Perception among ophthalmologists about webinars as a method of continued medical education during COVID-19 pandemic

Purpose:To ascertain ophthalmologist‘s perceptions about webinars as a method of continued medical education during the COVID-19 pandemic.Methods:In a cross-sectional study, a 21-question survey was circulated using digital media platform to approximately 1400 ophthalmologists in India between 16^th August 2020 to 31^st August 2020. The questionnaire focussed on the quality and usefulness of webinars based on the Bloom‘s taxonomy. The responses (on 4- or 5-point Likert scale) were analyzed among three professional groups- ophthalmologists in-training, consultants in public sector, and private practitioners.Results:393 ophthalmologists participated in the survey, with a response rate of 28%. The mean age was 34.6 ± 9.7 years, and males constituted 49.6% (199/393) of the respondents. Forty-seven percent of the respondents perceived the quality of webinars as good or excellent (185/393), 72.8% reported knowledge gain from webinars (286/393), and 63.9% felt that webinars are important in clinical practice and should continue post-COVID-19 pandemic (251/393), with distinct responses among the professional groups. The drawbacks perceived were overt number of webinars (371; 94.4%), confusion regarding which webinars to attend (313; 79.6%), repetition of the information (296; 75.3%), limited opportunity for participant interaction (146; 37.2%) and disparate weightage to the core disciplines of Ophthalmology.Conclusion:Most respondents had favorable perceptions of Ophthalmology webinars happening during the COVID-19 pandemic. However, there is need for improvisation in the volume of webinars, target-audience-based delivery, and participant interaction to add value to this new dimension of teaching-learning.     

Effects of COVID-19 pandemic on stress level of residents and fellows during ophthalmology training

Purpose:To evaluate the impact of coronavirus disease 2019 (COVID-19) on the mental health of residents and fellows in ophthalmology.Methods:A questionnaire composed of 42 questions was applied to Brazilian residents and fellows in Ophthalmology. The questionnaire addressed the demographics of participants, their working conditions before and during the COVID-19 pandemic, and the Perceived Stress Scale (PSS-10).Results:The study had a total of 271 participants in Ophthalmology training, from which 100 were fellows and 171 were residents. Before the pandemic, Ophthalmology residents and fellows had a higher workload (P < 0.001), and residents worked more hours than fellows (P = 0.001). During the pandemic, the workload of both residents and fellows decreased and equalized (P = 0.195). No correlation was found between the working hours during the pandemic and their stress level were observed (P = 0.760). Higher stress scores were identified in women ophthalmologists (P = 0.001) as well as in residents and fellows that had their surgical training interrupted during the pandemic (P < 0.001).Conclusion:The stress level of residents and fellows during the COVID-19 pandemic was similar, however, those that had their surgical training interrupted during the pandemic presented higher level of stress. Female physicians also presented higher level of stress compared to male physicians.     

All India Ophthalmological Society Financial Impact Survey on ophthalmology practice in India during COVID-19

Purpose:A survey was conducted by the All India Ophthalmological Society (AIOS) to document the initial coronavirus disease 2019 (COVID-19)-related financial impact on ophthalmology practice in India. It also assessed various measures taken by ophthalmologists and the possible role of AIOS in mitigating the economic crisis.Methods:An online questionnaire-based cross-sectional survey was conducted among its registered members from July to August 2020. The prevalidated questionnaire contained 25 items related to the impact of COVID-19 on patient volume, the extent of financial distress faced by the ophthalmologists, and various proactive measures taken by them. All valid responses were tabulated and analyzed.Results:Out of 1,026 respondents, more than 90% ophthalmologists faced a 25% or more reduction in outpatient and surgical volume. Nearly 59% reported that they can suffer from serious financial distress in near future due to COVID-19 pandemic-related losses. Those who are young (P < 0.0005), salaried (P < 0.0005), and practicing in private sector (P < 0.0005) and Tier 1 cities (P < 0.0005) are reported to be more vulnerable to become financially unstable. The major concerns were revenue losses (70%), preexisting debts (39%), and increased operating costs (27%). The majority (90%) believed that AIOS can help in alleviating the distress. There was also hesitancy regarding the adoption of teleophthalmology and home-based care.Conclusion:COVID-19 has significantly affected the financial sustainability of ophthalmologists practicing in India. Identification of vulnerable groups and timely advocacy efforts by AIOS can help in mitigating this financial crisis.     

A validated audio-visual educational module on examination skills in ophthalmology for undergraduate medical students in the COVID-19 season - An observational longitudinal study

Purpose:The aim of this study was to assess the impact of an audio visual (AV) teaching module on basic torchlight examination of the eye and direct ophthalmoscopy for undergraduate medical students.Methods:This observational longitudinal study was done on 33 consecutive medical interns during their Ophthalmology posting from December 2019 to March 2020 at a medical college in South-India. An AV-module was created using animation graphics, narratives, demonstrations on normal individuals and on patients with positive signs. All interns had a pretest consisting of Multiple-choice questions, (MCQs) and an Objective Structured Clinical Examination (OSCE) on torchlight examination and direct ophthalmoscopy (DO). They were then shown the 20-minute AV-module. A posttest was performed immediately and after one week.Results:The mean pretest MCQ score was 5.84 ± 1.98. It improved to 8.81 ± 1.15 in the immediate posttest and 8.87 ± 1.66 in the one-week posttest. The mean pretest OSCE score was 12.21 ± 3.39. It improved to 23.21 ± 3.39 in the immediate posttest and 23.90 ± 3.7 in the one-week posttest. Using Generalized Estimating Equation, MCQ score improved by 2.97 units and 3.03 units and the OSCE score improved by 11 units and 11.69 units in the immediate posttest and one-week posttest respectively when compared to the pretest corresponding to the MCQ score and OSCE score (p < 0.001).Conclusion:AV teaching modules-for torchlight examination and DO has a significant benefit in improving knowledge and skill in undergraduate medical students. These significant results have the great translatory capacity in the current COVID-19 pandemic, where physical demonstrations involving close proximity and groups of students are highly risk prone.     

An analysis of undergraduate ophthalmology training in Canada

Objective: To investigate the adequacy of undergraduate ophthalmology education in Canada in comparison with the International Council of Ophthalmology (ICO) guidelines.Design: Cross-sectional survey.Participants: First-year residents who had graduated from Canadian medical schools.Methods: Eligible residents were invited to participate in an online survey in 2007. Data were categorized by demographic variables, and basic statistics were done.Results: Responses were obtained from 386 of the 1425 individuals (27.0%) contacted. The majority (64.0%) stated they had “too little” or “no exposure” to ophthalmology in medical school. The majority (76.2%) of respondents stated that they had had 1 week or less of overall exposure to ophthalmology. Sufficient exposure to several ICO core subspecialty areas was reported, including lens/cataract (81.1%) and cornea/external diseases (81.6%); however, some areas did not receive adequate time allocation, such as vitreoretinal disease (41.9%). Similarly, competency was obtained in certain ICO examination skills, including assessment of visual acuity (83.3%) and pupillary reflexes (90.7%) but was not achieved for other skills, such as fundoscopy (52.3%), slit-lamp examination (44.8%), and intraocular pressure assessment (19.9%). When asked whether sufficient ophthalmology knowledge and skills had been obtained during medical school, only 42.9% and 25.9% agreed, respectively.Conclusions: Undergraduate ophthalmology training in Canada contains gaps in certain key areas. Developing a national, standardized curriculum could ensure that medical students acquire competency in the ophthalmology knowledge and skills required for future clinical practice.     

An insight into the altered ophthalmic dynamics during the COVID-19 pandemic

Purpose:The objective of this survey-based study was to examine the effects of personal protective measures taken at the level of instrument and surgeon during the pandemic on the optics in ophthalmology.Methods:The study involved an online questionnaire of 24 questions which was distributed to ophthalmologists practicing in several hospitals, including residents and fellows undergoing training in ophthalmology in India. The responses were collected through an online data collection tool (Google forms). The participants could choose from multiple options provided to them in each question.Results:A total of 285 participants out of 296 had used modified methods for examining and performing surgical procedures during the pandemic, while 78.7% (265) of the participants acknowledged having encountered difficulty in interpreting the ocular findings of patients while examining in personal protective equipment. Moreover, 58.7% (198) of our study respondents also reported that there was significant worsening of the quality of ophthalmological examination with pandemic-appropriate measures and 84.8% (286) of our study participants also felt that these measures have significantly added to the time of examination, hence increasing the risk of exposure to both patient and doctor.Conclusion:The workplace study has highlighted the crucial aspects of optics in ophthalmology during the pandemic. The protective measures taken during the pandemic have significantly worsened the quality of ophthalmological examination and increased the time taken to perform outpatient department-based and surgical procedures in ophthalmology.     

Teaching of ophthalmology in undergraduate curricula: a survey of Australasian and Asian medical schools

BACKGROUND: Despite established international guidelines on preferred teaching components for ophthalmology in undergraduate curricula, with increasingly less specialty-based undergraduate teaching within curricula, teaching of core ophthalmology knowledge and skills may become marginalized. This survey aims to evaluate the current state of undergraduate ophthalmology teaching in Australasia and proximate Asian medical schools. METHODS: A questionnaire was developed to determine the content and extent of ophthalmology teaching in the undergraduate medical curriculum. The questionnaire was sent to 25 medical schools throughout Australasia and Asia. RESULTS: Nineteen of the 25 questionnaires were returned (76% response rate). Ophthalmology teaching programmes ranged from 2 to 20 days: five (26%) medical schools having one ophthalmology attachment; six schools (32%) two attachments; and the remainder three or more. Only seven of the schools taught all 13 ophthalmology topics recommended in current curriculum guidelines. Ocular examination (100%), lens and cataract (95%) and ocular manifestations of systemic disease (95%) were the most commonly taught topics, with intraocular tumours only covered by 10 schools (53%). Students in 14 schools (74%) attended ophthalmology operating theatre, but only two schools (11%) offered attendance at optometry clinics. Ten schools (53%) required a pass in ophthalmology to complete the academic year. CONCLUSION: Ophthalmology may increasingly be a small, or even absent, component of undergraduate medical curricula. Despite established international ophthalmology curriculum guidelines, this survey highlights significant lack of uniformity in their implementation.     

以问题为基础学习教学法在八年制学员眼科临床实习中的应用

目的：探讨以问题为基础学习(problem-based learning,PBL)教学法在临床医学专业八年制学员眼科学临床实习过程中的教学效果。

方法：以2013-01/2014-03在第四军医大学西京医院眼科实习的40名临床医学专业八年制学员为研究对象,随机分为PBL教学组(PBL组)和传统教学组(对照组),每组20名。PBL组采用PBL教学法引导实习学员主动参与实习过程,以实习学员为主体; 对照组采用传统教学法以教师为主导引导学员完成临床实习。最后通过问卷调查、出科考试成绩分析等综合评价不同教学方法的实习效果。

结果：出科考试成绩分析中,PBL组的问答题、病例分析题和总成绩的分数均明显高于对照组(P<0.05); 选择题和名词解释的得分与对照组无显著差异(P>0.05)。实习学员对教学效果的自评指标中,在提高学员综合分析能力、学习主动性和实习效果等方面PBL组均明显优于对照组(P<0.05); 在激发学员兴趣和对教学法满意度方面PBL组略强于对照组,但统计学差异不显著(P>0.05)。教员对实习生的评价指标中,PBL组在实习前充分积极准备、实习中全面准确表达观点、临床思维逻辑性等方面均明显好于对照组(P<0.05); 在与患者沟通能力方面两组间差异不显著(P>0.05)。

结论：PBL教学法适用于临床医学专业八年制学员在眼科的实习教学,PBL教学法能够较好训练学员的临床综合分析能力,有助于其主动解决临床实际问题能力的培养。     

眼科门诊应对新型冠状病毒肺炎的管理实践

简述眼科门诊在新型冠状病毒肺炎疫情期间的管理措施。从预约就诊、预检分诊、分区管理、眼外伤等急症患者就诊处置和健康宣教方面进行门诊防控管理,同时加强医务人员防护,设备清洁消毒。希望为眼科医务工作者在新型冠状病毒肺炎疫情期,避免医患之间及患者与患者之间交叉感染提供新思路、新方法。     

Post-lockdown challenges for ophthalmologists during COVID-19 pandemic in India: A survey-based analysis

Purpose:The purpose of this study is to evaluate the post-lockdown challenges during Coronavirus disease 2019 (COVID-19) pandemic amongst the ophthalmologists in India.Methods:An online survey was sent to the practicing ophthalmologists across India. Data were collected from the responding ophthalmologists and analysed using Medcalc 16.4 software.Results:A total of 794 responses were obtained. Most respondents (51%) were in the age group 30–50 years and were in independent practice (40.05%). Almost three-fourth of ophthalmologists resumed their surgical services after a gap of more than a month post-lockdown. Almost a third of the respondents had significant reduction in their surgical workload during this period. Significant fear of contracting COVID-19 infection in the operation theatres was reported while moderate difficulty was found in procuring protective gear during immediate post-national lockdown period.Conclusion:The pandemic has changed the ophthalmic practice significantly, with patient and staff safety becoming areas of major concern. Both financial and psychological concerns affecting healthcare workers need addressing for continued patient care.     

改良的PBL教学模式在眼科专业学位研究生教学中的应用

目的:利用改良的PBL教学方式(SEC3模式,即系统专业课(传统PBL教学)-实验室培训-临床实践-回顾性检讨-临床工作),对眼科学专业学位硕士研究生进行临床前强化培训,探讨改良的PBL教学模式对于加强专业学位研究生临床适应性的作用。方法:选择中国医科大学眼科学系专业学位研究生31人,随机分成两组。I组采用传统模式,在临床工作中学习眼科基本知识与基本操作。II组采用改良的PBL模式进行为期1mo的教学,同时参与临床工作。两组研究生带教教师相同。3mo后,利用问卷、专业知识笔试、基本临床操作考核方式对两组学生进行考核,并对考核结果进行综合分析。结果:两组学生对于临床常见住院病种的掌握程度差异并不明显,但是在眼科基础知识掌握的广度与深度以及基本临床操作方面,II组显示出了比I组显著的优势。结论:改良的PBL教学模式是传统PBL教学模式的发展,比传统PBL模式具有更好的知识系统性与接受性。相对于传统医学教育模式,PBL还可以调动学生的自我学习兴趣。不仅仅适用于本科阶段临床教学,对于临床专业学位研究生尽快适应临床工作帮助很大,尤其对于眼科等本科阶段为考查科目的学科优势明显。     

#Ophthalmology: Popular ophthalmology hashtags as an educational source for ophthalmologists,an Instagram study

Purpose:This study aims to determine the content and intent of posts published under popular ophthalmology hashtags and to determine whether these posts were educational for ophthalmologists.Methods:A web-based, cross-sectional study design was used to evaluate the top public posts of five popular hashtags on three consecutive days by two ophthalmology specialists. The first 100 relevant English posts of each hashtag were studied. Selected hashtags were #Ophthalmology, #ophthalmosurgery, #ophthalmologyresident, #ophthalmologist, and #ophthalmicphotography. Posts were classified according to the type of post, post author, post intent, and whether the post was educational. Posts deemed educational were then categorized separately using the same classification system as above to determine whether there were defining characteristics of educational posts.Results:One thousand posts were recorded and analyzed and a total of 500 posts were included in the study. The majority of posts 79.8% (n = 399), were by medical doctors with 95% (n = 379) being ophthalmology specialists. Sixty-three percent of posts (n = 315) were deemed educational, 25% promotional (n = 127), and 12% (n = 58) were entertainment posts. Medical retina (n = 119) and anterior segment (n = 90) were the most common subspecialties explored. #ophthalmicphotography (P = 0.001) was the hashtag with the highest number of educational posts (n = 91). The least educational hashtag was #ophthalmologist with only 44% of posts (n = 44) that were deemed to be educational. One hundred percent of glaucoma posts (n = 19), 98% of cornea posts (n = 41), and 99% of medical retina posts (n = 118) were found to be educational which was significantly more educational than the other topics posted (P ≤ 0.001).Conclusion:Ophthalmologists are the main authors of posts in popular ophthalmology hashtags. The majority of posts were educational posts with promotional posts being the second most common intent. The authors conclude that while Instagram is a possible source of ancillary education for the visual specialty of ophthalmology, careful selection of hashtags and post authors are needed for maximum benefit.     

Managing vitreoretinal surgeries during COVID-19 lockdown in India: Experiences and future implications

Purpose:The study aims to describe the clinical and demographic profile of patients who required vitreoretinal surgeries during the novel coronavirus disease-2019 (COVID-19) lockdown in India. It also reports our operating protocols and initial experience while performing vitreoretinal surgeries during COVID-19 times at a government tertiary eye care hospital.Methods:This is a retrospective cross-sectional observational study of patients requiring emergent/urgent vitreoretinal surgeries between March 25, 2020 and May 31, 2020. A modified working protocol focussing on the enforcement of standard COVID-19 precautions, OT sterilization, and formation of dedicated infection control and disease surveillance committee was adopted. Patients underwent standard vitreoretinal procedures under general/local anesthesia. Relevant demographic and clinical data were recorded and analyzed. Surveillance data of healthcare workers (HCW) was also analyzed.Results:Eighty six patients were considered for vitreoretinal surgery in this period. Finally, 83 patients underwent surgery. The mean age of the patients was 38.4 ± 20.1 years (Range, 1 month - 75 years). Majority of them were males (66%) and adults (82.6%). Majority of them came from nearby hotspot areas. Most common indications were acute retinal detachment (38.5%) and diabetic vitrectomies (22.9%). Trauma-related cases (14.4%) were less. Surgery was deferred in 3 patients who turned out to be COVID-19 positive. 4 HCWs were quarantined but none of them developed COVID-19 disease.Conclusion:During COVID-19 lockdown, vitreoretinal surgeries were most commonly performed for retinal detachment and diabetic complications. Proper implementation of infection control protocols helps in delivering adequate patient care while ensuring the safety of caregivers during this pandemic.     

眼科学继续医学教育模式的思考及探索

继续医学教育贯穿于医者的终身职业生涯,是医务人员不断提高自身业务水平的关键。然而,目前眼科继续医学教育仍面临对象多样性、内容复杂性、形式化突出、知识技术更新快、多学科交叉及青年医生手术培养困局等难题。正面与反面教育结合、人文与专业教育结合、理论与实践教育结合、国内与国外教育结合、听课与授课教育结合、公益与商业模式结合、科室与小组模式结合、传统与新兴模式结合、医生与医技护理结合,是我们在眼科继续医学教育中进行的初步探索。（眼科, 2014, 23： 351-354）     

Neuro-ophthalmic presentation of COVID-19 disease: A case report

COVID-19 is a respiratory virus, which has affected various organ systems as well. Here we report a neuro-ophthalmic presentation of pituitary apoplexy under the setting of COVID-19 infection in a middle-aged man who presented to ophthalmic emergency with sudden bilateral loss of vision along with a history of fever past 10 days. There was sluggishly reacting pupils and RT-PCR for COVID was positive. Imaging pointed the diagnosis as pituitary macroadenoma with apopexy. In view of pandemic situation, patient was given symptomatic treatment as per the protocols and stabilized. Vision also showed improvement to some extent and the patient is awaiting neurosurgery     

新冠肺炎疫情期间本科生眼科学线上教学问题和原因分析

目的:分析眼科学线上教学所面临的问题,并分析其中原因。方法:调查时间为2020-05/06。采用自行设计的调查问卷及成绩对比的方法。问卷调查包括课前课后用时、线上教学面临的困惑和教学效果自评等。调查对象为63名五年制本科学员和眼科学所有带课教员。结果:学员线上和线下教学课前平均用时接近,但教员线上课前用时明显长于线下教学。63%学员认为线上教学课后复习需更长时间,95%学员承认线上教学因缺乏互动而走神,73%教员因缺乏互动而影响激情。73%的教员预计线上教学效果会差于线下教学,但95%学员认为通过重复观看视频,知识掌握无明显差别;线上教学最终成绩与往年同类学员线下教学无差别;91%教员和79%学员推荐录播与直播相结合作为未来的线上教学模式。结论:缺乏互动是影响线上教学效果的最主要因素。线上教学效果与线下教学类似,但课后所需复习时间更长。录播与直播相结合是师生推荐的线上教学方式。     

眼科本科留学生教学体会

接受眼科本科课程的在读留学生中随机选取 17人,通过调查问卷的形式探讨留学生对不同的授课方式的认可程度,分析总结留学生的主观感受。学生对目前教学方式基本满意（ 60%）,留学生更渴望实践讨论式的教学模式,同时创造国际化的教学环境也将是提高眼科本科留学生教学质量的一大重点。（眼科,2015, 24： 134 -135）     

Flipped classroom approach to global outreach: cross-cultural teaching of horizontal strabismus to Chinese ophthalmology residents

AIM: To evaluate the flipped classroom model for teaching horizontal strabismus didactics in an ophthalmology residency program in China as part of a visiting professorship from the United States. METHODS: Residents from an ophthalmology residency program in China were invited to participate in flipped classroom sessions taught by an experienced American ophthalmology faculty in 2018. Residents were instructed to watch a pre-class video lecture prior to the in-class-case-based activity. Content tests (5 Ophthalmic Knowledge Assessment Program style questions) and surveys were administered before and after the classroom sessions (100% response rate). These results were compared to that of an American cohort who were taught the same content. RESULTS: The Chinese cohort of 12 residents preferred the flipped classroom to the traditional classroom at higher rates than the American cohort of 40 residents (92% vs 55%, P=0.04) and felt that all ophthalmology topics would be appropriate for the flipped classroom teaching style (P-values between 0.008 and <0.001). In both Chinese and American cohorts, we found that the exotropia curriculum saw a small but significant improvement in performance following the flipped classroom session (P=0.025 for Chinese residents; P=0.001 for US residents), whereas scores in both groups for the esotropia course did not significantly improve. CONCLUSION: This is the first study to evaluate the flipped classroom model implemented by a visiting ophthalmology professor in a global outreach setting. The flipped classroom sessions are viewed favorably by the Chinese residents relative to the US cohort with a modest impact on knowledge. Decreased in-person interpreter requirement and increased student engagement make this model valuable in cross-cultural visiting professorship settings. Finally, the flipped classroom may lend itself well to a virtual format to prevent the transmission of COVID-19, although such a format requires further study.     

Understanding the changes in practice patterns in ophthalmology following COVID-19 lockdown

Purpose:Severe acute respiratory syndrome-Coronavirus 2 pandemic has brought the world to a halt. We performed a questionnaire-based survey to know more about these issues which affected them due to this pandemic and resultant lockdown.Methods:A questionnaire-based survey (53 questions) was conducted online among Indian ophthalmologists with a 2-week response time. The invitation to participate was also circulated widely among various ophthalmologists as members on different social media platforms and emails. It was mandatory to answer all the questions in the questionnaire to make it a valid response.Results:A total of 903 responses were received across the country. A majority of these responses, 403 (44.6%), were from private practitioners. Almost 876 (97%) of the responders had either kept the daily working hours as same as pre-COVID-19 era or had reduced the actual working hours. Overall, 547 (60.6%) responders did not downsize their staff and 569 (63%) did not reduce the staff salary. Consultation charges were not revised by a majority (659, 73%) of responders. Total of 663 (73.4%) were following the appointment system and 702 (77.7%) responders had reduced the number of patients to less than 6 an hour. Only 106 (11.7%) were doing a mandatory RT-PCR test before surgery, whereas 567 (62.8%) did on the basis of suspicious symptoms.Conclusion:Our survey gives valuable inputs regarding the changes made by different ophthalmologist groups during the times of COVID-19 and lockdown.