Penetrating Keratoplasty Performed by Residents Compared With an Experienced Cornea Transplant Surgeon

Standard ophthalmology residency training in China: an evaluation of resident satisfaction on training program in Guangdong Province

BACKGROUND

National standardized training for resident doctors (STRD) in mainland China has been formally established since 2014 as a kind of postgraduate education. The purpose of this survey was to assess the satisfaction of the training residents in Guangdong Province on the ophthalmology STRD program after a duration of 5 years.

METHOD

A 48-item survey was sent to all postgraduate ophthalmology residents from bases in Guangdong Province to inquire about their attitude towards the program. The survey contained questions about demographic and work-related information, job satisfaction, psychological resilience, and job performance. All responses were verified, and invalid questionnaires were excluded. Statistical analyses were performed using SPSS software version 22.0 (SPSS, Inc., Chicago, IL). Multiple logistic regression analysis was used to evaluate the factors (demographic information, working environment, clinical exposure, supervision and hands-on training opportunities, and involvement in academic activities) impacting the overall satisfaction. P < 0.05 was considered statistically significant.

RESULTS

A total of 471/635 (74.17%) valid questionnaires were returned from all the STRD bases of Guangdong Province, which included 38 hospitals. 60.3% of the respondents reported overall satisfaction with their training. The satisfaction with operative teaching (60.7%) was slightly lower than the other settings of teaching experience (above 65%). Meanwhile, the satisfaction on different secessions of operative experience was all below 70%, of which in the areas of cornea and orbit were 55.42% and 57.53%, respectively. Some potential factors were found to affect general satisfaction, including the training grade, marriage, working time, income level, the doctor-patient relationship, family members working as doctors, the time proportion spent on writing medical documents during clinical work, and the frequency of attending academic meetings. Improvement was observed in both performing and reporting clinical examinations in the last year of training in comparison to the first year. Finally, 82.8% of the residents acknowledged this training was helpful for future clinical work. The first five career preferences for residents were cataract (67.1%), refractive surgery (42.3%), vitreo-retina (36.5%), optometry (28.7%), and oculoplastic (27.2%).

CONCLUSION

Ophthalmology residents in Guangdong Province expressed comparable satisfaction with the STRD program. To further improve satisfaction, factors such as resident subsidy, harmonious marriage, the patient-doctor relationship, and chances of attending academic conferences should be emphasized.

Ophthalmology Residency in the United States: The Case for a National Curriculum

To identify strategies for effective curriculum development and implementation in United States (US) ophthalmology residency training programs. A literature review was conducted for all English-language PubMed/Medline articles relating to ophthalmology residency education or curriculum/curricula. Despite ACGME-defined program requirements outlining curricular goals for US ophthalmology residency training programs, there is no comprehensive, national curriculum with detailed plans for instruction of necessary topics within the 36-month residency training period. Several articles identify a need for detailed curricula on various topics, propose ideas on how residency programs could create curricula, and explore ways of assessing resident competence. There is a paucity of literature evaluating how ophthalmology residents best learn various ophthalmology topics. We need to develop an intentional, comprehensive, and timely national curriculum for ophthalmology residency programs in the US, with detailed plans on how to meet curricular objectives and consideration of the most effective teaching strategies for different ophthalmology concepts.

Effect of Resident Involvement in Ophthalmic Surgery on Patient Outcomes: A Systematic Review and Meta-analysis

PURPOSE

To determine the effect of resident- vs attending-led surgeries on patient outcomes in ophthalmic surgery.

DESIGN

Systematic review and meta-analysis.

METHODS

Two independent authors searched PubMed, EMBASE, and Cochrane Library from inception to March 2022. Categorical data from studies were pooled to report odds ratio (OR) and 95% CIs. Continuous data were analyzed to yield standardized mean difference (SMD) and 95% CIs. Propensity-matched studies were analyzed separately. Study quality was assessed using the Newcastle-Ottawa Scale.

RESULTS

Twenty-four studies were included in this meta-analysis. Seventeen of the 20 outcomes had no significant differences between the 2 cohorts. Notably, many critical cataract surgery-related outcomes showed no significant differences, including posterior capsular tear, lens fragment retainment, and retinal detachment. Among propensity-scored studies, the resident-led surgeries had longer operative duration (SMD 0.81, 95% CI 0.29, 1.33; 3 studies [260 patients], I² = 74%) and had an increased risk of an unplanned return to the operating room (OR 2.58, 95% CI 1.31, 5.06; 4 studies [342 patients], I² = 0%). Among 2 non-propensity-scored, resident-led surgeries had increased incidence of choroidal detachment or choroidal effusion (OR 2.28, 95% 1.02, 5.09; 2 studies [401 patients], I² = 19%). No significant difference was found for ocular hypotony. Significant heterogeneity existed among propensity-scored studies.

CONCLUSIONS

Resident-led surgeries appear overall safe, effective, and comparable to attending-led surgeries with respect to commonly encountered perioperative complications. Specific differences in outcomes exhibit significant heterogeneity and small sample sizes, and may be of unclear or equivocal clinical significance.

Resident Skills Assessment in Corneal Suturing: A Comprehensive Review of Currently Proposed Educational Programs and Evaluation Tools

Purpose This study aimed to perform a comprehensive review of publications proposing educational programs for resident skills assessment in corneal suturing.

Methods An extensive online article search in PubMed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PISMA) reporting guidelines was performed to identify prospective comparative studies or prospective before/after studies published up to March 2021 and reporting the assessment of ophthalmology residents' skills in corneal suturing during dedicated training sessions.

Results Three studies were identified for review. The first reported the efficiency of an electromagnetic tracking system placed on the surgeon's fingers coupled with a computer analysis of movements and time to identify surgeons with different backgrounds in corneal suturing. The second reported the efficiency of the reference system in assessing the improvement of corneal suturing conducted by residents after a training session, with video-based assessment for economy and confidence of movement, limiting tissue damage and precision of operative technique, reviewed by blind assessors. The third proposed an innovative remote corneal suturing training method using Zoom for direct feedback to the residents. The stitch quality was assessed for length, depth, radiality, and tension. The results were similar when compared with a group of residents without feedback.

Conclusion This review underlines the rarity and disparity of available tools for corneal suturing assessment, justifying the need for more complete models to be designed. These should consider body ergonomics and stitch quality and time. Comparative studies involving novices and attendings may provide reliable evaluation of existing gaps and specific metrics to target, helping residents to approach their superiors' experience.

Descemet stripping automated endothelial keratoplasty performed by trainees

PURPOSE

To assess the surgical outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) performed by trainees.

STUDY DESIGN

Retrospective, case control comparative study.

METHODS

This study compared cases performed by trainees with those performed by an experienced surgeon. First 10 cases of DSAEK performed by trainees with more than 6 months follow-up periods were recruited. The surgical outcomes of DSAEK performed by the trainees (Trainee group) were compared with disease-matched pairs of cases performed by an experienced surgeon (Experienced group). Graft clarity, best spectacle-corrected visual acuity, corneal endothelial cell density, and incidence of intra- or post-operative complications were studied.

RESULTS

Forty-one pairs were recruited. The graft clarity rate was not different between the Trainee and Experienced groups, with 95.1% and 97.6%, respectively, maintaining clear grafts at 12 months postoperatively. Trainee best spectacle corrected visual acuity was significantly worse at 6 and 12 months postoperatively compared with the Experienced group, and percent decreases in corneal endothelial density was more in the Trainee group at 3 months following surgery (P = 0.0029). While intra- or late post-operative complication rates were similar in both groups, incidences of early post-operative complications such as double chamber formation or pupillary block were observed more frequently in the Trainee group than in the Experienced group (P = 0.049).

CONCLUSION

DSAEK can be performed relatively safely by training physicians with careful preparation and supervision by attending physicians. However, careful case selection and education on management of air injected in the anterior chamber seemed to be a key to long-term success.