Guiding Residency Program Educational Goals Using Institutional Keyword Reports from the Ophthalmic Knowledge Assessment Program Examination

Introduction Residency programs receive an institutional keyword report following the annual Ophthalmic Knowledge Assessment Program (OKAP) examination containing the raw number of incorrectly answered questions. Programs would benefit from a method to compare relative performance between subspecialty sections. We propose a technique of normalizing the keyword report to determine relative subspecialty strengths and weaknesses in trainee performance.

Methods We retrospectively reviewed our institutional keyword reports from 2017 to 2019. We normalized the percentage of correctly answered questions for each postgraduate year (PGY) level by dividing the percent of correctly answered questions for each subspecialty by the percent correct across all subsections for that PGY level. We repeated this calculation for each PGY level in each subsection for each calendar year of analysis.

Results There was a statistically significant difference in mean performance between the subspecialty sections (p = 0.038). We found above average performance in the Uveitis and Ocular Inflammation section (95% confidence interval [CI]: 1.02–1.18) and high variability of performance in the Clinical Optics section (95% CI: 0.76–1.34).

Discussion The OKAP institutional keyword reports are extremely valuable for residency program self-evaluation. Performance normalized for PGY level and test year can reveal insightful trends into the relative strengths and weaknesses of trainee knowledge and guide data-driven curriculum improvement.

Completing the Basic and Clinical Science Course as a First-Year Ophthalmology Resident

Background The Basic and Clinical Science Course (BCSC) is the primary educational curriculum for ophthalmology resident physicians in the United States. The Ophthalmic Knowledge Assessment Program (OKAP) examination is an annual evaluation completed by residents that is based primarily on the BCSC curriculum. First-year ophthalmology residents are encouraged to complete the 13 volume BCSC series in preparation for the OKAP examination while balancing a steep clinical learning curve and substantial call schedule. By calculating the daily time commitment necessary to read each volume in the series, we hope to help residents create a realistic study plan to compete the entire BSCS series before the OKAP examination.

Methods We determine the word counts of each volume using an electronic copy of the 2018–2019 BCSC series. We include all text sections and legends, and we exclude all figures and tables. We calculate the time per day of dedicated reading required to complete a goal number of BCSC books between the start of ophthalmology residency (postgraduate year 2 [PGY2]) and the OKAP examination by developing a formula that is a function of self-assessed reading speed.

Results A first-year ophthalmology (PGY2) resident with an average reading speed of 250 words per minute must read for 25.0 minutes per day to complete the entire BCSC series before the OKAP examination. If studying is initiated at the beginning of intern (PGY1) year, the resident must read for 10.2 minutes per day. We introduce a formula and provide a table to guide residents on the amount of time needed to dedicate to reading the BCSC each day as a function of self-assessed reading speed.

Discussion Completion of all volumes of the BCSC requires a daily commitment with little room for missed sessions. The commitment is substantially more realistic if initiated during the PGY1 year; thus, residency programs should encourage an early start to OKAP preparation. We hope with a better understanding of the daily time commitment involved in completing the BCSC series, ophthalmology residents will be able to develop more successful study plans.

Results of a primary care-based quality improvement project to optimize chart-based vision screening for preschool age children

PURPOSE

To design chart-based vision screening for preschool-aged children.

METHODS

Our program consisted of educational sessions for providers as well as hands-on training for practice staff. We evaluated the intervention through pre- and post-intervention review of medical records.

RESULTS

Completion of full vision screening (distance visual acuity in each eye plus stereovision beginning at 3 years of age, as recommended at the time of the project) at well-child visits improved for 5-year-olds (45.0% to 58.2%; risk difference +13.2% [95% CI, 1.7-24.7]) and 4-year-olds (39.3% to 51.4%; risk difference +12.0% [95% CI, 0.7-23.4]) but declined somewhat among 3-year-olds (23.1% to 14.3%; risk difference, -8.8% [95% CI, -17.7 to 0.0]). Risk factors for not being fully screened included being 3 years old (risk ratio of 4.1 compared to 5-year-olds) and being a patient of a small practice (risk ratio of 1.9 compared to large practices).

CONCLUSIONS

This quality improvement project showed that screening for visual acuity and stereovision among preschool-aged children using chart-based techniques is difficult to accomplish and unlikely to be consistently successful, especially among 3-year-olds.

Ocular blast injuries in mass-casualty incidents: the marathon bombing in Boston, Massachusetts, and the fertilizer plant explosion in West, Texas

PURPOSE

To report the ocular injuries sustained by survivors of the April 15, 2013, Boston Marathon bombing and the April 17, 2013, fertilizer plant explosion in West, Texas.

DESIGN

Multicenter, cross-sectional, retrospective, comparative case series.

PARTICIPANTS

Seventy-two eyes of 36 patients treated at 12 institutions were included in the study.

METHODS

Ocular and systemic trauma data were collected from medical records.

MAIN OUTCOME MEASURES

Types and severity of ocular and systemic trauma and associations with mechanisms of injury.

RESULTS

In the Boston cohort, 164 of 264 casualties were transported to level 1 trauma centers, and 22 (13.4%) required ophthalmology consultations. In the West cohort, 218 of 263 total casualties were transported to participating centers, of which 14 (6.4%) required ophthalmology consultations. Boston had significantly shorter mean distances to treating facilities (1.6 miles vs. 53.6 miles; P = 0.004). Overall, rigid eye shields were more likely not to have been provided than to have been provided on the scene (P<0.001). Isolated upper body and facial wounds were more common in West largely because of shattered windows (75.0% vs. 13.6%; P = 0.001), resulting in more open-globe injuries (42.9% vs. 4.5%; P = 0.008). Patients in Boston sustained more lower extremity injuries because of the ground-level bomb. Overall, 27.8% of consultations were called from emergency rooms, whereas the rest occurred afterward. Challenges in logistics and communications were identified.

CONCLUSIONS

Ocular injuries are common and potentially blinding in mass-casualty incidents. Systemic and ocular polytrauma is the rule in terrorism, whereas isolated ocular injuries are more common in other calamities. Key lessons learned included educating the public to stay away from windows during disasters, promoting use of rigid eye shields by first responders, the importance of reliable communications, deepening the ophthalmology call algorithm, the significance of visual incapacitation resulting from loss of spectacles, improving the rate of early detection of ocular injuries in emergency departments, and integrating ophthalmology services into trauma teams as well as maintaining a voice in hospital-wide and community-based disaster planning.

Legislative issues facing pediatric ophthalmology in 2006

PURPOSE OF REVIEW

There has been a surge in legislative activity concerning children's vision in recent years. This review will summarize and compare newly enacted state statutes and review legislation that has been introduced at both the state and federal level. Detailed reference sites are provided and may be a useful resource for those involved in legislative advocacy.

RECENT FINDINGS

The legislative arena has often mirrored the disparate views of ophthalmology and optometry regarding the most appropriate methods for identifying vision problems in young children. While state legislation mandating comprehensive eye examinations for all asymptomatic and risk free children was passed in Kentucky in 2000, no other state since has successfully enacted and implemented similar legislation. In contrast, numerous states, have enacted mandatory preschool vision screening legislation. Federal legislation, introduced separately by ophthalmology and optometry, would provide funds for uninsured children's eye exams, but the two bills have important differences in eligibility requirements. Issues such as eye safety and retinoblastoma detection have also been addressed through the legislative process.

SUMMARY

There has been a myriad of state and federal legislative activity in the area of children's vision. The momentum is likely to continue as additional states file new legislation.

Effects of endothelin-1 on K(+) currents from rat ventricular myocytes

It has been suggested that the positive inotropic effect of the vasoactive peptide hormone, endothelin-1 (ET-1), involves inhibition of cardiac K(+) currents. In order to identify the K(+) currents modulated by ET-1, the outward K(+) currents of isolated rat ventricular myocytes were investigated using whole-cell patch-clamp recording techniques. Outward currents were elicited by depolarisation to +40 mV for 200 ms from the holding potential of -60 mV. Currents activated rapidly, reaching a peak (I(pk)) of 1310 +/- 115 pA and subsequently inactivating to an outward current level of 1063 +/- 122 pA at the end of the voltage-pulse (I(late)) (n = 11). ET-1 (20 nM) reduced I(pk) by 247.6 +/- 60.7 pA (n = 11, P < 0.01) and reduced I(late) by 323.2 +/- 43.9 pA (P < 0.001). The effects of ET-1 were abolished in the presence of the nonselective ET receptor antagonist, PD 142893 (10 microM, n = 5). Outward currents were considerably reduced and the effects of ET-1 were not observed when K(+) was replaced with Cs(+) in the experimental solutions; this indicates that ET-1 modulated K(+)-selective currents. A double-pulse protocol was used to investigate the inactivation of the currents. The voltage-dependent inactivation of the currents from potentials positive to -80 mV was fitted by a Boltzmann equation revealing the existence of an inactivating transient outward component (I(to)) and a noninactivating steady-state component (I(ss)). ET-1 markedly inhibited I(ss) by 43.0 +/- 3.8% (P < 0.001, n = 7) and shifted the voltage-dependent inactivation of I(to) by +3.3 +/- 1.2 mV (P < 0.05). Although ET-1 had little effect on the onset of inactivation of the currents elicited from a conditioning potential of -70 mV, the time-independent noninactivating component of the currents was markedly inhibited. In conclusion, the predominant effect of ET-1 was to inhibit a noninactivating steady-state background K(+) current (I(ss)). These results are consistent with the hypothesis that I(ss) inhibition contributes to the inotropic effects of ET-1.

The hospital evolution to discharge planning automation

An automated discharge planning system generates significant productivity benefits to hospitals committing to the process. It also allows full interactive communication to track patients at any level in the continuum of care. Not every hospital today is capable of operating in a network environment. In addition, many ECOs are not currently equipped to participate in the discharge planning process using personal computers. Capital investment costs present an obstacle to some providers contemplating participation in the process of interactive discharge patient information exchange through the continuum. Yet external pressures continue to mount for improved healthcare process productivity. As a result, both hospitals and extended care organizations seem likely to increasingly rely on automation of the discharge planning process in order to operate and compete effectively as the healthcare industry continues its evolution.

Toxoplasma gondii isolated from amniotic fluid

A pregnant woman contracted toxoplasmosis from exposure to oocysts shed by cats. She underwent amniocentesis for a therapeutic abortion, and Toxoplasma gondii was isolated from the amniotic fluid and placenta. This method may be useful in determining whether the fetus is infected in cases of toxoplasmosis acquired during pregnancy.