PURPOSE: To assess primary care practitioners' (PCPs) familiarity with American Academy of Ophthalmology Preferred Practice Pattern (PPP) guidelines on the fre-quency of comprehensive eye examinations (CEEs), and to explore their opinions and practices on counseling and referring patients for CEEs. DESIGN: Cross-sectional study. METHODS: Between February 1, 2019, and June 25, 2019, an anonymous survey was emailed to clinicians holding an MD, DO, PA, or NP degree, and residents at Brigham and Women's Hospital and the University of Oklahoma. Descriptive statistics of participants' re-sponses were reported.RESULTS: Regarding patient counseling on CEEs, 15.4% of PCPs reported "always," 48.1% "usually," and 36.5% "seldom" or "never" doing so. Few PCPs (11.1%) reported being able to describe the guidelines, and 63.9% were unaware of their existence. A strong majority of PCPs (90.7%) correctly referred a type 2 diabetic patient at their time of diagnosis, but a similar majority (77.8%) prematurely referred a newly diagnosed type 1 diabetic patient. One in 7 PCPs (13.4%) would refer a patient with family history of glaucoma only upon developing visual/ocular symptoms. Compared to other providers, PAs/NPs were more likely to recommend unnecessary CEEs for low-risk individuals ( P = .009), whereas resi-dents counseled patients less frequently ( P = .003), were less likely to be familiar with PPP guidelines ( P = .026), and were less likely to recommend appropriate follow-ups for patients with family history of glaucoma ( P = .004).CONCLUSIONS: PCPs' awareness of and familiarity with AAO CEE guidelines is variable and improves with provider age and experience. Efforts to improve PCP guideline awareness may be especially well suited to res-idents and mid-level practitioners. (Am J Ophthalmol 2023;247: 127-136.(c) 2022 Elsevier Inc. All rights re-served.)

This case report describes a diagnosis of lamellar and sutural cataract in a patient with a history of poorly controlled type 2 diabetes who presented with bilateral visual decline and significant glare and haloes around lights.

Purpose: To explore surgeons' perspectives and practice patterns in gray area surgical complications (GASCs) within cataract surgery. Setting: Tertiary care academic referral center. Design: Retrospective observational cross-sectional study. Methods: An anonymous, online survey consisting of 11 potential intraoperative GASC scenarios was developed and distributed to practicing and resident ophthalmologists in the U.S. Demographic data such as gender, experience, and practice settings were recorded. Using a Likert scale, respondents scaled their perception of likelihood that a GASC could lead to postoperative complications and their obligation toward patient disclosure and documentation in the operative report. Respondents also scaled their likelihood of agreement with a series of statements inserted to assess baseline anxiety levels and inherent perspectives regarding disclosure. Results: 389 responses were analyzed. Female surgeons were more likely than male surgeons to disclose GASCs to their patients and experience psychological anxiety regarding patient outcomes. Both early- and late-stage residents were more likely to believe that GASCs could lead to vision-limiting outcomes when compared with attending surgeons. Surgeons at academic centers were more likely than community-based surgeons to disclose GASCs in the operative report and experience psychological anxiety regarding patient outcomes. Conclusions: Significant differences based on gender, practice setting, and level of experience exist in disclosure and documentation of intraoperative GASCs. Additional studies are needed to further explore reasons for these differences, as reporting patterns may affect patient satisfaction, medicolegal risks, and postoperative surgeon-experienced anxiety.

ObjectiveTo identify factors that contribute to missed cataract surgery follow-up visits, with an emphasis on socioeconomic and demographic factors.MethodsIn this retrospective cohort study, patients who underwent cataract extraction by phacoemulsification at Massachusetts Eye and Ear between 1 January and 31 December 2014 were reviewed. Second eye cases, remote and international patients, patients with foreign insurance and combined cataract cases were excluded.ResultsA total of 1931 cases were reviewed and 1089 cases, corresponding to 3267 scheduled postoperative visits, were included. Of these visits, 157 (4.8%) were missed. Three (0.3%) postoperative day 1, 40 (3.7%) postoperative week 1 and 114 (10.5%) postoperative month 1 visits were missed. Age<30 years (adjusted OR (aOR)=8.2, 95% CI 1.9 to 35.2) and ≥90 years (aOR=5.7, 95% CI 2.0 to 15.6) compared with patients aged 70–79 years, estimated travel time of >2 hours (aOR=3.2, 95% CI 1.4 to 7.4), smokers (aOR=2.7, 95% CI 1.6 to 4.8) and complications identified up to the postoperative visit (aOR=1.4, 95% CI 1.0 to 2.1) predicted a higher rate of missed visits. Ocular comorbidities (aOR=0.7, 95% CI 0.5 to 1.0) and previous visit best-corrected visual acuity (BCVA) of 20/50–20/80 (aOR=0.4, 95% CI 0.3 to 0.7) and 20/90–20/200 (aOR=0.4, 95% CI 0.2 to 0.9), compared with BCVA at the previous visit of 20/40 or better, predicted a lower rate of missed visits. Gender, race/ethnicity, language, education, income, insurance, alcohol use and season of the year were not associated with missed visits.ConclusionsMedical factors and demographic characteristics, including patient age and distance from the hospital, are associated with missed follow-up visits in cataract surgery. Additional studies are needed to identify disparities in cataract postoperative care that are population-specific. This information can contribute to the implementation of policies and interventions for addressing them.

ow naded rom http:urnals.lw w om crs by hD M fePH bH 4TIm qeA+lpW IIBonhQ l60EtgYrLzSPu+hQ eJnbN aBfon 086/2021 Downloadedfromhttp://journals.lww.com/jcrsbyBhDMf5ePHKbH4TTImqenVA+lpWIIBvonhQl60EtgtdlLYrLzSPu+hQedJnbNaXBfon08/06/2021 valuable operating room resources. We agree that predicting operative time in cataract surgery is complex and that simply identifying high-risk preoperative clinical characteristics will not be adequate for developing a predictive model. We do, however, believe that these clinical characteristics in addition to knowledge of surgeon-specific factors will be essential elements of any future predictive model.—K. Matthew McKay, MD, Durga S. Borkar, MD, Giannis A. Moustafa, MD, Miriam J. Haviland, MSPH, Carolyn E. Kloek, MD, the PCIOL Study Group.

PURPOSE:To quantify the resident learning curve for cataract surgery using operative time as an indicator of surgical competency, to identify the case threshold at which marginal additional educational benefit became equivocal, and to characterize heterogeneity in residents' pathways to surgical competency. SETTING:Academic medical center. DESIGN:Large-scale retrospective consecutive case series. METHODS:All cataract surgery cases performed by resident physicians as primary surgeon at Massachusetts Eye and Ear from July 1, 2010, through June 30, 2015, were reviewed. Data were abstracted from Accreditation Council for Graduate Medical Education case logs and operative time measurements. A linear mixed-methods analysis was conducted to model changes in residents' cataract surgery operative times as a function of sequential case number, with resident identity included as a random effect in the model to normalize between-resident variability. RESULTS:A total of 2096 cases were analyzed. A marked progressive decrease in operative time was noted for resident cases 1 to 39 (mean change -0.17 minutes per additional case, 95% CI, -0.21 to -0.12; P < .001). A modest, steady reduction in operative time was subsequently noted for case numbers 40 to 149 (mean change -0.05 minutes per additional case, 95% CI, -0.07 to -0.04; P < .001). No statistically significant improvement was found in operative times beyond the 150th case. CONCLUSIONS:Residents derived educational benefit from performing a greater number of cataract procedures than current minimum requirements. However, cases far in excess of this threshold might have diminishing educational return in residency. Educational resources currently used for these cases might be more appropriately devoted to other training priorities.

We read with interest the recent publication by McKay et al. on the use of preoperative clinical variables for predicting cataract operative time.1 Although improved operating room utilization is a worthwhile endeavor that can improve healthcare productivity and save costs, it seems that several aspects relating to the data analysis preclude any real-world conclusions from being drawn. The first aspect of concern is the exclusion of cases primarily attended by a resident, which typically take longer regardless of any high-risk preoperative characteristics. The second and more important aspect is the fact that the authors adjusted their results for the surgeon's years of experience or identity, an adjustment that does not occur in real life. As reported by McKay et al., the strongest predictor of operative time was the identity of the surgeon. One might assume that cases with high-risk preoperative characteristics will be assigned to more experienced physicians. In a real-world setting, therefore, high-risk cases operated on by experienced surgeons and low-risk cases operated on by less-experienced surgeons might take similar amounts of time. To test this hypothesis, after receiving approval from the Institutional Review Board, we used a retrospective real-life registry-based cohort of consecutive cataract surgeries performed between August 2016 and April 2019 at the Department of Ophthalmology, Helsinki University Hospital, Helsinki, Finland. At this institution, all operating surgeons were specialists with varying degrees of experience, and cases were assigned based on the preoperative risk assessment to a surgeon based on the level of expertise. Included were 4752 cases in which operative time, preoperative clinical variables, and the surgeon’s identity were recorded. The mean age of the patients was 74.1 ± 10.1 years, and 59% were women. The results show that preoperative clinical variables had a minimal impact on operative time. These included the existence of pseudoexfoliation (21.4 ± 10.2 minutes vs 20.8 ± 11.9 minutes, P = .274), poor mydriasis (21.4 ± 9.9 minutes vs 20.7 ± 12.1 minutes, P = .196), and higher than “simple” preoperative grade according to the referral letter (grades 2 or 3 out of 3; 21.2 ± 12.3 vs 19.6 ± 9.4, P < .001). This is presumably due to surgeon selection. Indeed, when incorporating these variables into a linear regression analysis accounting for the surgeon's identity, all these preoperative variables become significantly predictive of operative time (all P < .001), similar to the results of the study by McKay et al. Predicting cataract operative time is complex. In a real-world setting, social and behavioral aspects come into play, which are challenging to incorporate in a statistical analysis. In our experience, surgeon selection plays an important role, which primarily serves to counteract the effect of high-risk preoperative patient characteristics. Using high-risk preoperative characteristics in a straightforward way to determine operating room utilization might, therefore, not work in clinical practice. We agree with McKay et al. that this is an important and pertinent issue and worthy of further discussion.

Objective To describe a stepwise surgical curriculum that was implemented to teach novice surgeons about currently available advanced technology intraocular lenses (ATIOLs) for correction of presbyopia and to report the experiences and surgical results of ATIOL surgery performed by residents who engaged in the curriculum. Design, Setting, and Participants Third-year ophthalmology residents participated in a curriculum incorporating didactic lectures (with objective assessment and wet-lab practice) and observation of attending-performed ATIOL surgeries prior to performing ATIOL surgery as primary surgeon under direct supervision. Post-operative outcomes studied were best corrected distance visual acuity (BCDVA) and uncorrected distance (UDVA), intermediate (UIVA) near (UNVA) visual acuity and correction of astigmatism with at least 3 months of follow-up (POM3+). Residents were also given a survey to assess experiences with the surgical curriculum, preparedness for use of ATIOLs post-residency, and ATIOL practice pattern post-residency. Results A total of 12 residents from four consecutive classes completed the curriculum. Residents overall had a favorable opinion of the curriculum and felt well prepared to use ATIOLs after training. Graduates who currently perform cataract surgery felt comfortable using all available ATIOLs. A total of 100 eyes from 72 patients met the inclusion criteria for analysis in the study. At the POM3+ timepoint, 88% of eyes had UDVA of 20/30 or better, 93% had UIVA of 20/30 or better, and 71.2% had UNVA of 20/30 (J2) or better. Among eyes that received an astigmatism-correcting ATIOL, 91% had <1 diopter of astigmatism after surgery. Conclusion Resident surgeons learned to perform ATIOL surgery (medical knowledge) and achieve strong surgical outcomes (patient care) with all currently available ATIOLs after completion of a stepwise curriculum. Educators may be encouraged to incorporate an ATIOL curriculum based on the results of this study. The curriculum presented is a prototype and may be further improved with future experiences and studies.

Purpose: To identify preoperative clinical characteristics affecting cataract surgery operative time. Setting: Academic center. Design: Large-scale retrospective cohort study. Methods: All cases of cataract extraction by phacoemulsification and intraocular lens insertion performed by Comprehensive Oph-thalmology at Massachusetts Eye and Ear between January 1, 2014, and December 31, 2014, were reviewed. Clinically relevant predictors of operative time were identified a priori, and a multivariate analysis was used to identify which predictors were associated with operative time. To quantify the surgeon effect, 2 regression models were built, one inclusive of surgeon identity and the other with years of experience and the training level of the supervised resident instead of identity. Results: Overall, 1349 cataract surgeries in 1072 patients were included. The mean operative time was 22.1 +/- 7.8 minutes. Multiple clinical factors were significantly associated with operative time, with attending surgeon identity being the most important. In the multivariate model with surgeon identity, longer operative time was associated with male sex, increased body mass index, first-eye surgery, left operative eye, advanced cataract, use of iris hooks, use of Malyugin ring, use of trypan blue, history of diabetic retinopathy, short axial length, and shallow anterior chamber depth. The R-2 value for the model inclusive of attending identity was 0.42, significantly higher than the R-2 value of 0.23 for the model exclusive of identity. Conclusion: Preoperative clinical characteristics, such as patient demographics, biometry data, and cataract severity, significantly correlate with operative time. Surgeon identity is highly correlated with operative time. Incorporating these results into predictive algorithms may allow for more predictable surgical scheduling and more efficient use of operative resources. Copyright (C) 2019 Published by Wolters Kluwer on behalf of ASCRS and ESCRS

Each year, thousands of medical students apply for residency training programs in the United States. Students compile their rank lists based on review of program websites, discussions with mentors, peer interactions, and online through blogs and the Student Doctor Network.1 Impressions shared in this way can be outdated and biased. In 2014, Doximity, an online social media platform for medical professionals, attempted to address this lack of reliable data to aid in residency program selection with the release of the Residency Navigator, which is described on its website as "a transparent look into US medical residency programs."2 In this perspective, we address the accuracy and the source of information represented on the Residency Navigator, and suggest improvements to offer reliable data on residency programs.The Residency Navigator allows medical students to learn more about residency programs from 28 different specialties.3 Research suggests that it is frequently used by medical students and changes their application decisions.4,5 A webpage for each residency program contains both qualitative and quantitative data about the program. Specifically, Doximity administers a "satisfaction survey" of recent alumni and shares those responses in short and long comment forms, and a "reputation survey" in which physicians list the 5 programs nationwide that provide the best clinical training within their specialty.3The process of reputation ranking has raised concerns among educators in a variety of fields of training, in part because it favors larger, more established programs with a strong alumni voice. Wilson and colleagues compared reputation ranking to outcomes (board pass rate and alumni publications) for 218 surgical programs and found only a moderate association, cautioning trainees about reliance on reputation ranking.6 Ashack and colleagues compared the rankings for dermatology on Doximity with those on another website that accounts for scholarly publication and found that the rankings only overlapped 50%.7 Medical students are aware of the weaknesses of reputation ranking; in one survey over 50% had doubts about its accuracy. Despite this, 60% of those students stated that the Doximity reputation rankings influenced their applications to residency programs.8 The Residency Navigator provides quantitative outcomes for each program in addition to reputation ranking, which includes but is not limited to research output, board pass rates, percent board certified, and subspecialty percentages.3 However, in our experience, these values are not always accurate.In July 2017, our program noticed that the board certification rate and subspecialist (fellowship trained) percentage for our alumni represented on Doximity were both lower than we expected based on our own data. We reached out to the company and requested information about the numbers they were using to generate this data and initiated an effort to understand the rates reported for our program. Initial discussions revealed that some physicians on Doximity had been wrongly attributed to our program and that other data had not been updated according to the latest publically available data. Doximity promptly changed our program's data online when we pointed this out, but would not provide the underlying raw data we requested. Given the inaccuracy of the first set of data that we received and the inability to review the underlying data, there is sufficient reason to question the integrity of the quantitative information that is being publicly shared for all programs, including ours.As educators, we agree wholeheartedly with the need to increase transparency around residency programs and provide information to medical students as they make choices about training. We also believe in transparency in research and accountability in data collection, principles to which any medical outcomes researcher would be subject. Many training programs do not share information about program performance that medical students might find useful in the residency selection process. Doximity has presented its Residency Navigator Tool to fill that important void. However, in doing so, it should adhere to standards of research integrity and transparency in publishing data. We suggest that programs be allowed annually to review the raw data that comprises objective metrics before they are published on Residency Navigator, to ensure accuracy when describing available training programs. Ultimately, residency programs cannot control what is published on social media, but this process would allow programs to provide up-to-date information to improve the accuracy of the tool.At the same time, programs should track and publish their own data for these quality metrics and other program-specific metrics, including qualitative feedback from recent graduates on their residency websites. It can be difficult for programs to quantify all of the important factors that medical students take into account when selecting a program, such as faculty involvement, patient variety, or resident culture.9 However, programs can report their own research output, board pass rates, percent board certified, and subspecialty percentages.Ultimately, there is a need for independent scrutiny of programs, such as that provided by Doximity. However, until there is more robust competition in the marketplace for this service, the risk of inaccurate reporting is real. The Association of American Medical Colleges has introduced more robust tools for researching residency programs online.10 Large-scale efforts like this can provide a check on online platforms and serve as a crucial step in providing transparency and accurate data to potential trainees.

Background: Teleophthalmology is an evidence-based method for diabetic eye screening. It is unclear whether the type of eye care provider performing teleophthalmology interpretation produces significant variability. Introduction: We assessed grading variability between an optometrist, general ophthalmologist, and retinal specialist using images from an urban, diabetic retinopathy teleophthalmology program. Methods: Three readers evaluated digital retinal images in 100 cases (178 eyes from 90 patients with type 2 diabetes). Fisher's exact test, percent agreement, and the observed proportion of positive (P-pos) or negative agreement (P-neg) were used to assess variability. Results: Among cases deemed gradable by all three readers (n = 65), there was substantial agreement on absence of any retinopathy (88% +/- 4.6%, P-neg = 0.91-0.95), presence of moderate nonproliferative or worse retinopathy (87% +/- 3.9%, P-pos = 0.67-1.00), and presence of macular edema (99% +/- 0.9%, P-pos = 0.67-1.00). There was limited agreement regarding presence of referable nondiabetic eye pathology (61% +/- 11%, P-pos = 0.21-0.59) and early, nonroutine referral for a follow-up clinical eye exam (66% +/- 8.1%, P-pos = 0.19-0.54). Among all cases (n = 100), there was acceptable agreement regarding which had gradable images (77% +/- 5.0%, P-pos = 0.50-0.90). Discussion: Inclusion of multiple types of eye care providers as teleophthalmology readers is unlikely to produce significant variability in the assessment of diabetic retinopathy among high-quality images. Greater variability was found regarding image gradability, nondiabetic eye pathology, and recommended clinical referral times. Conclusions: Our results suggest that more extensive training and uniform referral standards are needed to improve consensus on image gradability, referable nondiabetic eye pathology, and recommended clinical referral times.

PURPOSE:To evaluate the effect of a computer-based training program-Massachusetts Eye & Ear ROP Trainer-on residents' knowledge of retinopathy of prematurity (ROP) management. METHODS:In this prospective, randomized study, ophthalmology residents from nine different training programs consented to participate. Those who completed the study were randomly assigned to either the Trainer or the control group. The ROP Trainer was created using clinical cases encompassing the stages of ROP in digital pictures and videos. It includes sections on screening decisions, examination techniques, and diagnosis, and a reference section with the expert video clips and a searchable image library. Subjects in the control group were asked to study standard print material on ROP. A pre- and post-test, consisting of theoretical and practical (diagnosis) questions, and a post-intervention satisfaction test were administered. Accuracy of ROP diagnosis was assessed. RESULTS:A total of 180 residents agreed to participate, of whom 60 completed the study. Residents in the Trainer group had statistically significant improvements (P = 0.003) in ROP knowledge and diagnostic ability (P = 0.005). Residents randomized to the Trainer group were more satisfied with the training materials than were those in the control group. There was no significant difference in improving knowledge by year of training, sex, or country. Considering all training levels, a statistically significant increase was observed in sensitivity for the diagnosis of preplus or worse, zone I or II, ROP stage, category, and aggressive posterior ROP in the Trainer group. CONCLUSIONS:In this study, the Trainer was shown to significantly improve ROP knowledge and diagnostic skills of residents, regardless of sex, year, of training, or country.

PURPOSE:There is limited evidence to inform the optimal follow-up schedule after cataract surgery. This study aims to determine whether a standardized question set can predict unexpected management changes (UMCs) at the postoperative week one (POW1) timepoint. SETTING:Massachusetts Eye and Ear, Harvard Medical School. DESIGN:Prospective cohort study. METHODS:Two-hundred-and-fifty-four consecutive phacoemulsification cases having attended an examination between postoperative days 5-14. A set of 7 'Yes' or 'No' questions were administered to all participants by a technician at the POW1 visit. Patient answers along with perioperative patient information were recorded and analyzed. Outcomes were the incidence of UMCs at POW1. RESULTS:The incidence of UMCs was zero in uneventful cataract cases with unremarkable history and normal postoperative day one exam if no positive answers were given with the question set demonstrating 100% sensitivity (p<0.0001). A test version with 5 questions was equally sensitive in detecting UMCs at POW1 after cataract surgery. CONCLUSION:In routine cataract cases with no positive answers to the current set of clinical questions, a POW1 visit is unlikely to result in a management change. This result offers the opportunity for eye care providers to risk-stratify patients who have had cataract surgery and individualize follow-up.

OBJECTIVES:To evaluate the impact of a comprehensive cataract surgery curriculum on the incidence of intraoperative complications. DESIGN:We retrospectively compared the total number of cataract surgeries that the residents performed in all of the teaching sites, and the incidences of intraoperative complications (anterior capsule tear, posterior capsule rent, vitreous loss, anterior vitrectomy, zonular dialysis, iris trauma, hemorrhage, dropped lens fragment, corneal wound burn, incorrect intraocular lens) for the surgeries performed at Massachusetts Eye & Ear by residents in the pre-intervention group (residents graduating in 2004 and 2005), before the implementation of a surgical curriculum, and the residents in the post-intervention group (residents graduating in 2014 and 2015). SETTING:Ophthalmology residency program at a major academic institution. PARTICIPANTS:Residents graduating in 2004, 2005, 2014, and 2015. RESULTS:We reviewed 4373 charts. 2086 of those surgeries were performed at Massachusetts Eye & Ear. The incidence of posterior capsule rent/vitreous loss/anterior vitrectomy was lower in the post-intervention group (1.4% versus 7.7%, p < 0.0001). Other complications were also lower in the post-intervention group. CONCLUSIONS:Implementation of a comprehensive cataract surgery curriculum focusing on pre-operative, intra-operative and post-operative interventions, with an emphasis on patient outcomes resulted in a decrease in the rate of intraoperative complications.

PURPOSE: To ascertain the incidence of unexpected management changes at the postoperative week 1 visit in asymptomatic patients who have had an uncomplicated cataract surgery and a routine postoperative day 1 examination. DESIGN: Retrospective observational study. METHODS: A retrospective chart review was conducted of all cases of cataract extraction by phacoemulsification with intraocular lens insertion performed by the Comprehensive Ophthalmology Service at Massachusetts Eye and Ear between January 1, 2014 and December 31, 2014. The preoperative consultation, operative report, and postoperative day 1 and week 1 (postoperative days 514) visits were reviewed. Cases with intraoperative complications, as well as clinical findings at postoperative day 1 requiring close follow-up, were excluded. The main outcome measure was incidence of unexpected management changes at the postoperative week 1 visit after cataract surgery, defined as an unanticipated change in postoperative drops, additional procedures, or urgent referral to a specialty service. RESULTS: Overall, 1938 surgical cases of 1471 patients were reviewed, and 1510 cases (77.9%) underwent uncomplicated phacoemulsification with intraocular lens implantation with a routine postoperative day 1 examination. Of these 1510 cases, 238 (15.8%) reported symptoms at the postoperative week 1 visit, including flashes, floaters, redness, pain, or decreased vision, which warranted an examination. In total, 1272 cases were asymptomatic, and only 11 of these cases (0.9%) had an unexpected management change at postoperative week 1. Eight of 11 patients were asymptomatic steroid responders requiring alteration of their postoperative drops. Two of these patients had an intraocular pressure > 30 mm Hg. CONCLUSIONS: Unexpected management changes at the postoperative week 1 timepoint after cataract surgery are rare in asymptomatic patients who have had uncomplicated cataract surgery and a routine postoperative day 1 examination. Limited data are available to outline an optimal postoperative regimen after cataract surgery. The results of this study suggest that postoperative week 1 examinations could potentially be performed on an as-needed basis in the appropriate subgroup of patients after cataract surgery. (C) 2018 Elsevier Inc. All rights reserved.

Borkar, Durga S. MD; Moustafa, Giannis A. MD; Eton, Emily A. MD; Koulisis, Nicole MD; Kloek, Carolyn E. MD the Perioperative Care for Intraocular Lens Study Group Author Information

OBJECTIVE: To conduct a needs assessment to identify gaps in communication skills training in ophthalmology residency programs and to use these results to pilot a communication workshop that prepares residents for difficult conversations.& para;& para;DESIGN: A mixed-methods design was used to perform the needs assessment. A pre-and post-survey was administered to workshop participants.& para;& para;SETTING: Mass Eye and Ear Infirmary, Harvard Medical School (HMS), Department of Ophthalmology.& para;& para;PARTICIPANTS: HMS ophthalmology residents from postgraduate years 2-4 participated in the needs assessment and the workshop. Ophthalmology residency program directors in the United States participated in national needs assessment.& para;& para;METHODS: Ophthalmology program directors across the United States were queried on their perception of resident communication skills training through an online survey. A targeted needs assessment in the form of a narrative exercise captured resident perspectives on communication in ophthalmology from HMS residents. A group of HMS residents participated in the pilot workshop and a pre- and post-survey was administered to participants to assess its effectiveness.& para;& para;RESULTS: The survey of program directors yielded a response rate of 40%. Ninety percent of respondents agreed that the communication skills training in their programs could be improved. Fifteen of 24 residents (62%) completed the needs assessment. Qualitative analysis of the narrative material revealed four themes; (1) differing expectations, (2) work role and environment, (3) challenges specific to ophthalmology, and (4) successful strategies adopted. Nine residents participated in the workshop. There was a significant improvement postworkshop in resident reported scores on their ability to manage their emotions during difficult conversations (p = 0.03).& para;& para;CONCLUSIONS: There is an opportunity to improve communication skills training in ophthalmology residency through formalized curriculum. (C) 2017 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.