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Au SCL, Chong SSY. Prognostic factors for acute central retinal artery occlusion treated with hyperbaric oxygen: The Hong Kong study report number five. World J Methodol 2025; 15:96777. [DOI: 10.5662/wjm.v15.i2.96777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 10/11/2024] [Accepted: 11/07/2024] [Indexed: 11/27/2024] Open
Abstract
BACKGROUND Central retinal artery occlusion (CRAO) is a potentially blinding disease, and hyperbaric oxygen therapy (HBOT) is becoming increasingly popular with the support of scientific evidence. Despite the presence of various acute management measures, there is no clear evidence on the gold standard treatment for CRAO.
AIM To identify factors and imaging parameters associated with good visual outcome, which guide ophthalmologists in the triage of CRAO patients for HBOT.
METHODS Patients who suffered from CRAO and had a symptom onset ≤ 6 h were recruited for a course of HBOT in a tertiary hospital after failing bedside treatment. Patient demographics, onset time, CRAO eye parameters, and past medical history were prospectively collected. Visual outcomes after HBOT were also analyzed.
RESULTS A total of 26 patients were included; the female-to-male ratio was 1:1.6, and the mean age was 67.5 years ± 13.3 years (range 44–89 years). The mean duration of follow-up and mean visual acuity (VA) improvement were 10.0 mo ± 5.3 mo and 0.48 logarithm of minimal angle of resolution (logMAR) ± 0.57 logMAR (approximately 9 letters in ETDRS) (P = 0.0001, Z = -3.67), respectively. The 1 mm zone of central macular thickness (CMT) on optical coherence tomography was not associated with VA changes (P = 0.119); however, the 1-to-3 mm circular rim of CMT was fairly associated (P = 0.02, Spearman's coefficient = 0.45). Complete retinal perfusion time during fundus fluorescein angiography (FFA) was moderately associated (P = 0.01, Spearman's coefficient = 0.58) with visual outcome.
CONCLUSION A thinner 1-to-3 mm circular rim of CMT, but not the central 1 mm zone, is associated with better visual outcome. A shorter perfusion delay on FFA is also associated with better visual outcome.
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Affiliation(s)
- Sunny Chi Lik Au
- Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong 999077, China
- Department of Ophthalmology, Pamela Youde Nethersole Eastern Hospital, Hong Kong 999077, China
| | - Steffi Shing Yee Chong
- Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong 999077, China
- Department of Ophthalmology, Pamela Youde Nethersole Eastern Hospital, Hong Kong 999077, China
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Zhu H, Zhang C, Li N, Yang Z, Qian X, Ji M, Yang J, Liu M, Yang W, Li D, Sun J. Satisfaction survey on graduates of standardised training for resident doctors in Guizhou Province, China. BMJ Open 2024; 14:e085789. [PMID: 39366715 PMCID: PMC11481131 DOI: 10.1136/bmjopen-2024-085789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 08/30/2024] [Indexed: 10/06/2024] Open
Abstract
OBJECTIVES This study aimed to investigate the satisfaction levels of graduate residents in Guizhou Province and analyse the factors influencing their satisfaction. METHODS A cross-sectional survey was conducted using a simple random sampling method with all graduate residents from 24 hospitals in Guizhou Province. The survey covered the residents' demographic information, information about the training hospitals and satisfaction survey responses. Statistical analyses were performed using SPSS 29.0, including descriptive statistics using component ratios, binomial distribution tests for specific satisfaction situations, X 2 tests for between-group comparisons and binary logistic regression analyses to analyse the associations between residency satisfaction and related factors. The significance level was set at α=0.05. RESULTS The survey included 1070 graduate residents of Guizhou Province, China, including 500 males (46.7%) and 570 females (53.3%). The satisfaction questionnaire revealed that 23.8% were very satisfied; 45.4% were somewhat satisfied; and 26.4%, 2.3% and 2.1% were average, somewhat dissatisfied and very dissatisfied, respectively. Factors influencing residency satisfaction included gender, age, training base level, identity type, training participation year and average monthly income. CONCLUSION Based on this study, the satisfaction of graduate residents in Guizhou Province, China, is relatively lower than that in other countries and provinces. Therefore, Guizhou Province should take appropriate measures to address these influencing factors and enhance residency training satisfaction, thereby improving the residency training quality.
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Affiliation(s)
- Haijian Zhu
- Department of Science and Education, Guiyang Stomatological Hospital, Guiyang, Guizhou Province, China
| | - Chanchan Zhang
- Department of the Medical, Guiyangyunyan District Hospital, Guiyang, Guizhou Province, China
| | - Na Li
- Department of Science and Education, Guiyang Stomatological Hospital, Guiyang, Guizhou Province, China
| | - Zhe Yang
- Department of Histology and Embryology, Guizhou Medical University, Guiyang, Guizhou Province, China
| | - Xin Qian
- Department of Science and Education, Guiyang Stomatological Hospital, Guiyang, Guizhou Province, China
| | - Min Ji
- Department of Science and Education, Guiyang Stomatological Hospital, Guiyang, Guizhou Province, China
| | - Jing Yang
- Department of Science and Education, Guiyang Stomatological Hospital, Guiyang, Guizhou Province, China
| | - Mingkun Liu
- Guizhou University, Guiyang, Guizhou Province, China
| | - Wei Yang
- Guizhou University, Guiyang, Guizhou Province, China
| | - Dongdong Li
- Department of Clinical Teaching, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou Province, China
| | - Jiangling Sun
- Department of Science and Education, Guiyang Stomatological Hospital, Guiyang, Guizhou Province, China
- Guizhou University, Guiyang, Guizhou Province, China
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Peng J, Xie X, Lu Z, Xu Y, Xie M, Luo L, Xiao H, Ye H, Chen L, Yang J, Zhang M, Zhao P, Zheng C. Generative adversarial networks synthetic optical coherence tomography images as an education tool for image diagnosis of macular diseases: a randomized trial. Front Med (Lausanne) 2024; 11:1424749. [PMID: 39050535 PMCID: PMC11266019 DOI: 10.3389/fmed.2024.1424749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 06/19/2024] [Indexed: 07/27/2024] Open
Abstract
Purpose This study aimed to evaluate the effectiveness of generative adversarial networks (GANs) in creating synthetic OCT images as an educational tool for teaching image diagnosis of macular diseases to medical students and ophthalmic residents. Methods In this randomized trial, 20 fifth-year medical students and 20 ophthalmic residents were enrolled and randomly assigned (1:1 allocation) into Group real OCT and Group GANs OCT. All participants had a pretest to assess their educational background, followed by a 30-min smartphone-based education program using GANs or real OCT images for macular disease recognition training. Two additional tests were scheduled: one 5 min after the training to assess short-term performance, and another 1 week later to assess long-term performance. Scores and time consumption were recorded and compared. After all the tests, participants completed an anonymous subjective questionnaire. Results Group GANs OCT scores increased from 80.0 (46.0 to 85.5) to 92.0 (81.0 to 95.5) 5 min after training (p < 0.001) and 92.30 ± 5.36 1 week after training (p < 0.001). Similarly, Group real OCT scores increased from 66.00 ± 19.52 to 92.90 ± 5.71 (p < 0.001), respectively. When compared between two groups, no statistically significant difference was found in test scores, score improvements, or time consumption. After training, medical students had a significantly higher score improvement than residents (p < 0.001). Conclusion The education tool using synthetic OCT images had a similar educational ability compared to that using real OCT images, which improved the interpretation ability of ophthalmic residents and medical students in both short-term and long-term performances. The smartphone-based educational tool could be widely promoted for educational applications.Clinical trial registration: https://www.chictr.org.cn, Chinese Clinical Trial Registry [No. ChiCTR 2100053195].
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Affiliation(s)
- Jie Peng
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaoling Xie
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou University Medical College, Shantou, China
| | - Zupeng Lu
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Ophthalmology, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yu Xu
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Meng Xie
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Luo
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou University Medical College, Shantou, China
| | - Haodong Xiao
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hongfei Ye
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Chen
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianlong Yang
- School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Mingzhi Zhang
- Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong, Shantou University Medical College, Shantou, China
| | - Peiquan Zhao
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ce Zheng
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Institute of Hospital Development Strategy, China Hospital Development Institute Shanghai Jiao Tong University, Shanghai, China
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Zheng C, Li W, Wang S, Ye H, Xu K, Fang W, Dong Y, Wang Z, Qiao T. Automated detection of steps in videos of strabismus surgery using deep learning. BMC Ophthalmol 2024; 24:242. [PMID: 38853240 PMCID: PMC11163806 DOI: 10.1186/s12886-024-03504-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 05/28/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND Learning to perform strabismus surgery is an essential aspect of ophthalmologists' surgical training. Automated classification strategy for surgical steps can improve the effectiveness of training curricula and the efficient evaluation of residents' performance. To this end, we aimed to develop and validate a deep learning (DL) model for automated detecting strabismus surgery steps in the videos. METHODS In this study, we gathered 479 strabismus surgery videos from Shanghai Children's Hospital, affiliated to Shanghai Jiao Tong University School of Medicine, spanning July 2017 to October 2021. The videos were manually cut into 3345 clips of the eight strabismus surgical steps based on the International Council of Ophthalmology's Ophthalmology Surgical Competency Assessment Rubrics (ICO-OSCAR: strabismus). The videos dataset was randomly split by eye-level into a training (60%), validation (20%) and testing dataset (20%). We evaluated two hybrid DL algorithms: a Recurrent Neural Network (RNN) based and a Transformer-based model. The evaluation metrics included: accuracy, area under the receiver operating characteristic curve, precision, recall and F1-score. RESULTS DL models identified the steps in video clips of strabismus surgery achieved macro-average AUC of 1.00 (95% CI 1.00-1.00) with Transformer-based model and 0.98 (95% CI 0.97-1.00) with RNN-based model, respectively. The Transformer-based model yielded a higher accuracy compared with RNN-based models (0.96 vs. 0.83, p < 0.001). In detecting different steps of strabismus surgery, the predictive ability of the Transformer-based model was better than that of the RNN. Precision ranged between 0.90 and 1 for the Transformer-based model and 0.75 to 0.94 for the RNN-based model. The f1-score ranged between 0.93 and 1 for the Transformer-based model and 0.78 to 0.92 for the RNN-based model. CONCLUSION The DL models can automate identify video steps of strabismus surgery with high accuracy and Transformer-based algorithms show excellent performance when modeling spatiotemporal features of video frames.
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Affiliation(s)
- Ce Zheng
- Department of Ophthalmology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wen Li
- Department of Ophthalmology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Lu Ding Road # 355, Shanghai, 200000, China
| | - Siying Wang
- Department of Ophthalmology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Lu Ding Road # 355, Shanghai, 200000, China
| | - Haiyun Ye
- Department of Ophthalmology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Lu Ding Road # 355, Shanghai, 200000, China
| | - Kai Xu
- Department of Ophthalmology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Lu Ding Road # 355, Shanghai, 200000, China
| | - Wangyi Fang
- Department of Ophthalmology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Lu Ding Road # 355, Shanghai, 200000, China
| | - Yanli Dong
- Department of Ophthalmology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Lu Ding Road # 355, Shanghai, 200000, China
| | - Zilei Wang
- Department of Ophthalmology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Lu Ding Road # 355, Shanghai, 200000, China
| | - Tong Qiao
- Department of Ophthalmology, Shanghai Children's Hospital, School of Medicine, Shanghai Jiao Tong University, Lu Ding Road # 355, Shanghai, 200000, China.
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Li H, Li T, Fan Y, Zheng B, Zhao Y. A survey on the willingness of outpatients to participate in fundus examination procedures conducted by ophthalmology training residents in China: A cross-sectional study. Health Sci Rep 2024; 7:e1870. [PMID: 38357492 PMCID: PMC10864684 DOI: 10.1002/hsr2.1870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 01/09/2024] [Accepted: 01/17/2024] [Indexed: 02/16/2024] Open
Abstract
Background and Aims The National Standardized Training for Resident Doctors (STRD) in mainland China encounters many challenges in its implementation. To investigate whether outpatients are willing to undergo indirect ophthalmoscopy examination conducted by ophthalmology residents in the ophthalmology STRD program in China. Methods This study conducted a cross-sectional survey at the Eye Hospital of Wenzhou Medical University between September 2021 and September 2023. A cohort of 300 initial outpatients requiring indirect ophthalmoscopy examinations were enlisted from the outpatient department. Based on whether the patients are willing to undergo an indirect ophthalmoscopy examination by resident doctors, patients were divided into two groups: Group 1 (willing) and Group 2 (unwilling), and their questionnaire responses were comparatively analyzed. Results A total of 261/300 (87%) valid questionnaires were returned in the survey, which included 149 males and 112 females. No notable gender difference (p = 0.400) or disparity in medical expense categories (p = 0.786) was observed between the two groups. However, variables such as outpatient marital status (p = 0.002), the presence of training faculty during fundus examinations with residents and outpatients (p < 0.001), the demeanor of training residents toward patients (p < 0.001), and the quality of doctor-patient communication (p < 0.001) significantly varied between the groups. Conclusion The level of outpatients' cooperation with ophthalmology residents during fundus examinations in the Chinese ophthalmology STRD program was observed to be low. Enhancing the presence of training faculty during examinations and enhancing the communication skills of training residents could significantly improve this situation.
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Affiliation(s)
- Haidong Li
- National Clinical Research Center for Ocular Diseases, Eye HospitalWenzhou Medical UniversityWenzhouChina
| | - Tiankun Li
- Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Institute, Tianjin Eye Hospital, School of MedicineNankai UniversityTianjinChina
| | - Yuanyuan Fan
- National Clinical Research Center for Ocular Diseases, Eye HospitalWenzhou Medical UniversityWenzhouChina
| | - Bin Zheng
- National Clinical Research Center for Ocular Diseases, Eye HospitalWenzhou Medical UniversityWenzhouChina
| | - Yun‐e Zhao
- National Clinical Research Center for Ocular Diseases, Eye HospitalWenzhou Medical UniversityWenzhouChina
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Yu Y, Ding Y, Paulus YM, Jiang H. Attitudes toward ophthalmology as a prospective career among pre-clinical medical students in China. BMC MEDICAL EDUCATION 2023; 23:539. [PMID: 37507723 PMCID: PMC10375776 DOI: 10.1186/s12909-023-04518-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023]
Abstract
BACKGROUND A questionnaire was developed and administered to 450 medical students at the Xiangya Medical College, Central South University in Changsha, China to understand the attitudes among medical students in China toward different medical specialties and to find the factors that influenced their choice of career in ophthalmology. PARTICIPANTS Fourth-year medical students in the five-year program and sixth-year medical students in the eight-year program. METHODS All the students were asked to rate the importance of nine possible factors in choosing a specialty as their vocation and their first ranked future specialty career choice. RESULTS When asked about the reasons for choosing to go to medical school, the top four reasons are the ability to help patients, interesting and challenging work, prestige, and job stability. When asked about the reasons for choosing a specialty, the top four reasons are the ability to find employment, financial reward, career upward mobility, and professional pressure. About the first career choice of the future specialty, for clinical medicine students, ophthalmology is the fifth ranked choice for clinical medicine students. 5.6% (five-year) and 3.4% (eight-year) of them choose ophthalmology as their top ranked specialty for their career. For anesthesia medicine and oral medicine students, most of them preferred to choose the same specialty as before. 1.5% (anesthesia) and 4.5% (oral) of them chose ophthalmology as their top ranked specialty. CONCLUSIONS Medical students in China have numerous factors that motivate their choice in a specialty. Ophthalmology is the fifth ranked choice among clinical medicine students.
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Affiliation(s)
- Yixin Yu
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan Province, China
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan Province, China
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA
| | - Yi Ding
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan Province, China
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan Province, China
| | - Yannis M Paulus
- Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, MI, USA.
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA.
| | - Haibo Jiang
- Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan Province, China.
- Hunan Key Laboratory of Ophthalmology, Changsha, Hunan Province, China.
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Tan RJD. Shortening Training Duration to Address the Insufficiency of Ophthalmologists: A Deeper Look at the China Experience. ACTA MEDICA PHILIPPINA 2023; 57:77-80. [PMID: 39483293 PMCID: PMC11522578 DOI: 10.47895/amp.vi0.5989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/03/2024]
Abstract
The availability of ophthalmologists is vital to making eyecare accessible to everyone. Medical education and ophthalmology residency training in China was reduced to address the high demand for ophthalmologists. This is something the Philippines can consider to increase the number of ophthalmologists in the country. However, decreasing the duration, together with insufficient monitoring of medical education and ophthalmology residency training, were not without consequences in eyecare in China.
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Affiliation(s)
- Roland Joseph D. Tan
- Department of Ophthalmology and Visual Sciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila
- National Teacher Training Center for the Health Professions, University of the Philippines Manila
- Department of Ophthalmology, Baguio General Hospital and Medical Center
- Southern Isabela Medical Center, Santiago, Isabela
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Dong J, Wang X, Wang X, Li J. A practical continuous curvilinear capsulorhexis self-training system. Indian J Ophthalmol 2021; 69:2678-2686. [PMID: 34571614 PMCID: PMC8597480 DOI: 10.4103/ijo.ijo_210_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose To describe a practical, self-assembled continuous curvilinear capsulorhexis (CCC) self-training system to facilitate resident self-training and shorten the CCC learning curve. Methods This was a prospective experimental study that included a total of 600 capsulorhexis cases. A device for CCC practice was self-assembled and used for training and testing. Based on capsulorhexis manipulation experience, three main groups of residents (A, capsulorhexis experience with <50 cases; B, capsulorhexis experience with 400-500 cases; and C, capsulorhexis experience with >1000 cases) were created. Furthermore, based on different capsulorhexis conditions, each main group was divided into four subgroups (1, CCC without an anterior chamber cover and capsulorhexis marker; 2, CCC with an anterior chamber cover without a capsulorhexis marker; 3, CCC with an anterior chamber cover and a capsulorhexis marker; and 4, CCC with an anterior chamber cover and a capsulorhexis marker under 2.5 times magnification). Three CCC-related parameters, including acircularity index (AI), axis ratio (AR), and capsulorhexis time, were statistically evaluated. Results We compared the differences in study parameters among 50 consecutively completed capsulorhexis cases by one trainee with different capsulorhexis experience in each subgroup. The CCC-related parameter values in subgroups 1 and 4 were significantly different among the three groups (P < 0.001). The capsulorhexis time in subgroup 2 was significantly different among the three groups (P < 0.001). The capsulorhexis time and AI in subgroup 3 were significantly different among the three groups (P < 0.001). Moreover, with increasing manipulation experience (from group A-C), the capsulorhexis time, the AI, and AR tended to decrease. With the help of the CCC marker, in subgroups 3 and 4, the AI and AR were closer to 1.0. Conclusion This self-assembled CCC self-training system is practical. The CCC marker seems helpful for size specification and centration during self-training.
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Affiliation(s)
- Jing Dong
- The First Hospital of Shanxi Medical University, Taiyuan, Shanxi, P.R. China
| | - Xiaogang Wang
- Shanxi Eye Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi, P.R. China
| | - Xiaoliang Wang
- School of Aeronautics and Astronautics, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Junhong Li
- Shanxi Eye Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi, P.R. China
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Lens Opacities Classification System III-based artificial intelligence program for automatic cataract grading. J Cataract Refract Surg 2021; 48:528-534. [PMID: 34433780 DOI: 10.1097/j.jcrs.0000000000000790] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 08/15/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To establish and validate an artificial intelligence (AI)-assisted automatic cataract grading program based on the Lens Opacities Classification System III (LOCSIII). SETTING Eye and Ear, Nose, and Throat (EENT) Hospital, Fudan University, Shanghai, China. DESIGN AI training. METHODS Advanced deep-learning algorithms, including Faster R-CNN and ResNet, were applied to the localization and analysis of the region of interest. An internal dataset from the EENT Hospital of Fudan University and an external dataset from the Pujiang Eye Study were used for AI training, validation, and testing. The datasets were automatically labeled on the AI platform in terms of the capture mode and cataract grading based on the LOCSIII system. RESULTS The AI program showed reliable capture mode recognition, grading, and referral capability for nuclear and cortical cataract grading. In the internal and external datasets, 99.4% and 100% of automatic nuclear grading, respectively, had an absolute prediction error of ≤ 1.0, with a satisfactory referral capability (area under the curve [AUC]: 0.983 for the internal dataset; 0.977 for the external dataset). 75.0% (internal dataset) and 93.5% (external dataset) of the automatic cortical grades had an absolute prediction error of ≤ 1.0, with AUCs of 0.855 and 0.795 for referral, respectively. Good consistency was observed between automatic and manual grading when both nuclear and cortical cataracts were evaluated. However, automatic grading of posterior subcapsular cataracts was impractical. CONCLUSIONS The AI program proposed in this study shows robust grading and diagnostic performance for both nuclear and cortical cataracts, based on LOCSIII.
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Gogate PM, Biswas P, Honavar SG, Sharma N, Sinha R, Sachdev MS, Verma L, Nayak BK, Natarajan S. Ophthalmology residency trainers' perspective on standardization of residency training in India. Indian J Ophthalmol 2021; 69:836-841. [PMID: 33727442 PMCID: PMC8012940 DOI: 10.4103/ijo.ijo_2358_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose The aim of this study was to study the perception of residency trainers about an optimum residency program. Methods A survey, using a pre-validated questionnaire, was conducted by the Academic and Research Committee of the All India Ophthalmological Society, in 2019-20 with questions directed to teachers in medical colleges and national board of examination's ophthalmology residency programs on demography, teaching experience, imparting clinical and surgical skills, ideal academic schedule and dissertation in the post-graduate residency program. Results The response rate in the survey was 47.6%. Valid responses were obtained from 309 residency trainers. Of these, 132 of 309 (42.7%) were females. The mean age was 45.3 ± 9.5 years, range 26-68 years. The trainers believed that on a scale of 0-10, clinical skills teaching should be taught, mean ± SD: slit lamp 9.8 ± 0.7; indirect ophthalmoscopy 9.3 ± 1.3; gonioscopy 9.2 ± 1.5; perimetry 8.9 ± 1.5; OCT 8.4 ± 1.9; applanation tonometry 9.5 ± 1.2 and orthoptic evaluation 8.1 (±1.9). A resident should ideally perform independently surgeries (median, inter-quartile range IQR): SICS 50 (IQR 40-100); phaco 50 (20-60); pterygium excision 20 (10-40); DCR 10 (5-20); chalazion 20 (10-50), trabeculectomy 7 (5-15); strabismus 5 (2-10), LASIK and retinal detachment 0. Ideally there should be four lectures, four seminars, four case presentations, five journal clubs and four wet labs every month. Conclusion Teachers expected their wards to become competent professionals. There was near unanimity about the content of clinical skills training, non-medical skills and academics, but there was a significant variation on extent of surgical training that should be imparted to the residents.
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Affiliation(s)
- Parikshit Madhav Gogate
- Community Eye Care Foundation, Dr. Gogate's Eye Clinic, Pune; Department of Ophthalmology, D. Y. Patil Medical College, Pimpri, Pune, Maharashtra, India; School of Medicine, Dentistry and Biomedical Engineering, Queens University, Belfast, United Kingdom
| | | | | | - Namrata Sharma
- Cornea & Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Sinha
- Cornea, Lens and Refractive Surgery Services, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | | | - Lalit Verma
- Retina Services, Centre for Sight, New Delhi, India
| | - Barun Kumar Nayak
- Department of Ophthalmology, P. D. Hinduja Hospital and Research Centre, Mumbai, Maharashtra, India
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Geary A, Wen Q, Adrianzén R, Congdon N, Janani R, Haddad D, Timbo CS, Khalifa YM. The impact of distance cataract surgical wet laboratory training on cataract surgical competency of ophthalmology residents. BMC MEDICAL EDUCATION 2021; 21:219. [PMID: 33874941 PMCID: PMC8054504 DOI: 10.1186/s12909-021-02659-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 04/05/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND This study assessed the impact of distance cataract surgical wet laboratory training on surgical competency of ophthalmology residents at a tertiary-level ophthalmic training center in Trujillo, Peru. METHODS Three five-week distance wet lab courses were administered through Cybersight, Orbis International's telemedicine platform. Weekly lectures and demonstrations addressed specific steps in phacoemulsification surgery. Each lecture had two accompanying wet lab assignments, which residents completed and recorded in their institution's wet lab and uploaded to Cybersight for grading. Competency was assessed through anonymous grading of pre- and post-training surgical simulation videos, masked as to which occurred before and after training, using a standardized competency rubric adapted from the Ophthalmology Surgical Competency Assessment Rubric (OSCAR, scale of 0-32). Day one best-corrected post-operative visual acuity (BVCA) was assessed in the operative eye on the initial consecutive 4-6 surgeries conducted by the residents as per the norms of their residency training. An anonymous post-training satisfaction survey was administered to trainees'. RESULTS In total, 21 ophthalmic residents participated in the courses, submitting a total of 210 surgical videos. Trainees' average competency score increased 6.95 points (95%CI [4.28, 9.62], SD = 5.01, p < 0.0001, two sample t-test) from 19.3 (95%CI [17.2, 21.5], SD = 4.04) to 26.3 (95%CI [24.2, 28.3], SD = 3.93). Visual acuity for 92% of post-training resident surgeries (n = 100) was ≥20/60, meeting the World Health Organization's criterion for good quality. CONCLUSIONS Structured distance wet lab courses in phacoemulsification resulted in significantly improved cataract surgical skills. This model could be applicable to locations where there are obstacles to traditional in-person training, such as the current COVID-19 pandemic.
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Affiliation(s)
- Amelia Geary
- Orbis International, 520 8th Avenue, Floor 12, New York, NY, 10018, USA.
| | - Qing Wen
- Centre for Public Health, Queen's University Belfast, Belfast, BT12 6BJ, Northern Ireland
| | - Rosa Adrianzén
- Instituto Regional de Oftalmología Javier Servat Univazo, Trujillo, La Libertad, Peru
- Universidad Nacional de Trujillo, Trujillo, La Libertad, Peru
| | - Nathan Congdon
- Orbis International, 520 8th Avenue, Floor 12, New York, NY, 10018, USA
| | - R Janani
- Aravind eye hospital, Madurai, Tamil Nadu, 625020, India
| | - Danny Haddad
- Orbis International, 520 8th Avenue, Floor 12, New York, NY, 10018, USA
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12
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Dean WH, Gichuhi S, Buchan JC, Makupa W, Mukome A, Otiti-Sengeri J, Arunga S, Mukherjee S, Kim MJ, Harrison-Williams L, MacLeod D, Cook C, Burton MJ. Intense Simulation-Based Surgical Education for Manual Small-Incision Cataract Surgery: The Ophthalmic Learning and Improvement Initiative in Cataract Surgery Randomized Clinical Trial in Kenya, Tanzania, Uganda, and Zimbabwe. JAMA Ophthalmol 2021; 139:9-15. [PMID: 33151321 PMCID: PMC7645744 DOI: 10.1001/jamaophthalmol.2020.4718] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 09/21/2020] [Indexed: 02/06/2023]
Abstract
Importance Cataracts account for 40% of cases of blindness globally, with surgery the only treatment. Objective To determine whether adding simulation-based cataract surgical training to conventional training results in improved acquisition of surgical skills among trainees. Design, Setting, and Participants A multicenter, investigator-masked, parallel-group, randomized clinical educational-intervention trial was conducted at 5 university hospital training institutions in Kenya, Tanzania, Uganda, and Zimbabwe from October 1, 2017, to September 30, 2019, with a follow-up of 15 months. Fifty-two trainee ophthalmologists were assessed for eligibility (required no prior cataract surgery as primary surgeon); 50 were recruited and randomized. Those assessing outcomes of surgical competency were masked to group assignment. Analysis was performed on an intention-to-treat basis. Interventions The intervention group received a 5-day simulation-based cataract surgical training course, in addition to standard surgical training. The control group received standard training only, without a placebo intervention; however, those in the control group received the intervention training after the initial 12-month follow-up period. Main Outcomes and Measures The primary outcome measure was overall surgical competency at 3 months, which was assessed with a validated competency assessment rubric. Secondary outcomes included surgical competence at 1 year and quantity and outcomes (including visual acuity and posterior capsule rupture) of cataract surgical procedures performed during a 1-year period. Results Among the 50 participants (26 women [52.0%]; mean [SD] age, 32.3 [4.6] years), 25 were randomized to the intervention group, and 25 were randomized to the control group, with 1 dropout. Forty-nine participants were included in the final intention-to-treat analysis. Baseline characteristics were balanced. The participants in the intervention group had higher scores at 3 months compared with the participants in the control group, after adjusting for baseline assessment rubric score. The participants in the intervention group were estimated to have scores 16.6 points (out of 40) higher (95% CI, 14.4-18.7; P < .001) at 3 months than the participants in the control group. The participants in the intervention group performed a mean of 21.5 cataract surgical procedures in the year after the training, while the participants in the control group performed a mean of 8.5 cataract surgical procedures (mean difference, 13.0; 95% CI, 3.9-22.2; P < .001). Posterior capsule rupture rates (an important complication) were 7.8% (42 of 537) for the intervention group and 26.6% (54 of 203) for the control group (difference, 18.8%; 95% CI, 12.3%-25.3%; P < .001). Conclusions and Relevance This randomized clinical trial provides evidence that intense simulation-based cataract surgical education facilitates the rapid acquisition of surgical competence and maximizes patient safety. Trial Registration Pan-African Clinical Trial Registry, number PACTR201803002159198.
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Affiliation(s)
- William H. Dean
- International Centre for Eye Health, Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Division of Ophthalmology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Stephen Gichuhi
- Department of Ophthalmology, University of Nairobi, Kenyatta National Hospital, Nairobi, Kenya
| | - John C. Buchan
- International Centre for Eye Health, Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Agrippa Mukome
- Department of Ophthalmology, Parirenyatwa Hospitals, University of Zimbabwe, Harare, Zimbabwe
| | - Juliet Otiti-Sengeri
- Department of Ophthalmology, Makerere University School of Medicine, Kampala, Uganda
| | - Simon Arunga
- International Centre for Eye Health, Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Mbarara University and Referral Hospital Eye Centre, Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Min J. Kim
- Tropical Epidemiology Group, Faculty of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - David MacLeod
- Tropical Epidemiology Group, Faculty of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Colin Cook
- Division of Ophthalmology, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Matthew J. Burton
- International Centre for Eye Health, Clinical Research Department, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Moorfields Eye Hospital, London, United Kingdom
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Li R, Yang Y, Wu S, Huang K, Chen W, Liu Y, Lin H. Using artificial intelligence to improve medical services in China. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:711. [PMID: 32617331 PMCID: PMC7327308 DOI: 10.21037/atm.2019.11.108] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Artificial intelligence (AI) is one hotspot of research in the field of modern medical technology. Medical AI has been applied to various areas and has two main branches including virtual and physical. Recently, Chinese State Council issued a guideline on developing AI and indicated that the widespread application of AI will improve the level of precision in medical services and achieve the intelligent medical care. Medical resources, especially the high-quality resources, are deficient across the entire health service system in China. AI technologies, such that virtual AI and telemedical technology, are expected to overcome the current limitations of the distribution of medical resources and relieve the pressure associated with obtaining high-quality health care.
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Affiliation(s)
- Ruiyang Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yahan Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Shaolong Wu
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Kai Huang
- School of Data and Computer Science, Sun Yet-sen University, Guangzhou, China
| | - Weirong Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yizhi Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Center for Precision Medicine, Sun Yat-sen University, Guangzhou, China
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Wang YE, Zhang C, Chen AC, Pineles S, Hou J. Current Status of Ophthalmology Residency Training in China: The Experience From Well-Structured Centers Around the Country. Asia Pac J Ophthalmol (Phila) 2020; 9:369-373. [PMID: 32501893 DOI: 10.1097/apo.0000000000000284] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Chinese ophthalmology residency training is continuously evolving with an emphasis on standardization. In this article, we assess the current status of ophthalmology residency training in China compared with that in the United States through analysis of literature review and onsite data collection. We comprehensively review various aspects of the residency training structure in China, including accreditation, resident selection, clinical and surgical curricula, research requirements, and evaluation. Our report demonstrates significant regional differences among training programs due to the lack of a national standard, resulting in varying competencies of graduating Chinese ophthalmology residents. The Chinese ophthalmology community is determined to improve the standardization process and quality of training for their ophthalmologists, an important goal that will facilitate international fellowship studies, exchange scholars, and research collaboration.
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Affiliation(s)
- Ye Elaine Wang
- Stein Eye Institute, UCLA Department of Ophthalmology, Los Angeles, CA
- Bascom Palmer Eye Institute, University of Miami, Coral Gables, FL
- Harvard Eye Associates, Laguna Hills, CA
| | - Chuan Zhang
- Department of Ophthalmology, People's Hospital, Peking University, Beijing, China
| | | | - Stacy Pineles
- Stein Eye Institute, UCLA Department of Ophthalmology, Los Angeles, CA
- UCLA GSM
| | - Jing Hou
- Department of Ophthalmology, People's Hospital, Peking University, Beijing, China
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15
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Chen SX, Fan K, Leung LP. Epidemiological characteristics and disease spectrum of emergency patients in two cities in China: Hong Kong and Shenzhen. World J Emerg Med 2020; 11:48-53. [PMID: 31893003 DOI: 10.5847/wjem.j.1920-8642.2020.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- Shao-Xi Chen
- Accident and Emergency Department, University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
| | - Karren Fan
- Accident and Emergency Department, University of Hong Kong-Shenzhen Hospital, Shenzhen 518053, China
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Dean W, Gichuhi S, Buchan J, Matende I, Graham R, Kim M, Arunga S, Makupa W, Cook C, Visser L, Burton M. Survey of ophthalmologists-in-training in Eastern, Central and Southern Africa: A regional focus on ophthalmic surgical education. Wellcome Open Res 2019; 4:187. [PMID: 31886411 PMCID: PMC6913214 DOI: 10.12688/wellcomeopenres.15580.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2019] [Indexed: 11/20/2022] Open
Abstract
Background: There are 2.7 ophthalmologists per million population in sub-Saharan Africa, and a need to train more. We sought to analyse current surgical training practice and experience of ophthalmologists to inform planning of training in Eastern, Central and Southern Africa. Methods: This was a cross-sectional survey. Potential participants included all current trainee and recent graduate ophthalmologists in the Eastern, Central and Southern African region. A link to a web-based questionnaire was sent to all heads of eye departments and training programme directors of ophthalmology training institutions in Eastern, Central and Southern Africa, who forwarded to all their trainees and recent graduates. Main outcome measures were quantitative and qualitative survey responses. Results: Responses were obtained from 124 (52%) trainees in the region. Overall level of satisfaction with ophthalmology training programmes was rated as 'somewhat satisfied' or 'very satisfied' by 72%. Most frequent intended career choice was general ophthalmology, with >75% planning to work in their home country post-graduation. A quarter stated a desire to mainly work in private practice. Only 28% of junior (first and second year) trainees felt surgically confident in manual small incision cataract surgery (SICS); this increased to 84% among senior trainees and recent graduates. The median number of cataract surgeries performed by junior trainees was zero. 57% of senior trainees were confident in performing an anterior vitrectomy. Only 29% of senior trainees and 64% of recent graduates were confident in trabeculectomy. The mean number of cataract procedures performed by senior trainees was 84 SICS (median 58) and 101 phacoemulsification (median 0). Conclusion: Satisfaction with post-graduate ophthalmology training in the region was fair. Most junior trainees experience limited cataract surgical training in the first two years. Focused efforts on certain aspects of surgical education should be made to ensure adequate opportunities are offered earlier on in ophthalmology training.
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Affiliation(s)
- William Dean
- International Centre for Eye Health (ICEH), Clinical Research Department Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, WC1E7HT, UK
- Department of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Stephen Gichuhi
- Department of Ophthalmology, University of Nairobi, Nairobi, Kenya
| | - John Buchan
- International Centre for Eye Health (ICEH), Clinical Research Department Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, WC1E7HT, UK
| | - Ibrahim Matende
- College of Ophthalmology of Eastern Central & Southern Africa, Nairobi, Kenya
| | - Ronnie Graham
- International Agency for the Prevention of Blindness, Durban, South Africa
| | - Min Kim
- Tropical Epidemiology Group, Faculty of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Simon Arunga
- International Centre for Eye Health (ICEH), Clinical Research Department Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, WC1E7HT, UK
| | | | - Colin Cook
- Department of Ophthalmology, University of Cape Town, Cape Town, South Africa
| | - Linda Visser
- Department of Ophthalmology, University of KwaZulu-Natal, Durban, South Africa
| | - Matthew Burton
- International Centre for Eye Health (ICEH), Clinical Research Department Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, WC1E7HT, UK
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
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17
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Gogate P, Biswas P, Das T, Nirmalan P, Natarajan S. Ophthalmology residency training in India: Comparing feedback about how the training equips ophthalmologists to combat retinal diseases. READS report #6. Indian J Ophthalmol 2019; 67:1816-1819. [PMID: 31638039 PMCID: PMC6836610 DOI: 10.4103/ijo.ijo_1960_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 05/21/2019] [Accepted: 07/23/2019] [Indexed: 11/04/2022] Open
Abstract
Purpose To document whether the residency training in management of retinal diseases has improved in 2000s to meet the increasing demand of retina care in India. Methods A survey, using a prevalidated questionnaire, was conducted by Academic and Research Committee (ARC) of the All India Ophthalmological Society (AIOS) in 2014-2016 among ophthalmologists to document teaching of retina-related clinical and surgical skills in the postgraduate residency program. Results The 144-item questionnaire was mailed to 4512 practicing ophthalmologists with residency training in two different periods, between 1967 and 2000 (group 1; 20th-century trained) and between 2003 and 2012 (group 2; 21st-century trained). Response was received from 320 (19.1%) of group 1 ophthalmologists and 531 (18.7%) of group 2 ophthalmologists. The average age was 49.2 ± 8.7 and 32.6 ± 4 years, respectively. Group 2 residents had received superior training in indirect ophthalmoscopy, slit lamp biomicroscopy using + 78 and + 90D lens, optical coherence tomography, fundus photography, and fluorescein angiography (all P < 0.001), but there was large variation between the training institutions. The residents were not taught vitreous and retinal detachment surgeries in either period of training. Conclusion Teaching of retina-related clinical skills have improved in Indian residency program, but there are variations across programs. This information might help redesign the ophthalmology residency programs to meet the demands of comprehensive eye care and universal health coverage of increasing retinal diseases in India.
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Affiliation(s)
- Parikshit Gogate
- Community Eye Care Foundation, Dr. Gogate's Eye Clinic, Pune, Maharashtra, India
- Department of Ophthalmology, D.Y. Patil Medical College, Pune, Maharashtra, India
| | | | - Taraprasad Das
- L.V. Prasad Eye Institute, Hyderabad, Telangana, India
- L V Prasad, Eye Institute, Bhubaneshwar, Odisha, India
| | - Praveen Nirmalan
- Independent Researcher, Aditya Jyot Eye Hospital, Mumbai, Maharashtra, India
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18
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Majola N. The ophthalmology postgraduate training programme in South Africa: The registrars’ perspective. AFRICAN VISION AND EYE HEALTH 2019. [DOI: 10.4102/aveh.v78i1.493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: In South Africa, to become an ophthalmologist, one must successfully complete a 4-year postgraduate training programme as a registrar. This training has been offered at different institutions around the country for many years without ever being scrutinised.Aim: The aim of this study was to evaluate the training methods and platforms, overall satisfaction levels, problems and solutions pertaining to postgraduate ophthalmology training as identified by ophthalmology registrars.Setting: The study was conducted in all the institutions across South Africa offering ophthalmology postgraduate training.Methods: This was an educational evaluation study. The data collection instrument used was a questionnaire created using SurveyMonkey.com and sent via email to all ophthalmology registrars, including supernumerary candidates. Ethical approval was granted by the university’s Biomedical Research Ethics Committee.Results: There was a 48% response rate to the survey. Registrars were satisfied that they had received adequate teaching and support, although there was room for improvement. The common problems that impacted the quality of training, as cited by the registrars, were staff shortages, large patient numbers as well as old and broken-down infrastructure or equipment. Despite 86% of the registrars spending at least 5–10 h a week in theatre, 13.3% indicated that they had no supervision during that time. Access to teaching materials (journals, library and Internet) was not available to 34% of the respondents.Conclusion: Registrars were generally satisfied with their training, but major problems that negatively affect their time as trainees were highlighted. Cooperation between registrars, universities, heads of departments and the department of health will be important to remedy this situation.
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Dean WH, Grant S, McHugh J, Bowes O, Spencer F. Ophthalmology specialist trainee survey in the United Kingdom. Eye (Lond) 2019; 33:917-924. [PMID: 30710112 DOI: 10.1038/s41433-019-0344-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 11/14/2018] [Accepted: 12/21/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Currently there are a total of 780 post-graduate ophthalmology trainees in the United Kingdom (UK). Post-graduate ophthalmology training in the UK is 7 years in duration, and follows a comprehensive competency-based curriculum. Changes to training have been proposed as part of the government's Shape of Training paper. METHODS UK ophthalmic trainees and trainers, in partnership with the Royal College of Ophthalmologists, designed a national questionnaire to explore the confidence of trainees in different clinical and non-clinical aspects of ophthalmology. The questions and possible responses underwent a process of refinement through the Royal College of Ophthalmologists Training Committee and Trainee Group. An online survey platform was used for the questionnaire, which was sent to all ophthalmology trainees within the UK. Reminders were sent via the Royal College of Ophthalmologists and Regional Training Programme Directors. A 4-week period was allowed for responses. Quantitative data were analysed, and qualitative data analysis included collation and thematisation of free-text responses. RESULTS A total of 188 trainees (24.1% response rate) replied. Ninety-four percent of trainees were in full-time training posts. The most popular career choice was oculoplastics (31.4%), followed by vitreo-retina (25.1%), glaucoma (24.6%) and cornea (24.0%). One-quarter had opted out of the European working time directive (EWTD), and 54.8% agreed that their work contract reflected the number of hours actually worked. In total, 34.4% of trainees thought that ophthalmic specialist training should be shortened from the current 7-year programme. Overall, 79.9% of respondents felt confident in performing phacoemulsification cataract surgery independently. For more senior trainees in years 4-7, 100% felt confident in phacoemulsification. However, overall, only 47.9% were confident in independently performing an anterior vitrectomy (91.1% of final-year trainees). Overall, 77.6% thought that all surgical ophthalmologists should be trained to perform cataract surgery. For non-clinical skills, trainees felt least confident in 'preparing a business case', with 64.5% disagreeing that they felt confident in this task. The most confidence was felt for communication with patients: 100% of trainees (all of whom have completed at least 2 years of medical work following qualification) reported feeling confident. CONCLUSIONS Most doctors in post-graduate specialist training in ophthalmology in the UK aim to specialise in surgical sub-specialities. The subjective reports collected in this survey suggest targets for strengthening of the UK's highly rated training system. Further research is necessary to determine overall satisfaction with training, the effect of changing training within the recent Shape of Training review; and how recent newly imposed junior doctor contracts as well as Brexit affects training.
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Affiliation(s)
- William H Dean
- International Centre for Eye Health, London School of Hygiene and Topical Medicine, London, UK. .,Community Eye Health Institute, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa.
| | - Susannah Grant
- The Royal College of Ophthalmologists, London, UK.,The Royal College of Emergency Medicine, London, UK
| | - Jim McHugh
- Department of Neuro-Ophthalmology, National Hospital for Neurology and Neurosurgery, University College London Hospital NHS Trust, London, UK
| | - Oliver Bowes
- Department of Ophthalmology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Fiona Spencer
- The Royal College of Ophthalmologists, London, UK.,Manchester University NHS Foundation Trust, Manchester, UK
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Gogate P. Effect of wet-laboratory training on resident-performed manual small-incision cataract surgery. Indian J Ophthalmol 2018; 66:798. [PMID: 29785986 PMCID: PMC5989500 DOI: 10.4103/ijo.ijo_702_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Parikshit Gogate
- Department of Ophthalmology, Padmashree D. Y. Patil Medical College; Community Eye Care Foundation, Dr. Gogate's Eye Clinic, Pune, Maharashtra, India
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Biswas P, Gogate PM, Maskati QB, Natarajan S, Verma L, Bansal PK. Residency Evaluation and Adherence Design Study III: Ophthalmology residency training in India: Then and now-Improving with time? Indian J Ophthalmol 2018; 66:785-792. [PMID: 29785984 PMCID: PMC5989498 DOI: 10.4103/ijo.ijo_108_17] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 06/18/2017] [Indexed: 02/05/2023] Open
Abstract
Purpose To gauge the differences in ophthalmology residency training, academic, clinical and surgical, in the last three decades of the 20th century and the first decade of the 21st century. Methods A survey was conducted by the Academic and Research Committee of the All India Ophthalmological Society, in 2014-2016, using a prevalidated questionnaire, which was circulated to ophthalmologists to gauge the practicality of the teaching protocols of clinical and surgical skills during postgraduate residency program. Results Of the 1005 respondents, 320 ophthalmologists who completed residency between 1967 and 2002 (20th century trained) and 531 who completed a residency in 2003-2012 (21st century trained) fulfilled the inclusion criteria. The average age was 49.2 years (standard deviation [SD] 4) and 32.6 years (SD 4), respectively. Twenty-first century trained ophthalmologists rated their training significantly better than the 20th century trained ophthalmologists for slit lamp examination (P = 0.001), indirect ophthalmoscopy, gonioscopy, automated perimetry, optical coherence tomography, and fundus photography (all having P < 0.001), while the 20th century trained rated their teaching of refraction, synoptophore, diplopia charting better (all P < 0.001). The range of grading was 0-10 in all categories. The median number of surgeries performed independently by 20th century and 21st century trained (during their training period) were: intracapsular cataract extraction (ICCE) 10, 0; extracapsular cataract extraction (ECCE) 43, 18; small incision cataract surgery (SICS) 5, 55; phacoemulsification (Phaco) 0, 1; pterygium excision 20, 15; dacryocystectomy 11, 4; dacryocystorhinostomy 11, 2; chalazion 35, 30; trabeculectomies 5, 0; strabismus correction 0, 0; vitrectomy 0, 0; keratoplasty 0, 0; eyelid surgery 6, 2; and ocular emergencies 18, 20. Conclusion Teaching of many clinical skills had improved over decades. Cataract surgery training has shifted from ICCE and ECCE to SICS and Phaco, but other surgeries were still taught sparingly. There was an enormous variation across the country in residency training which needs immediate attention.
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Affiliation(s)
- Partha Biswas
- All India Ophthalmology Society, New Delhi
- B B Eye Foundation, Kolkata, West Bengal, India
| | - Parikshit Madhav Gogate
- All India Ophthalmology Society, New Delhi
- Department of Ophthalmology, Dr. D. Y. Patil Medical College, Pimpri, Pune, India
- Dr. Gogate's Eye Clinic, Pune, India
| | | | - Sundaram Natarajan
- All India Ophthalmology Society, New Delhi
- Aditya Jyot Eye Hospital, Mumbai, India
| | - Lalit Verma
- All India Ophthalmology Society, New Delhi
- Centre for Sight, New Delhi, India
| | - Payal K Bansal
- Medical Education Technology Cell, Maharashtra University of Health Sciences, Nasik, Maharashtra, India
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Gogate P, Biswas P, Natarajan S, Ramamurthy D, Bhattacharya D, Golnik K, Nayak BK. Residency evaluation and adherence design study: Young ophthalmologists' perception of their residency programs - Clinical and surgical skills. Indian J Ophthalmol 2017. [PMID: 28643708 PMCID: PMC5508454 DOI: 10.4103/ijo.ijo_643_16] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Residency training is the basis of good clinical and surgical practice. Purpose: The aim is to know the demographics, training experience, and perception of young ophthalmologists to improve the present residency programs in India. Setting: Young ophthalmologists trained in India. Methods: A survey was conducted by the Academic and Research Committee of the All India Ophthalmology Society, in 2014–2016 of young ophthalmologists (those trained between 2002 and 2012, with 2–10 years' postresidency experience) to gauge teaching of clinical and surgical skills during the postgraduate residency program. Statistical Analysis: Statistical Package for Social Sciences version 16. Results: Of the 1005 respondents, 531 fulfilled inclusion criteria. Average age was 32.6 years (standard deviation [SD] 4). On a scale of 0–10, clinical skills teaching was graded as (mean, SD): Slit lamp examination (7.2, SD 2.8), indirect ophthalmoscopy (6.2, SD 3.3), gonioscopy (5.7, SD 3.4), perimetry (6.2, SD 3.2), optical coherence tomography (4.6, SD 4), and orthoptic evaluation (4.3, SD 3.1). The mean (SD) and median of surgeries performed independently was intracapsular cataract extraction 3.0 (14.9), 0; extracapsular cataract extraction 39.9 (53.2), 18; small incision cataract surgery 75.3 (64.4), 55; phacoemulsification 30 (52.6), 1; pterygium excision 31.5 (43.5), 15; dacryocystectomy 20.3 (38.1), 4; dacryocystorhinostomy 11.7 (26.2), 2; chalazion 46.4 (48.3), 30; trabeculectomies 4 (14.9), 0; strabismus correction 1.4 (4.9), 0; laser-assisted in situ Keratomileusis 1.5 (12.2), 0; retinal detachment 1.5 (12.5), 0; vitrectomy 3.0 (17.0), 0; keratoplasty 5.2 (17.8), 0; eyelid surgery 8.6 (18.9), 2 and ocular emergencies 41.7 (52.4), 20. Observed and assisted surgeries were more common. However, the range of grading was 0–10 in all categories. Conclusion: Residency training in India varies considerably from program to program. Standardization is needed to assure all graduates are competent and render consistent quality of service.
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Affiliation(s)
- Parikshit Gogate
- All India Ophthalmology Society, New Delhi; Padmashree Dr D Y Patil Medical College; Dr. Gogate's Eye Clinic, Community Eye Care Foundation, Pune, Maharashtra, India
| | - Partha Biswas
- All India Ophthalmology Society, New Delhi; BB Eye Foundation, Kolkata, West Bengal, India
| | - Sundaram Natarajan
- All India Ophthalmology Society, New Delhi; Aditya Jyot Eye Hospital, Mumbai, Maharashtra, India
| | - Dandapani Ramamurthy
- All India Ophthalmology Society, New Delhi; The Eye Foundation, Coimbatore, Tamil Nadu, India
| | - Debashish Bhattacharya
- All India Ophthalmology Society, New Delhi; Disha Eye Hospital, Kolkata, West Bengal, India
| | - Karl Golnik
- All India Ophthalmology Society, New Delhi, India; Cincinnati Eye Institute, University of Cincinnati, Cincinnati, Ohio, USA
| | - Barun Kumar Nayak
- All India Ophthalmology Society, New Delhi; Department of Ophthalmology, Hinduja Hospital, Mumbai, Maharashtra, India
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23
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Singman EL, Srikumaran D, Green L, Tian J, McDonnell P. Supervision and autonomy of ophthalmology residents in the outpatient Clinic in the United States: a survey of ACGME-accredited programs. BMC MEDICAL EDUCATION 2017; 17:105. [PMID: 28651531 PMCID: PMC5485577 DOI: 10.1186/s12909-017-0941-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 06/13/2017] [Indexed: 06/09/2023]
Abstract
BACKGROUND The development and demonstration of incremental trainee autonomy is required by the ACGME. However, there is scant published research concerning autonomy of ophthalmology residents in the outpatient clinic setting. This study explored the landscape of resident ophthalmology outpatient clinics in the United States. METHODS A link to an online survey using the QualtricsTM platform was emailed to the program directors of all 115 ACGME-accredited ophthalmology programs in the United States. Survey questions explored whether resident training programs hosted a continuity clinic where residents would see their own patients, and if so, the degree of faculty supervision provided therein. Metrics such as size of the resident program, number of faculty and clinic setting were also recorded. Correlations between the degree of faculty supervision and other metrics were explored. RESULTS The response rate was 94%; 69% of respondents indicated that their trainees hosted continuity clinics. Of those programs, 30% required a faculty member to see each patient treated by a resident, while 42% expected the faculty member to at least discuss (if not see) each patient. All programs expected some degree of faculty interaction based upon circumstances such as the level of training of the resident or complexity of the clinical situation. 67% of programs that tracked the contribution of the clinic to resident surgical caseloads reported that these clinics provided more than half of the resident surgical volumes. More ¾ of resident clinics were located in urban settings. The degree of faculty supervision did not correlate to any of the other metrics evaluated. CONCLUSIONS The majority of ophthalmology resident training programs in the United States host a continuity clinic located in an urban environment where residents follow their own patients. Furthermore, most of these clinics require supervising faculty to review both the patients seen and the medical documentation created by the resident encounters. The different degrees of faculty supervision outlined by this survey might provide a useful guide presuming they can be correlated with validated metrics of educational quality. Finally, this study could provide an adjunctive resource to current international efforts to standardize ophthalmic residency education.
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Affiliation(s)
- Eric L. Singman
- Wilmer Eye Institute General Eye Services Clinic, @ Johns Hopkins Hospital, Wilmer B-29, 600 N. Wolfe St, Baltimore, MD 21287 USA
| | - Divya Srikumaran
- Wilmer Eye Institute General Eye Services Clinic, @ Johns Hopkins Hospital, Wilmer B-29, 600 N. Wolfe St, Baltimore, MD 21287 USA
| | - Laura Green
- Ophthalmology Residency Program Director, Lifebridge Health Krieger Eye Institute, 2411 W. Belvedere Ave, Baltimore, MD 21215 USA
| | - Jing Tian
- Biostatistics Consulting Center, Johns Hopkins University Bloomberg School of Public Health, 615 N. Wolfe St, Room 3148, Baltimore, MD 21287 USA
| | - Peter McDonnell
- Wilmer Eye Institute, @ Johns Hopkins Hospital, Maumenee 727, 600 N. Wolfe St, Baltimore, MD 21287 USA
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24
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Wang B, Congdon N, Bourne R, Li Y, Cao K, Zhao A, Yusufu M, Dong W, Zhou M, Wang N. Burden of vision loss associated with eye disease in China 1990 -2020: findings from the Global Burden of Disease Study 2015. Br J Ophthalmol 2017; 102:220-224. [PMID: 28607177 DOI: 10.1136/bjophthalmol-2017-310333] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 05/02/2017] [Accepted: 05/17/2017] [Indexed: 11/04/2022]
Abstract
AIMS To assess the burden of vision loss due to eye disease in China between 1990 and 2015, and to predict the burden in 2020. METHODS Data from the GBD 2015 (Global Burden of Diseases, Injuries, and Risk Factors Study 2015) were used. The main outcome measures were prevalence and years lived with disability (YLDs) for vision loss due to cataract, glaucoma, macular degeneration, other vision loss, refraction and accommodation disorders and trachoma. RESULTS Prevalence for eye diseases increased steadily from 1990 to 2015, and will increase until 2020. From 1990 to 2015, the most common eye disorder was refraction and accommodation disorders. From 1990 to 2015, the vision loss burden due to eye disease decreased for those aged 0-14 years, and increased for those aged 15 years and above, with the most notable increases occurring among those aged 50 years and above. China ranked 10th when comparing YLDs for vision loss due to eye disease with the other members of the G20 (Group of Twenty, an international forum for the governments from 20 major economies) . Age-standardised YLD rates for vision loss due to eye disease declined in all 19 countries, except for China. The burden from vision loss due to eye disease ranked 12th and 11th among all causes of health loss in China in 1990 and 2015, respectively. CONCLUSION Alone among major economies, China has experienced an increase in the burden of age-standardised vision loss from eye disease over the last two decades. In the future, China may expect a growing burden of vision loss due to population growth and ageing.
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Affiliation(s)
- Bingsong Wang
- Beijing Institute of Ophthalmology, Beijing, China.,Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Nathan Congdon
- Centre for Public Health, Queen's University Belfast, Belfast, UK.,Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.,Orbis International, New York, New York, USA
| | - Rupert Bourne
- Vision and Eye Research Unit, Postgraduate Medical Institute, Anglia Ruskin University, Cambridge, UK
| | - Yichong Li
- Clinical Research Institute, Peking University, Beijing, China
| | - Kai Cao
- Beijing Institute of Ophthalmology, Beijing, China
| | - Aiping Zhao
- Beijing Institute of Ophthalmology, Beijing, China
| | | | - Wenlan Dong
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Maigeng Zhou
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Ningli Wang
- Beijing Institute of Ophthalmology, Beijing, China.,Beijing Tongren Hospital, Capital Medical University, Beijing, China
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25
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Jiang Y, Luo L, Congdon N, Wang S, Liu Y. Who will be wielding the lancet for China's patients in the future? Lancet 2016; 388:1952-1954. [PMID: 27751402 DOI: 10.1016/s0140-6736(16)31792-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 09/04/2016] [Accepted: 09/08/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Yuzhen Jiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China; UCL Institute of Ophthalmology, University College London and Moorfields Eye Hospital, London, UK
| | - Lixia Luo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Nathan Congdon
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China; Orbis International, New York, NY, USA; Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Shenming Wang
- Department of Vascular Surgery, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yizhi Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
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