|Year : 2020 | Volume
| Issue : 1 | Page : 3-5
Postgraduate residency training in ophthalmology: An overview
Department of Ophthalmology, Amala Institute of Medical Sciences, Amalanagar, Thrissur - 680 555, Kerala, India
|Date of Submission||18-Jan-2020|
|Date of Acceptance||18-Jan-2020|
|Date of Web Publication||17-Apr-2020|
Dr. Charles Skariah
Department of Ophthalmology, Amala Institute of Medical Sciences, Amalanagar, Thrissur - 680 555, Kerala
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Skariah C. Postgraduate residency training in ophthalmology: An overview. Kerala J Ophthalmol 2020;32:3-5
Postgraduate residency training is an important phase in the career of a medical student that molds and transforms the graduate into a competent comprehensive ophthalmologist with appropriate expertise to perform his/her professional duties independently. However, due to commercialization of medical education and absence of competence-based standard uniform training pattern, there is no uniformity in the competent skills acquired by the residents on completion of the course.
A vast majority of residents complete their course without assisting or even observing surgeries such as trabeculectomy, keratoplasty, squint, oculoplasty, vitreoretinal surgery, refractive surgery, or even phacoemulsification. Nearly one-third of the residents on completion of their course are not competent to practice as independent eye surgeons, and they are forced to pursue further surgical training in some other premier institutions to accomplish their goal to become eye surgeons. Another one-third do not go for further training and continue as medical ophthalmologists. Only the remaining one-third who are fortunate to be trained in some good institutions acquire reasonable surgical skills to practice as independent eye surgeons.
I don't want to stir up a controversy by comparing training in the government versus private institutions or by comparing MS course versus DNB course. There are positives and negatives in all the categories. A modified dynamic curriculum, updated infrastructure, trained faculty, modern methods of training, aptitude, attitude, enthusiasm, initiative, and determination shown by the trainees are all important factors in determining the outcome of the training.
| Curriculum|| |
The universities should formulate a curriculum responsive to the changing demands of the society taking into account the disease pattern in the country and keeping pace with the development and advances in the field around the world. The curriculum should lay emphasis on professionalism, ethics, research methodology, and community ophthalmology. Hospital management, practice management, and finance management should also be part of the curriculum. The curriculum should outline the cognitive and technical skills to be acquired during the course and also the minimum required diagnostic, therapeutic, and surgical procedures a resident should perform during the period of training. Preferred practice patterns put forth by the American Academy of Ophthalmology can be modified as per the national and regional needs and recommended in the curriculum.
| Infrastructure|| |
All postgraduate training centers should be well equipped with basic diagnostic and therapeutic equipment and these should be accessible to the residents. Ophthalmic subspecialty services such as cornea, glaucoma, retina, squint, oculoplasty, pediatric ophthalmology, neuro-ophthalmology, low vision aid center, ocular pathology, and microbiology should be available in all the teaching institutions. In majority of the training institutes, the infrastructure development has not kept pace with the advances in the field and changing times.
| Faculty|| |
Lack of trained teachers with an aptitude in teaching is an important factor in the decline in the standards of postgraduate training. Training the trainers is still in its infancy. Participation in teachers' training program and periodic assessment of teachers' proficiency should be made mandatory. Unfortunately, there is no provision to test the quality of training or the trainers either by the affiliating university or by the government. Training in subspecialties is a prime requisite, for which teachers can be send to institutes of excellence for specified periods. Teaching methodology has remained essentially unchanged and a change in the teaching pattern is essential incorporating multimedia resources, e-conferencing, and web-based learning. Services of guest faculty can be utilized to overcome the shortage of trained faculty. Inadequate monetary compensation and simultaneous private practice are some of the reasons for poor motivation of the faculty. The increasing commercialization has resulted in a constraint in the time available for the teacher to teach. Reorganization within the department, time management, motivating the young faculty with an aptitude and interest to teach and making them coordinate the teaching programs, one-to-one mentoring of residents, having a fixed time daily teaching schedule, etc., will help to improve the training.
| Role of Residents|| |
Postgraduate learning is a process of self-learning under the guidance of the teacher. With the availability of Video Assisted Skill Transfer (VAST) and other online resources, there is no excuse not to self-learn and fill in for any deficiencies in the training. Most of the new-generation residents lack the depth of knowledge in ophthalmology because they study just to pass the examination and later on undergo a subspecialty training of their choice for commercial success in their career. However, an excellent foundation of comprehensive ophthalmology is essential to further build up subspecialty skills. Paper and poster presentation in national or state conferences and stipulated number of attendance in the continuing medical education (CME) programs should be made mandatory to be eligible to appear for examination. Residents should be encouraged to attend training programs conducted by regional institutes and institutes of excellence. If subspecialty services are not available in the department, residents should be deputed to centers where such facilities are available. Theory and clinical knowledge and surgical skills should be assessed by conducting clinical audit and periodic examinations. Ophthalmic Clinical Evaluation Exercise as adapted from the curriculum of the International Council of Ophthalmology (ICO) can be implemented here with necessary modifications.
| Refraction|| |
Uniform poor performance in refraction across all the training institutes reflects the students' own indifference in learning the art of refraction. A resident on passing out should be able to confidently prescribe a comfortable glass.
| Surgical Training|| |
Ophthalmological surgical training should not only train cataract surgeons, but also provide exposure to a good surgical mix of trabeculectomy, keratoplasty, squint, oculoplasty, refractive surgery, posterior segment surgeries, and laser procedures. Foundation can be laid by wet lab training and supervised step-by-step surgical exposure. The ICO Ophthalmology Surgical Competency Assessment Rubric is a standardized, internationally valid tool to teach and assess a resident's competence in surgery.
Virtual simulation is the future of surgical education. Use of a simulated environment to practice the steps of surgery allows residents to achieve basic proficiency in a low-stress environment, promoting surgical confidence and patient safety and improving the resident performance in the operating room. Role of national and state ophthalmic societies – the All India Ophthalmological society (AIOS) has prepared a common national curriculum for residency training. The Academic Research Committee (ARC) of AIOS is bringing out CME series and conducting workshops and CME programs exclusively for residents. The Kerala Society for Ophthalmic Surgeons (KSOS) is also conducting academic programs exclusively for residents. Free paper and poster presentations, teachers of tomorrow sessions, Quiz, etc., are included in the state conference for the residents. District ophthalmic clubs are organizing various academic programs for the postgraduate students. Such activities by the national and state societies and district ophthalmic clubs should be continued and new innovative academic programs benefitting the resident should be started. The services of AIOS and KSOS faculty can be utilized for imparting training in the teaching institutes by incorporating them as guest faculty.
To conclude, postgraduate residency training is not up to the expectations in many training centers and has scope for improvement. It needs to be more structured, streamlined, and standardized with a uniform curriculum, with competency-based training and assessment. Procuring adequate infrastructure, opening subspecialties, recruiting motivated well-trained faculty, providing periodic training update for teachers and proficiency assessment of faculty, and incorporating modern teaching methodology and surgical training methods can go a long way in improving the standards of residency training. The process of guided self-learning during the residency training is physically, emotionally, and intellectually challenging and demanding. The residents should develop a positive attitude and determination to meet these challenges and succeed.
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