new roles and responsibilities. The COVID-19 pandemic has led to multiple emergent adjustments in training schedules to accommodate increasing needs in patient care. The physician training period, in itself, has been consistently shown to be associated with vulnerability with respect to mental well-being. The impact of the COVID-19 pandemic on the experience of IM trainees is not well established. OBJECTIVE: Characterize the impact of the COVID-19 pandemic on trainee clinical education, finances, and well-being. METHODS: We developed a survey composed of 25 multiple choice questions, 6 of which had an optional short-answer component. The survey was distributed by the American College of Physicians (ACP) to 23,289 IM residents and subspecialty fellows. We received 1,128 complete surveys and an additional 269 partially completed surveys. RESULTS: The majority of respondents reported a disruption in their clinical schedule (76%) and a decrease in both didactic conferences (71%) and protected time for education (56%). A majority of respondents (81%) reported an impact on their well-being with an increase in their level of burnout and 41% of respondents reported a decrease in level of direct supervision. Despite these changes, the majority of trainee respondents (78%) felt well prepared for clinical practice after graduation. CONCLUSIONS: These results outline the vulnerable position of internal medicine physicians in training. Preserving educational experiences, adequate supervision, and humane work hours are essential in protecting trainees from mental illness and burnout during global emergencies.

Impact of mobilization of residents in otolaryngology-head-neck surgery in COVID-19 units on mental health status.

BACKGROUND: To investigate mental health, sleep, and addiction features of young otolaryngologists (YO) according to the mobilization in COVID-19 units at the end of the third European wave of infections. METHODS: A cross-sectional survey was sent to 220 YO of 6 European University hospitals. The following outcomes were evaluated: postgraduate year; age; management of COVID-19 patients; workload; nights on call; stress; Beck depression inventory; Insomnia severity index; sleep and mental health status evolutions throughout pandemic; consumption of alcohol, tobacco, and drugs before and during pandemic. RESULTS: A total of 128 YO completed the evaluations (58.2%). Twenty responders (15.6%) did not manage COVID-19 patients, while 65 (50.8%), 20 (15.6%), and 23 (18%) managed rarely, frequently or daily COVID-19 patients during the pandemic, respectively. The management of COVID-19 patients was associated with increases of workload (p = 0.023) and number of nights on-call (p < 0.001). At the end of the third wave, the depression rates were 34% (N = 31/68) and 57% (N = 34/60) in YO who worked less and more than 50 h weekly, respectively. Sleep disturbance concerned 39% (N = 26/66) and 55% (N = 27/60) of YO who worked less and more than 50 h weekly, respectively. Mobilized YO reported a significant increase of alcohol consumption compared with control group (p = 0.002). Tobacco and drugs consumptions did not evolve. The consumption of alcohol was positively correlated with the number of nights on-call (p = 0.036) and the total hours of work (p = 0.009). CONCLUSIONS: Young otolaryngologists (YO) mobilized in COVID-19 units reported higher hours worked, nights on call, and alcohol consumption compared with others. Future large cohort-studies are needed to confirm our observations.

Relationship between epa level of supervision with their associated subcompetency milestone levels in pediatric fellow assessment.

BACKGROUND: Entrustable Professional Activities (EPA) and competencies represent components of a competency-based education framework. EPAs are assessed based on the level of supervision (LOS) necessary to perform the activity safely and effectively. The broad competencies, broken down into narrower subcompetencies, are assessed using milestones, observable behaviors of one's abilities along a developmental spectrum. Integration of the two methods, accomplished by mapping the most relevant subcompetencies to each EPA, may provide a cross check between the two forms of assessment and uncover those subcompetencies that have the greatest influence on the EPA assessment. OBJECTIVES: We hypothesized that 1) there would be a strong correlation between EPA LOS ratings with the milestone levels for the subcompetencies mapped to the EPA; 2) some subcompetencies would be more critical in determining entrustment decisions than others, and 3) the correlation would be weaker if the analysis included only milestones reported to the Accreditation Council for Graduate Medical Education (ACGME). METHODS: In fall 2014 and spring 2015, the Subspecialty Pediatrics Investigator Network asked Clinical Competency Committees to assign milestone levels to each trainee enrolled in a pediatric fellowship for all subcompetencies mapped to 6 Common Pediatric Subspecialty EPAs as well as provide a rating for each EPA based upon a 5-point LOS scale. RESULTS: One-thousand forty fellows were assessed in fall and 1048 in spring, representing about 27% of all fellows. For each EPA and in both periods, the average milestone level was highly correlated with LOS (rho range 0.59-0.74; p < 0.001). Correlations were similar when using a weighted versus unweighted milestone score or using only the ACGME reported milestones (p > 0.05). CONCLUSIONS: We found a strong relationship between milestone level and EPA LOS rating but no difference if the subcompetencies were weighted, or if only milestones reported to the ACGME were used. Our results suggest that representative behaviors needed to effectively perform the EPA, such as key subcompetencies and milestones, allow for future language adaptations while still supporting the current model of assessment. In addition, these data provide additional validity evidence for using these complementary tools in building a program of assessment.

Brief Report: Improving Fellow Performance of the Pharmacology Section of the American Society of Clinical Oncology In-Training Exam.

Though the electronic medical record has streamlined the process for ordering chemotherapy and reduced medical error, it has come at the cost of potentially hindering medical oncology fellows' acquisition of basic principles of chemotherapy administration. Recognizing the need for improving fellow knowledge and comfort level in chemotherapy prescription, we created an anticancer therapeutics curriculum for fellows at the University of North Carolina (UNC). The curriculum, which was comprised of a self-assessment, review session, and chemotherapy writing workshop, was offered voluntarily to all UNC fellows planning to take the medical oncology boards. We distributed a pre-intervention and post-intervention survey. In total, 11 of 18 fellows participated. After our interventions, there were statistically significant improvements in comfortability with calculating a dose of chemotherapy (p = 0.002), writing orders (p = 0.004), and taking the American Society of Clinical Oncology (ASCO) In-Training Exam (ITE) (p = 0.002). Furthermore, we saw a 4% overall improvement in pharmacology subset scores on the ITE compared to the prior year. Overall, our study suggested that the addition of a chemotherapy competency curriculum led to improved outcomes on the ASCO ITE, improved comfortability in chemotherapy administration, and hopefully improved patient care.

The Path Toward Fellow Designation in the Academy of Emergency Nursing: Understanding and Navigating the Process to Ensure Your Success.

The Academy of Emergency Nursing was established to honor emergency nurses who have made enduring and substantial contributions that have had significant impact and continue to advance the emergency nursing specialty. Nurses who have been recognized as having made enduring and substantial contributions to emergency nursing achieve fellow status in the Academy of Emergency Nursing and are conferred the credential, Fellow of the Academy of Emergency Nursing. Academy of Emergency Nursing Board Members want to dismantle any structural barriers, clarify any misunderstandings or mysteries, and support diverse candidates by providing clear and equitable resources about the path toward fellow designation and the application process. Therefore, the purpose of this article is to support interested persons in their path toward Academy of Emergency Nursing fellow designation and give explicit details of each section of the application to develop a shared understanding among potential applicants, sponsors, and Fellows of the Academy of Emergency Nursing.

Cyber-bullying among university students: Concurrent relations to belief in a just world and to empathy.

The aim of this study was to investigate concurrent relations of belief in a just world (BJW), justice experiences, and empathy to cyber-bullying perpetration and victimization. Our theoretical framework contained a distinction between personal and general BJW and between affective and cognitive empathy. Due to theory and recent research, we expected students' BJW, lecturer and fellow student justice, and empathy to relate negatively to cyber-bullying perpetration. Furthermore, BJW and academic justice experiences are also expected to negatively relate to cyber-bullying victimization. In order to test our hypotheses, we conducted a cross-sectional questionnaire study with N = 663 German university students (Mage = 22.6, SDage = 3.5; 68% female). Gender, internet use, and social desirability were considered as control variables. A structural equation model showed that students' personal BJW, academic justice experiences, and both empathy dimensions but not general BJW negatively related to cyber-bullying perpetration. Additionally, students' personal BJW and academic justice experiences but not general BJW or empathy were associated with cyber-bullying victimization. Male students and those with a low social desirability were more likely to report cyber-bullying perpetration and victimization. Altogether, not only university students' personal BJW and empathy but also their academic justice experiences related to cyber-bullying perpetration or victimization. Thus, researchers should develop strategies aiming to prevent or reduce cyber-bullying. Those should simultaneously foster students' personal BJW and empathy as well as an academic environment characterized by just behavior of lecturers and students. Supplementary Information: The online version contains supplementary material available at 10.1007/s12144-022-03239-z.

The fellow eye of retinal detachment patients: Vision and clinical presentation.

Background: The fellow eye of a retinal detachment is at risk of developing a retinal detachment and other visually debilitating disease. Aim: To investigate the rate of bilaterality of retinal detachment (RD), the presenting visual acuity (VA), and the presence of ocular morbidity in the fellow eye of patients with RD. Patients and Methods: A multicenter, prospective, cross-sectional study examining the fellow eye of consecutive patients who were diagnosed with different types of RD. The patients were seen within one year and examined in four Nigerian eye hospitals and clinics. Demographics, VA, and clinical findings at the presentation were reported on examination of the fellow eyes. Results: Twenty-seven (11.4%) out of 237 patients (264 eyes) had an RD in the fellow eye. The mean age of all study patients was 46.2 ± 16.8 years, M/F: 161 (67.9%)/76 (32.1%). The rates of bilaterality for rhegmatogenous, exudative, and tractional RDs were 4.2%, 11.1%, and 31.1%, respectively. Diagnosis of RD in an eye was associated with a risk of developing fellow eye rhegmatogenous retinal detachment (RRD) (P < 0.001) and tractional RD (P < 0.001), respectively. RRD in an eye was associated with a 17% risk of developing RD in the fellow eye (ß = -1.6, OR = 0.202, P < 0.001). The BCVA in the fellow eye of the three types of RD varied significantly (P < 0.001). The fellow eye was blind in 25.2% of RRD, 54.1% of tractional retinal detachment (TRD), and 11.1% of exudative retinal detachment (ERD). Bilateral RD eyes were blind in RRD (85.7%), TRD (71.1%), and ERD (50%). One hundred and seven eyes (40.5%) of the total 264 RD eyes studied had other fellow eye events at the presentation. Conclusion: A patient with an RD in one eye is at significant risk of developing a blinding RD in the fellow eye. This risk varies with the type of RD and is highest with TRD. However, RRD, the commonest type of RD, can benefit from prophylactic treatment to the fellow eye RD predisposing lesions.

The systemic antiangiogenic effect of intravitreal aflibercept injection in a mouse model of retinopathy of prematurity.

Retinopathy of prematurity (ROP) is a leading cause of childhood blindness and intravitreal anti-vascular endothelial growth factor (VEGF) injection is becoming a first-line choice for treatment of ROP. However, there is a major concern that intravitreally injected anti-VEGF agents could escape from the eye into the systemic circulation and impair systemic development. Moreover, escaped anti-VEGF agents could have an effect on the retina of the fellow eye. In this study, we investigated the hematogenous effect of a single intravitreal anti-VEGF injection in a mouse model of ROP. Here, we showed that single intravitreal aflibercept injection to one eye can affect body weight gain, the fellow eye, and renal vessels, although no apparent effect was observed in brain vessels. Furthermore, this hematogenous effect was dose-dependent. Our results provide very important insights into the clinical use of anti-VEGF agents for ROP treatment.

All Politics Are Local: A Single Institution Investigation of the Educational Impact of Residents and Fellows Working Together.

BACKGROUND: Most general surgery residents pursue fellowship; there is limited understanding of the impact residents and fellows have on each other's education. The goal of this exploratory survey was to identify these impacts. MATERIALS AND METHODS: Surgical residents and fellows at a single academic institution were surveyed regarding areas (OR assignments, the educational focus of the team, roles and responsibilities on the team, interpersonal communication, call, "other") hypothesized to be impacted by other learners. Impact was defined as "something that persistently affects the clinical learning environment and a trainee's education or ability to perform their job". Narrative responses were reviewed until dominant themes were identified. RESULTS: Twenty-three residents (23/45, 51%) and 12 fellows (12/21, 57%) responded. Responses were well distributed among resident year (PGY-1:17% [4/23], PGY-2, 35% [8/23], PGY-3 26% [6/23], PGY-4 9% [2/23%], PGY-5 13% [3/23]). Most residents reported OR assignment (14/23, 61%) as the area of primary impact, fellows broadly reported organizational categories (Roles and responsibilities 33%, educational focus 16%, interpersonal communication 16%). Senior residents reported missing out on operations to fellows while junior residents reported positive impacts of operating directly with fellows. Residents of all levels reported that fellows positively contributed to their education. Fellows, senior residents, and junior residents reported positive experiences when residents and fellows operated together as primary surgeon and assistant. CONCLUSIONS: Residents and fellows impact one another's education both positively and negatively. Case allocation concerns senior residents, operating together may alleviate this, providing a positive experience for all trainees. Defining a unique educational role for fellows and delineating team expectations may maximize the positive impacts in this relationship.

The impact of EAES Fellowship Programme: a five-year review and evaluation.

BACKGROUND: The European Association of Endoscopic Surgery (EAES) fellowship programme was established in 2014, allowing nine surgeons annually to obtain experience and skills in minimally invasive surgery (MIS) from specialist centres across the Europe and United States. It aligns with the strategic focus of EAES Education and Training Committee on enabling Learning Mobility opportunities. To assess the impact of the programme, a survey was conducted aiming to evaluate the experience and impact of the programme and receive feedback for improvements. METHODS: A survey using a 5-point Likert scale was used to evaluate clinical, education and research experience. The impact on acquisition of new technical skills, change in clinical practice and ongoing collaboration with the host institute was assessed. The fellows selected between 2014 and 2018 were included. Ratings were analysed in percentage; thematic analysis was applied to the free-text feedbacks using qualitative analysis. RESULTS: All the fellows had good access to observing in operating theatres and 70.6% were able to assist. 91.2% participated in educational activities and 23.5% were able to contribute through teaching. 44.1% participated in research activities and 41.2% became an author/co-author of a publication from the host. 97.1% of fellows stated that their operative competency had increased, 94.3% gained new surgical skills and 85.7% was able to introduce new techniques in their hospitals. 74.29% agreed that the clinical experience led to a change in their practices. The most commonly suggested improvements were setting realistic target in clinical and research areas, increasing fellowship duration, and maximising theatre assisting opportunities. Nevertheless, 100% of fellows would recommend the fellowship to their peers. CONCLUSION: EAES fellowship programme has shown a positive impact on acquiring and adopting new MIS techniques. To further refine the programme, an individualised approach should be adopted to set achievable learning objectives in clinical skills, education and research.

Influence of fellow eye on the diagnosis and classification of central serous chorioretinopathy.

PURPOSE: To assess the influence of fellow eye information on diagnosis and classification of central serous chorioretinopathy (CSCR) using multimodal imaging-based classification. METHODS: This was a retrospective, observational study including patients with CSCR with unilateral or bilateral involvement. Multimodal images of both eyes of each patient were compiled and presented to two masked retina specialists subdivided into three groups: (1) both eye data, (2) right eye data and (3) left eye data. The masked observers graded the CSCR as per the new CSCR classification into simple and complex CSCR in three different scenarios as subdivided above. Interobserver and intraobserver agreement was assessed using Cohen's kappa (95% confidence intervals). RESULTS: A total of 206 eyes of 103 patients with unilateral or bilateral CSCR were graded. We found a "strong" intraobserver and interobserver agreement when one eye versus both eye data was provided in terms of "simple CSCR" or "complex CSCR" (kappa value = 0.77 and 0.87, p < 0.001, and kappa value = 0.85 and 0.76, p < 0.001, respectively). Forty-three eyes (10.55%) showed discrepancy in classification between observers for individual eyes, whereas only 13 eyes (6.53%) showed discrepancy between observers when both eye data was provided. CONCLUSION: We conclude that fellow eye information was helpful in solving diagnostic dilemmas and reached 85% consensus in the diagnosis of CSCR between the observers. We found that information of fellow eyes led to a discrepancy only in 6.53% cases with 2.42% cases that had a controversial diagnosis of CSCR. Multimodal imaging-based CSCR classification provides objective approach to diagnose and classify CSCR.