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Ghannam AB, Ibrahim HA, Hammoud B, Hamam R. Impact of the economic crisis, COVID-19 and the Beirut explosion on ophthalmology training in Lebanon: an observational cohort survey-based study. BMJ Open 2024; 14:e075321. [PMID: 38448079 PMCID: PMC10916134 DOI: 10.1136/bmjopen-2023-075321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 02/07/2024] [Indexed: 03/08/2024] Open
Abstract
OBJECTIVES The objective of the study is to investigate the effects of the COVID-19 pandemic, the economic crisis and the Beirut explosion on the training and work of ophthalmology residents and faculty in Lebanon. DESIGN This is an observational cohort survey-based research conducted between January and December 2022. SETTING The study targeted all ophthalmology residents and core faculty in Lebanon. PARTICIPANTS A total of 52 participants, including 27 residents and 25 core faculty members, completed the survey. PRIMARY OUTCOME MEASURE Primary outcomes comprised the subjectively reported effect of the three major external stressors on the training and well-being of ophthalmology trainees and educators in Lebanon. RESULTS The study found that the majority of ophthalmology residents and core faculty members were significantly affected by the COVID-19 pandemic, Beirut explosion and the economic crisis in Lebanon. Significant percentage reported financial burden, decrease in outpatient and surgical load and educational activities. Furthermore, most participants reported higher levels of stress, anxiety and depression during the time of crises. CONCLUSIONS This study emphasises the need to support healthcare professionals during times of crisis, as they are on the frontlines and can experience high levels of stress, anxiety and depression. By providing support and resources to healthcare professionals, they can better cope with the challenges they face and continue to provide essential care to their patients.
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Affiliation(s)
- Alaa Bou Ghannam
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon
| | | | - Bassel Hammoud
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon
| | - Rola Hamam
- Department of Ophthalmology, American University of Beirut, Beirut, Lebanon
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Daily AM, Popat S, Koenig HG, Fuller TW, Lee UJ. Female pelvic medicine and reconstructive surgery fellows' case logs remained stable during the COVID-19 pandemic. Neurourol Urodyn 2023; 42:1789-1794. [PMID: 37545331 DOI: 10.1002/nau.25261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/12/2023] [Accepted: 07/27/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION During the COVID-19 pandemic and subsequent staffing shortages there was concern about the case volume, and thus competency, of graduating trainees due to reduced surgical volumes. Elective procedures were particularly affected, which includes Female Pelvic Medicine and Reconstructive Surgery (FPMRS) cases. To understand whether FPMRS fellows were affected, we assessed their case logs for changes during the pandemic. METHODS The nationally aggregated case logs of graduating FPMRS fellows, both urology and obstetrics and gynecology (OBGYN), were obtained from the Accreditation Council for Graduate Medical Education. The available academic years (AYs) included 2018-2019, 2019-2020, and 2020-2021. Standard deviation for each index category was derived from the average and 90th percentile data. One-way analysis of variance was used to compare differences in case volumes for tracked index categories between AYs. RESULTS Graduating fellows logged an average of 517.4 (standard deviation [SD] 28.6) and 818.0 (SD 37.9) cases, for urology and OBGYN respectively, over their fellowship training during the examined period. No significant differences in total surgical procedures were found for either specialty between pre-COVID AY 2018-2019 and COVID-affected AYs 2019-2020 and 2020-2021. For urology fellows, gastrointestinal (GI) procedures was the only index case category with a significant difference, and it was a decrease between the two COVID-affected AYs: 2020-2021 compared to 2019-2020 (8.9 vs. 4.2, p = 0.04). For both urology and OBGYN fellows, there was a statistically significant decrease in graft/mesh augmentation procedures from COVID-affected AY 2019-2020 to AY 2020-2021. This may be attributed to the reclassification of mesh removal cases from graft/mesh augmentation procedures to genital procedures in 2020-2021. There was not a significant decrease in these procedures from pre-COVID AY 2018-2019 to the COVID-affected AYs. There were no other statistically significant differences between AYs for OBGYN fellows. CONCLUSIONS Surgical case volumes for FPMRS urology and OBGYN fellows who trained during the COVID-19 pandemic were comparable to those of their pre-pandemic peers. No significant differences between pre-COVID and COVID-affected years were found for either total surgical procedures or index case categories. Despite disruptions in health care nationwide, FPMRS trainee case volumes were largely unaffected.
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Affiliation(s)
- Adam M Daily
- Section of Urology and Renal Transplantation, Virginia Mason Franciscan Health, Seattle, Washington, USA
| | - Shreeya Popat
- Section of Urology and Renal Transplantation, Virginia Mason Franciscan Health, Seattle, Washington, USA
| | - Hannah G Koenig
- Department of Laboratory Medicine & Pathology, University of Washington, Seattle, Washington, USA
| | - Thomas W Fuller
- Section of Urology and Renal Transplantation, Virginia Mason Franciscan Health, Seattle, Washington, USA
| | - Una J Lee
- Section of Urology and Renal Transplantation, Virginia Mason Franciscan Health, Seattle, Washington, USA
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Kim E, Lee J, Rana V, Migliori M. Longitudinal trends in volume of oculoplastic procedures without ACGME minimum requirements among United States ophthalmology residents: an ACGME case log analysis. Orbit 2023; 42:517-522. [PMID: 36398702 DOI: 10.1080/01676830.2022.2146727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 11/08/2022] [Indexed: 06/16/2023]
Abstract
PURPOSE To our knowledge, there have been no previous reports that investigate trends in ophthalmology residents' exposure to oculoplastic procedures without Accreditation Council for Graduate Medical Education (ACGME) minimum requirements. To fill this knowledge gap, we investigated publicly available ACGME ophthalmology residency case logs from 2009 to 2021. METHODS National resident averages and standard deviations were collected for the following oculoplastic procedures without minimum ACGME requirements: eye removal and implant, lacrimal surgery, other orbital surgery (e.g. orbitotomy), tarsorrhaphy, entropion/ectropion repair, temporal artery biopsy, and other oculoplastic surgery. We also collated average yearly surgical volumes of all oculoplastic procedures, "Total Oculoplastic Surgery," which includes procedures with minimum requirements and procedures without requirements. Finally, we collected the average yearly volumes of all ophthalmic procedures. Linear regressions were used to characterize trends in resident oculoplastic surgical volume. RESULTS We provide evidence that the average yearly volumes of all but one oculoplastic procedure without ACGME minimum requirements have been decreasing. The decreases in volume for these procedures are driven by residents having fewer cases both as primary surgeon and as assistant. In addition, while the total number of ophthalmic procedures logged by residents on average increased (β = 7.519, p = 0.0163), the average volume of total oculoplastic procedures did not demonstrate any statistically significant trends. CONCLUSIONS Volumes of oculoplastic procedures without ACGME minimum requirements between 2009 and 2021 have been decreasing among ophthalmology residents.
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Affiliation(s)
- Eric Kim
- Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - James Lee
- Department of Biology, Brown University, Providence, Rhode Island, USA
| | - Viren Rana
- Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
| | - Michael Migliori
- Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA
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Sarıdemir Ünal D, Doğru V, Avanaz A, Arıcı C. Impact of COVID-19 on operating assignments in residency training of endocrine surgery: A retrospective cohort study. Asian J Surg 2023; 46:4283-4289. [PMID: 36933961 PMCID: PMC9992058 DOI: 10.1016/j.asjsur.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 01/30/2023] [Accepted: 03/02/2023] [Indexed: 03/18/2023] Open
Abstract
PURPOSE Airborne pandemics illustrate a significant problem in training grounds. From the endocrine surgery point of view, we scrutinized the impact of Covid-19 on general surgery residency training in our university hospital. METHODS The number of endocrine procedure curves was forecasted using the expert modeler in a time series model from March to September 2020 based on data from previous years. We then compared the estimation curves to actual numbers. RESULTS There were 1340 resident participants in thyroid procedures, 405 in parathyroid procedures, 65 in other neck procedures, and 304 in adrenal procedures. In 884 of the endocrine procedures, the operating surgeon was a resident. The median experience of operating residents in endocrine procedures was 3.2 years (interquartile range 2.7-3.6) before the impact and 3.8 years (interquartile range 3.1-4.1) after it (p = 0.023). The monthly number of actual procedures with at least one resident participation in the Covid-19 period was significantly lower (8.7 ± 7.5 vs. 19.9 ± 3.7, p = 0.012) than the forecasted numbers. There were no semi-autonomous operating chief residents, although we expected a moderate level (0 actual vs. 0.5 ± 0.2 predicted, p = 0.002). CONCLUSION This study clearly represents sustainability in surgical training and includes usual trends. Essential endocrine surgical procedures the pandemic disrupted the most were the treatment of thyroid and parathyroid diseases. Covid-19 reduced our surgical volume and resulted in delays in training. A full-scale disaster plan is necessary for possible crises threatening surgical education.
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Affiliation(s)
- Demet Sarıdemir Ünal
- Department of General Surgery, Akdeniz University School of Medicine, Antalya, Turkey.
| | - Volkan Doğru
- Department of General Surgery, Akdeniz University School of Medicine, Antalya, Turkey
| | - Ali Avanaz
- Department of General Surgery, Akdeniz University School of Medicine, Antalya, Turkey
| | - Cumhur Arıcı
- Department of General Surgery, Akdeniz University School of Medicine, Antalya, Turkey
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Oke I, Hunter DG, Mantagos IS, Heidary G. The impact of the COVID-19 pandemic on the surgical volume of pediatric ophthalmology and strabismus fellows. J AAPOS 2023; 27:305-307. [PMID: 37611817 DOI: 10.1016/j.jaapos.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 06/14/2023] [Accepted: 06/23/2023] [Indexed: 08/25/2023]
Abstract
This study used data from the annual fellowship survey over 7 academic years (2014-15 to 2020-21) to describe the trends in surgical experience for pediatric ophthalmology and strabismus fellows and to quantify the impact of the COVID-19 pandemic on trainee surgical volume. The overall number of procedures performed by fellows in the primary surgeon role declined during the first academic year impacted by the pandemic but recovered in the second year. There was an increase in the number of intraocular cases performed per year during the 7-year study interval.
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Affiliation(s)
- Isdin Oke
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - David G Hunter
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Iason S Mantagos
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gena Heidary
- Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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Aggarwal S, Wisely CE, Pepin MJ, Bryan W, Raghunathan K, Challa P. Resident involvement in cataract surgery at the Veterans Health Administration: complications, case complexity, and the role of experience. J Cataract Refract Surg 2023; 49:259-265. [PMID: 36378266 DOI: 10.1097/j.jcrs.0000000000001092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 11/03/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE To characterize intraoperative complications, case complexity, and changes in complication rates with surgical experience for cataract surgeries involving residents at the Veterans Health Administration (VHA). SETTING All VHA facilities where cataract surgery was performed. DESIGN Multicenter, retrospective cohort study. METHODS A retrospective review of all cataract surgeries within the VHA between July 2010 and June 2021 was conducted. Several parameters, including resident involvement, intraoperative complications, and case complexity as determined by Current Procedural Terminology codes, and use of pupil expansion or capsular support devices, were collected. Complication rates were compared between residents and attendings. RESULTS Of 392 428 cataract surgeries completed across 108 VHA facilities, 90 504 were performed by attendings alone, while 301 924 involved a resident. Of these, 10 244 (11.3%) of attending cases were complex compared with 32 446 (10.7%) of resident cases. Pupil expansion devices were required in 8191 of attending cases (9.05%) and 31 659 (10.5%) of cases involving residents ( P < .001). Similarly, cases involving residents were more likely than attending-only cases to require a capsular support device (0.835% vs 0.586%, P < .001). Cases involving residents were more likely to have posterior capsular rupture (4.75% vs 2.58%, P < .001) and dropped nucleus (0.338% vs 0.198%, P < .001). Higher resident case volumes were associated with significantly lower complication rates for posterior capsular rupture, dropped nucleus, zonular loss, and suprachoroidal hemorrhage. CONCLUSIONS Although residents had higher intraoperative complication rates than attendings, these rates were reduced with surgical experience. Residents were involved in a similar number of complex surgical cases as attendings.
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Affiliation(s)
- Sahil Aggarwal
- From the Duke Eye Center, Durham, North Carolina (Aggarwal, Wisely, Challa); Durham Veterans Affairs Medical Center, Durham, North Carolina (Pepin, Bryan, Raghunathan, Challa); Duke Anesthesiology, Durham, North Carolina (Raghunathan)
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Lansingh VC, Ravindran RD, Garg P, Fernandes M, Nair AG, Gogate PJ, Natarajan S, Swaminathan M, Bachhav AE, Gandhi RA. Embracing technology in cataract surgical training - The way forward. Indian J Ophthalmol 2022; 70:4079-4081. [PMID: 36308167 PMCID: PMC9907277 DOI: 10.4103/ijo.ijo_1725_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
While ophthalmology as a surgical branch itself has evolved technologically with newer instruments, techniques and procedures; ophthalmic surgical training appears to have stagnated in terms of how it is delivered and how trainees' learning and performance are assessed. This collaborative editorial attempts to identify the lacunae in ophthalmic residency training and highlight how technological tools such as surgical simulators can be incorporated into ophthalmic training even in limited-resource settings with good results.
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Affiliation(s)
- Van C Lansingh
- Department of Research, Instituto Mexicano de Oftalmología, Queretaro, Mexico,Help MeSee Inc., Jersey City, New Jersey, USA,Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA,Correspondence to: Dr. Van C Lansingh, Department of Research, Instituto Mexicano de Oftalmología, Queretaro, Mexico. E-mail:
| | | | - Prashant Garg
- Executive Chair, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Merle Fernandes
- Director, L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, Hyderabad, Telangana, India
| | - Akshay Gopinathan Nair
- Help MeSee Inc., Jersey City, New Jersey, USA,Aditya Jyot Eye Hospital, A Unit of Dr. Agarwals’ Group of Eye Hospitals, Mumbai, Maharashtra, India,R. Jhunjhunwala Sankara Eye Hospital, Panvel, Maharashtra, India
| | - Parikshit J Gogate
- Community Eye Care Foundation, Dr. Gogate’s Eye Clinic, Pune, Maharashtra, India,Department of Ophthalmology, Padmashri D. Y. Patil Medical College, Pimpri-Chinchwad, Maharashtra, India,School of Health Sciences, Queens University, Belfast, United Kingdom
| | - Sundaram Natarajan
- Aditya Jyot Eye Hospital, A Unit of Dr. Agarwals’ Group of Eye Hospitals, Mumbai, Maharashtra, India
| | - Meenakshi Swaminathan
- Ophthalmic Educator, Consultant Ophthalmologist, Capstone Clinic, Chennai, Tamil Nadu, India
| | - Ashish E Bachhav
- Help MeSee Inc., Jersey City, New Jersey, USA,Eknath Eye Hospital & Laser Centre, Thane, Maharashtra, India
| | - Rashmin A Gandhi
- Ophthalmic Educator, Foresight International, Hyderabad, Telangana, India
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Oke I, Heidary G, Mantagos IS, Shah AS, Hunter DG. A decline in the strabismus surgical experience of ophthalmology residents in the United States from 2010 to 2019. J AAPOS 2022; 26:263-265. [PMID: 36113703 DOI: 10.1016/j.jaapos.2022.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 11/19/2022]
Abstract
Subspecialty exposure during residency can influence the future pursuit of fellowship training. In this study, we compared the trends in strabismus surgical experience reported by graduating ophthalmology residents in the United States with other categories of ophthalmic surgery. Over the 10-year period (2010-2019), there was a decline in the total number of strabismus procedures performed during residency by ophthalmology residents graduating in a given year (1.4 fewer cases per year; 95% CI, 1.1-1.6 [P < 0.001]). Although several surgical categories experienced a decrease in cases performed in the assistant role, strabismus surgery was the only category with a decrease in cases performed in the surgeon role (0.4 fewer cases per year; 95% CI, 0.3-0.5 [P < 0.001]).
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Affiliation(s)
- Isdin Oke
- Department of Ophthalmology, Boston Children's Hospital, Massachusetts Eye and Ear, and Harvard Medical School, Boston, Massachusetts
| | - Gena Heidary
- Department of Ophthalmology, Boston Children's Hospital, Massachusetts Eye and Ear, and Harvard Medical School, Boston, Massachusetts
| | - Iason S Mantagos
- Department of Ophthalmology, Boston Children's Hospital, Massachusetts Eye and Ear, and Harvard Medical School, Boston, Massachusetts
| | - Ankoor S Shah
- Department of Ophthalmology, Boston Children's Hospital, Massachusetts Eye and Ear, and Harvard Medical School, Boston, Massachusetts
| | - David G Hunter
- Department of Ophthalmology, Boston Children's Hospital, Massachusetts Eye and Ear, and Harvard Medical School, Boston, Massachusetts.
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The Role of Technology in Ophthalmic Surgical Education During COVID-19. CURRENT SURGERY REPORTS 2022; 10:239-245. [PMID: 36404795 PMCID: PMC9662128 DOI: 10.1007/s40137-022-00334-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 11/16/2022]
Abstract
Purpose of Review To describe the effect of COVID-19 on ophthalmic training programs and to review the various roles of technology in ophthalmology surgical education including virtual platforms, novel remote learning curricula, and the use of surgical simulators. Recent Findings COVID-19 caused significant disruption to in-person clinical and surgical patient encounters. Ophthalmology trainees worldwide faced surgical training challenges due to social distancing restrictions, trainee redeployment, and reduction in surgical case volume. Virtual platforms, such as Zoom and Microsoft Teams, were widely used during the pandemic to conduct remote teaching sessions. Novel virtual wet lab and dry lab curricula were developed. Training programs found utility in virtual reality surgical simulators, such as the Eyesi, to substitute experience lost from live patient surgical cases. Summary Although several of these described technologies were incorporated into ophthalmology surgical training programs prior to COVID-19, the pandemic highlighted the importance of developing a formal surgical curriculum that can be delivered virtually. Novel telementoring, collaboration between training institutions, and hybrid formats of didactic and practical training sessions should be continued. Future research should investigate the utility of augmented reality and artificial intelligence for trainee learning.
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