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Purpose: To describe the use of the journal club as a tool to teach and assess competency in practice-based learning (PBL) and improvement among residents in ophthalmology. Design: Interventional case series. Participants: Ophthalmology residents. Setting: Three academic ophthalmology residency programs in the United States. Methods: A survey was performed of self-assessed skills in PBL among residents in ophthalmology training before and after the implementation of a structured review checklist during a traditional resident journal club. The survey had 5 domains, including (A) appraise and assimilate evidence, (B) read a journal article critically, (C) use a systematic and standardized checklist, (D) apply knowledge of study designs and statistical methods, and (E) maintain a self-documented written record of compliance. The respondents scored their ability (range, 1–5). Results: The use of a structured journal club tool was associated with a statistically significant improvement in self-assessed ability in all 5 domains. Conclusions: Although validity, reliability, and long-term efficacy studies are necessary, the structured journal club is one method of teaching and assessing resident competency in PBL and improvement. [Copyright &y& Elsevier]

Purpose: To describe the characteristics and outcomes of international medical graduates (IMGs) applying for ophthalmology fellowship match., Methods: Design Case control study. Setting San Francisco Fellowship Match data between 2010 and 2017. Participants IMGs applying for ophthalmology fellowships. Main outcome(s) and measure(s) Applicant characteristics for IMGs were stratified by their match outcome and compared using Chi-Square and Mann-Whitney U test. A multivariable logistic regression model was used to assess the effect of applicant characteristics on their match outcomes., Results: 22.62% (785/3471) of the fellowship match applicants were IMGs of which 35.92% (n = 282) matched. This rate was 58% lower than the 86.4% match rate for US-MG (p < 0.001). Factors associated with higher odds of matching among IMGs were graduating from a US residency (Odds Ratio (OR):2.330; 95% Confidence Interval (CI):1.433-3.789), higher USMLE Step 3 score (OR:1.019; 95% CI: 1.006-1.032), applying to more programs (OR:1.035; 95% CI: 1.017-1.053), ranking more programs (OR:1.200; 95% CI: 1.096-1.313) and having a higher percentage of programs ranked (OR:1.021; 95% CI: 1.014-1.028)., Conclusions: Fellowship match rates for IMGs were significantly lower than for US-MGs. IMGs graduating from an ophthalmology residency in the US, scoring higher Step 3 scores, distributing more applications, and ranking more programs had increased odds of matching. This information may assist IMG fellowship applicants and their mentors when they consider pursuing an ophthalmology fellowship program in the US., (© 2022. The Author(s), under exclusive licence to Springer Nature B.V.)

Purpose: To assess the resources, progress, and barriers for program director (PD) compliance with the Accreditation Council for Graduate Medical Education (ACGME) mandate., Design: Survey., Participants: Ophthalmology PDs in the United States., Methods: A survey instrument was sent to all ophthalmology PDs in the United States., Main Outcome Measures: The survey instrument assessed PD tenure, funding, current efforts, evaluation modalities, barriers, and desired resources to meet the ACGME competency mandate., Results: The survey was completed by 88 of 104 (85%) PDs. Significant disparities exist between PD financial compensation and actual time spent performing PD duties. This disparity and lack of understanding by faculty of the ACGME competencies were the most frequently cited barriers to success in complying with the ACGME mandate. The most commonly utilized assessment tools are the global or 360 degrees evaluations and clinical evaluation exercises., Conclusions: Program directors surveyed believe they are not receiving adequate resources to allow them to comply with the ACGME mandate. Although some tools have been implemented by PDs for assessing the competencies, additional national and centralized resources would be helpful.

Objective: To evaluate young ophthalmologists' perceptions of how well residency training prepared them for various aspects of their clinical practice., Design: Self-administered survey., Participants: Two hundred sixty-nine United States ophthalmologists who have been in practice for < or =5 years., Methods: A 4-page questionnaire was mailed to a randomly selected sample of 900 U.S. members and fellows of the American Academy of Ophthalmology who had been in practice for < or =5 years., Main Outcome Measures: Comparison of perceived preparedness in clinical and nonclinical areas of ophthalmology practice., Results: Two hundred sixty-nine surveys were completed and returned (margin of error, +/-5%). Analysis of tabulated results indicated that 86% said they were extremely or very well prepared to practice comprehensive ophthalmology after residency training. Even so, about half of those respondents also desired some additional clinical training, and two thirds felt the need for some additional training in surgical areas (refractive, oculoplastics/orbital, glaucoma, retina, and pediatric ophthalmic surgery). At least 60% reported being not very or not at all well prepared in 6 of the nonclinical areas explored (business operations and finance, personal financial management, practice management skills, coding and reimbursement, political advocacy, and exposure to practice setting models). With the exception of personal financial management, most ophthalmologists thought training in all of these nonclinical areas was the responsibility of the residency training program., Conclusion: The transition from residency training to successful, efficient, ethical, high-quality ophthalmic practice demands a number of skills in addition to diagnostic acumen and surgical ability. In general, the U.S. residency program graduates surveyed are comfortable with their clinical training, but less so with their training in nonclinical areas. Opportunities to help ophthalmologists prepare better for the transition to clinical practice after training appear to exist and might be addressed by training programs, professional organizations, informal physician networks, and other stakeholders.

The traditional journal club has historically been used to teach residents about critically reading and reviewing the literature in order to improve patient care. The Accreditation Council for Graduate Medical Education competencies mandate requires that ophthalmology residency programs both teach and assess practice-based learning and improvement. A systematically conducted review of the literature regarding the use of the journal club in resident medical education was performed to define specific recommendations for implementation of a journal club tool. Selected best practices for a successful journal club were gleaned from the existing medical literature. These include the following: 1) the use of a structured review checklist, 2) explicit written learning objectives, and 3) a formalized meeting structure and process. The journal club might prove to be an excellent tool for the assessment of competencies like practice-based learning which may be difficult to assess by other means. Future study is necessary to determine if journal club can improve educational outcomes and promote lifelong competence in practice-based learning.

Purpose: Reliable and valid tools must be developed to assess the core residency competencies identified by the Accreditation Council for Graduate Medical Education. The Ophthalmic Clinical Evaluation Exercise (OCEX) is a tool designed to assess the ophthalmology resident's competence in patient care. The OCEX has been shown to have face and content validity. This study will determine the degree to which the OCEX is reliable and has construct validity., Participants: Ninety-four academic ophthalmology teaching faculty from ophthalmology residency programs across the country., Methods: Participants reviewed a video compact disc of the same resident and new patient encounter and then completed the OCEX. A scoring rubric was provided., Results: Results indicate that the OCEX is a reliable tool for faculty to use to assess residency competency. The coefficient alpha statistic (a measure of reliability/internal consistency) for the OCEX as a whole was 0.81. The alpha statistics for 3 of 4 subscales that comprise the OCEX (i.e., interviewing skills = 0.65, interpersonal skills/professionalism = 0.73, case presentation = 0.70) were lower than the OCEX as a whole, but were acceptable for new scales. However, the alpha for the examination subscale (i.e., 0.27) was extremely low. Interrater reliability assessment shows that of 33 individual OCEX items, 31 (94%) had at least 85% of the raters rating the student in 1 of 2 consecutive rating categories., Conclusions: The OCEX shows both reliability and validity and, therefore, meets the Accreditation Council for Graduate Medical Education criteria for an acceptable assessment tool.

Purpose: To design and implement a valid tool for assessment of ophthalmology resident on-call performance., Design: Retrospective chart audit., Setting: Tertiary care academic ophthalmology programs., Participants: Ophthalmology faculty and residents at the University of Cincinnati and the University of Iowa., Methods: A 1-page on-call assessment tool (OCAT) and scoring rubric were developed to evaluate ophthalmology resident on-call performance. A retrospective chart audit of consecutive resident on-call charts was performed at the University of Cincinnati and the University of Iowa, and resident performance was scored using the OCAT., Results: A consensus of faculty comments established the face and content validity of the OCAT. One hundred ninety-one on-call consultations were assessed. Timeliness of consultation was the most common category receiving a borderline or unsatisfactory rating. Borderline ratings in knowledge-based categories (history, examination, assessment and plan, urgency rating) occurred more often for postgraduate year 2 (PGY2) residents than for PGY3 residents (P = 0.05, chi-square test). Incomplete differential diagnosis (n = 6) and lack of follow-up instruction (n = 5) were the most common deficiencies observed., Conclusions: The OCAT has face, content, and discriminative validity. It can be used to assess resident competence in patient care, professionalism, and medical knowledge. Interrater and intrarater reliability still need to be determined. The OCAT may prove to be an additional assessment tool for meeting the Accreditation Council for Graduate Medical Education competencies mandate.

Purpose: New concise tools must be developed to assess reliably and validly the core residency competencies identified by the Accreditation Council for Graduate Medical Education., Participants: Eighteen content experts (residency program directors)., Methods: A 1-page Ophthalmic Clinical Exercise Examination (OCEX) checklist, for use during observed resident-patient interactions, was developed by an American Board of Ophthalmology taskforce. The OCEX checklist was sent to 18 content experts for their review and constructive comments., Results: Experts' comments were incorporated, establishing face and content validity., Conclusions: The OCEX has face and content validity. It can be used to assess a resident's patient care skills, medical knowledge, and interpersonal skills. Reliability and predictive validity still need to be determined.