The ophthalmology residency match: a new era.

PURPOSE OF REVIEW: The average number of applications per ophthalmology residency applicant continues to rise. The present article reviews the history and negative impacts of this trend, the dearth of effective solutions and the potential promise of preference signalling as an alternative strategy to address this and potentially improve match outcomes. RECENT FINDINGS: Application inflation adversely impacts applicants and programmes and undermines holistic review. Most recommendations to limit volume have been largely unsuccessful or undesirable. Preference signalling does not restrict applications. Early results from initial pilots in other specialties are promising. Signalling has the potential to facilitate holistic review, reduce interview hoarding and promote equitable distribution of interviews. SUMMARY: Preliminary data suggest preference signalling could be a useful strategy to address current issues with the Match. Building upon the blueprints and experiences of our colleagues, Ophthalmology should conduct its own investigation and consider a pilot project.

Integrating the Internship into Ophthalmology Residency Programs: Association of University Professors of Ophthalmology American Academy of Ophthalmology White Paper.

Future ophthalmologists will need to have broad skills to thrive in complex health care organizations. However, training for ophthalmologists does not take advantage of all of the postgraduate years (PGYs). Although the traditional residency years seem to have little excess capacity, enhancing the internship year does offer an opportunity to expand the time for ophthalmology training in the same 4 PGYs. Integrating the internship year into residency would allow control of all of the PGYs, allowing our profession to optimize training for ophthalmology. In this white paper, we propose that we could capture an additional 6 months of training time by integrating basic ophthalmology training into the intern year. This would allow 6 additional months to expand training in areas such as quality improvement or time for "mini-fellowships" to allow graduates to develop a deeper set of skills.

Accuracy and Utility of Internet Image Search as a Learning Tool for Retinal Pathology.

Purpose Ophthalmology residency training heavily relies on visual and pattern recognition-based learning. In parallel with traditional reference texts, online internet search via Google Image Search (GIS) is commonly used and offers an accessible fund of reference images for ophthalmology trainees seeking rapid exposure to images of retinal pathology. However, the accuracy and quality of this tool within this context is unknown. We aim to evaluate the accuracy and quality of GIS images of selected retinal pathologies. Methods A cross-sectional study was performed of GIS of 15 common and 15 rare retinal diseases drawn from the American Academy of Ophthalmology residency textbook series. A total of 300 evaluable image results were assessed for accuracy of images and image source accountability in consultation with a vitreoretinal surgeon. Results A total of 377 images were reviewed with 77 excluded prior to final analysis. A total of 288 (96%) search results accurately portrayed the retinal disease being searched, whereas 12 (4%) were of an erroneous diagnosis. More images of common retinal diseases were from patient education Web sites than were images of rare diseases ( p < 0.01). Significantly more images of rare retinal diseases were found in peer-reviewed sources ( p = 0.01). Conclusions GIS search results yielded a modest level of accuracy for the purposes of ophthalmic education. Despite the ease and rapidity of accessing multimodal retinal imaging examples, this tool may best be suited as a supplementary resource for learning among residents due to limited accuracy, lack of sufficient supporting information, and the source Web site's focus on patient education.

Navigating the Ophthalmology & Urology Match with a Significant Other.

OBJECTIVE: Medical students with a significant other in medical school face challenges when applying for residency as they attempt to match in proximity to their partner. The National Resident Matching Program (NRMP) offers a Couples Match to aid such applicants. This system is not available for ophthalmology and urology because these specialties utilize match systems outside the NRMP and have an early match timeline. The purpose of this study is to analyze usage of the Couples Match and assess ophthalmology and urology applicant viewpoints on the Couples Match system. DESIGN & SETTING: First, NRMP data on the Couples Match from 1987 to 2021 was reviewed. Second, an online survey was sent to 559 ophthalmology and 321 urology applicants to The Johns Hopkins University School of Medicine in the 2021 match cycle. PARTICIPANTS: 342 ophthalmology and urology applicants (39% response rate). RESULTS: There is increased usage of the Couples Match over time. In response to the survey, 89% of participants agreed that a Couples Match should be implemented in their specialty. 107 (31%) had a significant other in medicine. 78% of 68 respondents whose significant other also applied in 2021 reported that they would have used the Couples Match had it been available. 21% of those with a significant other considered not applying to ophthalmology or urology because there was no Couples Match. There are mixed responses regarding whether the early match timeline is beneficial to couples. Female applicants were more likely to report hesitancy about mentioning a significant other during the application process. CONCLUSIONS: The Couples Match is highly desired by applicants to ophthalmology and urology, and the lack of such a system is a deterrent to pursuing these fields. Future studies will help elucidate how the match system can be leveraged to aid individuals applying with a significant other.

Ophthalmology resident selection: current trends in selection criteria and improving the process.

OBJECTIVE: To document and assess current ophthalmology resident selection practices as well as to initiate discussion on how best to improve the process. DESIGN: Online survey comprising 56 questions. PARTICIPANTS: Program directors, chairpersons, or members of the resident selection committee representing 65 United States ophthalmology residency programs accredited by the Accreditation Council on Graduate Medical Education. METHODS: Study participants completed an online, anonymous survey consisting primarily of multiple choice questions, with single or multiple answers. MAIN OUTCOME MEASURES: Ophthalmology resident selection practices were evaluated and included: screening of applications, interview processes, selection factors, and formation of rank lists; recommendations given to applicants; and respondent satisfaction with the current selection process. RESULTS: As a group, survey respondents deemed the following factors most important in resident selection: interview performance (95.4%), clinical course grades (93.9%), letters of recommendation (83.1%), and board scores (80%). Statistical analyses deemed that the best predictors of resident performance are interviews, clinical course grades, recommendation letters, and ophthalmology rotation performance. CONCLUSIONS: Ophthalmology resident selection is a relatively subjective process, continuing to rely heavily on cognitive factors. Because these factors are not always indicative of ultimate resident quality, it would be helpful if ophthalmology training programs improved selection practices to discern who most likely will become a successful resident and future ophthalmologist. Long-term studies correlating applicant attributes with residency and postresidency success are needed to recommend guidelines for a more standardized selection process.

Evaluation of the virtual mentor cataract training program.

OBJECTIVE: Evaluate the effectiveness of an interactive cognitive computer simulation for teaching the hydrodissection portion of cataract surgery compared with standard teaching and to assess the attitudes of residents about the teaching tools and their perceived confidence in the knowledge gained after using the tools. DESIGN: Case-control study. PARTICIPANTS AND CONTROLS: Residents at academic institutions. METHODS: Prospective, multicenter, single-masked, controlled trial was performed in 7 academic departments of ophthalmology (Harvard Medical School/Massachusetts Eye and Ear Infirmary, University of Iowa, Emory University, University of Cincinnati, University of Pennsylvania/Scheie Eye Institute, Jefferson Medical College of Thomas Jefferson University/Wills Eye Institute, and the Aravind Eye Institute). All residents from these centers were asked to participate and were randomized into 2 groups. Group A (n = 30) served as the control and received traditional teaching materials; group B (n = 38) received a digital video disc of the Virtual Mentor program. This program is an interactive cognitive simulation, specifically designed to separate cognitive aspects (such as decision making and error recognition) from the motor aspects. Both groups took online anonymous pretests (n = 68) and posttests (n = 58), and answered satisfaction questionnaires (n = 53). Wilcoxon tests were completed to compare pretest and posttest scores between groups. Analysis of variance was performed to assess differences in mean scores between groups. MAIN OUTCOME MEASURES: Scores on pretests, posttests, and satisfaction questionnaires. RESULTS: There was no difference in the pretest scores between the 2 groups (P = 0.62). However, group B (Virtual Mentor [VM]) scored significantly higher on the posttest (P = 0.01). Mean difference between pretest and posttest scores were significantly better in the VM group than in the traditional learning group (P = 0.04). Questionnaire revealed that the VM program was "more fun" to use (24.1% vs 4.2%) and residents were more likely to use this type of program again compared with the likelihood of using the traditional tools (58.6% vs 4.2%). CONCLUSIONS: The VM, a cognitive computer simulation, augmented teaching of the hydrodissection step of phacoemulsification surgery compared with traditional teaching alone. The program was more enjoyable and more likely to be used repetitively by ophthalmology residents.

Current Applicant Perceptions of the Ophthalmology Residency Match.

Importance: The ophthalmology residency application process is critical for applicants and residency programs, and knowledge about the preferences of applicants would assist both groups in improving the process. Objective: To evaluate the experiences and preferences of ophthalmology residency applicants. Design, Setting, and Participants: This cross-sectional, nonvalidated survey was conducted online. All applicants to the Bascom Palmer Eye Institute ophthalmology residency program during the 2018-2019 application cycle were invited to complete the survey. Data collection occurred from April 1, 2019, to April 30, 2019. Main Outcomes and Measures: Applicant demographics, application submissions, interview experiences, financial considerations, match results, and suggestions for improvement of the application process. Results: Responses were received from 185 applicants (36.4%), including 77 women (41.6%). A successful match into an ophthalmology residency was achieved by 172 respondents (93.0%). There was a mean (SD) US Medical Licensing Examination Step 1 score of 245.8 (13.3) points. Respondents applied to a mean (SD) of 76.4 (23.5) ophthalmology residency programs, received 14.0 (9.0) invitations to interview, and attended 10.3 (4.4) interviews. Choices regarding applications and interviews were based mostly on program reputation, location, and advisor recommendation. A usual lead time of at least 3 weeks between the invitation and interview was reported by 126 respondents (69.2%), which was reduced to 14 respondents (15.1%) when a wait-list was involved. The ophthalmology residency application process cost a mean (SD) of $5704 ($2831) per applicant. Respondents reported that they were most able to reduce costs through housing choices (hotel stays or similar arrangements) and least able to reduce costs by limiting the number of programs to which they applied or at which they interviewed. Conclusions and Relevance: The ophthalmology residency application process is complex and poses substantial challenges to applicants and residency programs. These findings suggest that many current applicants have difficulty selecting programs to apply to, and most respondents desired changes to the current system of interview invitations and scheduling.

Knowledge about glaucoma and barriers to follow-up care in a community glaucoma screening program.

OBJECTIVE: To assess perceived barriers to glaucoma follow-up care, including the lack of glaucoma knowledge and the lack of health care access, among participants in a community glaucoma screening program. DESIGN: Community survey. PARTICIPANTS: Two hundred forty-three consecutive participants in a series of free glaucoma screenings between November 2002 and August 2003. METHODS: The survey consisted of 20 questions designed to elicit knowledge of glaucoma and perception of potential barriers to follow-up care. Our aim was to find correlations between patient demographics and knowledge of glaucoma as well as perceived potential barriers to follow-up care. The data were analyzed using SPSS, v. 10.1. RESULTS: The average age of the respondents was 70 years, and females predominated (66%). About half of the respondents knew of an eye doctor in their neighborhood, and 60% had had an eye examination in the past year. Two hundred twenty-two (91%) indicated they could get to an eye doctor if the screening examination indicated they needed a follow-up examination. Two hundred twenty (90.5%) had medical insurance. One hundred seventy-eight (73%) of the participants had heard of glaucoma; 71 (29%) identified an accurate definition of glaucoma. The level of education and the language spoken at home were correlated with both glaucoma awareness (p < 0.001; p < 0.001) and knowledge of an accurate definition of glaucoma (p < 0.001; p < 0.025). CONCLUSIONS: In this population, a lack of adequate education about glaucoma may be more significantly associated with poor follow-up rates than a lack of access to care in those identified as glaucoma suspects.

The Residency Application Process: Pursuing Improved Outcomes Through Better Understanding of the Issues.

The residency application process requires that applicants, their schools, and residency programs exchange and evaluate information to accomplish successful matching of applicants to postgraduate training positions. The different motivations of these stakeholders influence both the types of information provided by medical schools and the perceived value and completeness of information received by residency programs. National standards have arisen to shape the type and format of information reported by medical schools about their students, though criticisms about the candor and completeness of the information remain. Growth in the number of applicants without proportional expansion of training positions and continued increases in the number of applications submitted by each applicant contribute to increases in the absolute number of applications each year, as well as the difficulty of evaluating applicants. Few standardized measures exist to facilitate comparison of applicants, and the heterogeneous nature of provided information limits its utility. Residency programs have been accused of excluding qualified applicants through use of numerical screening methods, such as United States Medical Licensing Examination (USMLE) Step 1 scores. Applicant evaluation includes review of standardized measurements such as USMLE Step 1 scores and other surrogate markers of future success. Proposed potential improvements to the residency application process include limiting applications; increasing the amount and/or types of information provided by applicants and by residency programs; shifting to holistic review, with standardization of metrics for important attributes; and fundamental reanalysis of the residency application process. A solution remains elusive, but these approaches may merit further consideration.

Optic disc hemorrhages in glaucoma and ocular hypertension: implications and recommendations.

PURPOSE OF REVIEW: To describe the epidemiology of disc hemorrhages and underscore the importance of detecting these markers of potential glaucomatous damage and progression. RECENT FINDINGS: The Ocular Hypertension Treatment Study has confirmed that disc hemorrhages are an independent risk factor in the development of glaucoma. The risk of developing glaucoma was six times more likely in ocular hypertensive patients with disc hemorrhages compared with ocular hypertensive patients without disc hemorrhages. This study also highlighted the difficulty in detecting disc hemorrhages on clinical examination, noting that only 16% of disc hemorrhages detected on stereophotographs were identified on funduscopic examination. One study has demonstrated that surgical lowering of intraocular pressure decreased the occurrence of disc hemorrhages. SUMMARY: Although the mechanism for the development of disc hemorrhages remains vague, the recent literature describes the difficulty in detecting disc hemorrhages, the importance of identifying this negative prognostic indicator and the effectiveness of intraocular pressure lowering with trabeculectomy in decreasing the risk of future disc hemorrhages.