Elsevier

Ophthalmology

Volume 113, Issue 7, July 2006, Pages 1237-1244
Ophthalmology

Original Article
Ophthalmology Resident Surgical Competency: A National Survey

https://doi.org/10.1016/j.ophtha.2006.03.026Get rights and content

Purpose

To describe the prevalence, management, and career outcomes of ophthalmology residents who struggle with surgical competency and to explore related educational issues.

Design

Fourteen-question written survey.

Participants

Fifty-eight program directors at Accreditation Council on Graduate Medical Education-accredited, United States ophthalmology residency programs, representing a total of 2179 resident graduates, between 1991 and 2000.

Methods

Study participants completed a mailed, anonymous survey whose format combined multiple choice and free comment questions.

Main Outcome Measures

Number of surgically challenged residents, types of problems identified, types of remediation, final departmental decision at the end of residency, known career outcomes, and residency program use of microsurgical skills laboratories and applicant screening tests.

Results

One hundred ninety-nine residents (9% overall; 10% mean per program) were labeled as having trouble mastering surgical skills. All of the programs except 2 had encountered such residents. The most frequently cited problems were poor hand–eye coordination (24%) and poor intraoperative judgment (22%). Most programs were supportive and used educational rather than punitive measures, the most common being extra practice-laboratory time (32%), scheduling cases with the best teaching surgeon (23%), and counseling (21%). Nearly one third (31%) of residents were believed to have overcome their difficulties before graduation. Other residents were encouraged to pursue medical ophthalmology (22%) or to obtain further surgical training through a fellowship (21%) or a supervised practice setting (12%); these residents were granted a departmental statement of satisfactory completion of residency for Board eligibility. Twelve percent were asked to leave residency. Of reported career outcomes, 92% of residents were practicing ophthalmology, 65% as surgical and 27% as medical ophthalmologists. Ninety-eight percent of residency programs had microsurgical practice facilities, 64% had a formal teaching course, and 36% had mandatory practice time. Most programs (76%) did not perform applicant vision or dexterity screening tests; questions existed about the legality and validity of such tests.

Conclusions

The issue of ophthalmology residents who struggle to develop surgical competency appears common. Although many problems appear to be remediable with time, practice, and dedicated, patient teachers, more specific guidelines for a statement of surgical competency are likely necessary to standardize the Board certification process.

Section snippets

Materials and Methods

An anonymous written survey was mailed to program directors of ACGME-accredited ophthalmology residency programs in the United States in January 2001. Postage-paid envelopes without identifying marks were provided as an anonymous means by which to submit completed surveys.

The survey consisted of 14 questions whose format was a combination of multiple choice and free comment. All questions but 1 were grouped into 4 basic categories. The first group involved experiences with surgically challenged

Results

Of 110 distributed surveys, 58 (52%) were returned. These programs graduated 2179 residents between 1991 and 2000. One hundred ninety-nine residents were identified as having a significant problem developing surgical skills, representing 9% of the total residents considered. On an individual-program basis, the mean proportion of surgically challenged residents was 10% (standard deviation, 7%; range, 0%–35%). These figures were similar regardless of program size: 11% (standard deviation, 7%;

Discussion

The issue of ophthalmology residents who struggle to develop surgical competency seems to be very common. Ninety-seven percent of programs had such residents, who averaged 10% of an individual program’s graduates, and 9% of all residents in the responding programs had such problems. The latter figures are comparable with those found for problem residents in internal medicine programs and are half that of general surgery programs.7, 8 However, our data may underestimate the prevalence of

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