Feedback of final year ophthalmology postgraduates about their residency ophthalmology training in South India.

BACKGROUND AND AIMS: This study documents a survey of final-year ophthalmology postgraduate students on the subject of their residency training. A similar survey conducted 7 years ago published in IJO had concluded that the residency program was not up to expectations in many centers. Our study aimed to see if ophthalmology training and student perceptions differed since then.
MATERIALS AND METHODS: For our study, we added a few questions to the same questionnaire used in the article "which is the best method to learn ophthalmology? Resident doctors' perspective of ophthalmology training" published in IJO, Vol. 56 (5).
RESULTS: Forty-nine students (62.02%) returned completed forms. Most students desired an orientation program on entering residency, and wished to undergo diagnostic training initially. Case-presentation with demonstration and Wet-lab learning were most preferred. There was a big difference between the number of surgeries students actually performed and the number they felt would have been ideal.
CONCLUSION: On the whole, the students still felt the need for improved training across all aspects of ophthalmology.

Ophthalmology is a unique field, offering the chance of doing both medical and surgical practice. Technology is extensive in ophthalmology and has revolutionized the field. Be it cataract, retinal or refractive surgery, the changes are awe-inspiring. It should therefore be a highly satisfying field for postgraduate students. However, this appears not to be the case. On graduating, most ophthalmologists in India feel the necessity to seek additional training and rarely feel confident to practice ophthalmology independently.[12] This is probably because ophthalmology training in India has not evolved in parallel with the subject itself.[3] Issues plaguing ophthalmology training in India have been studied, both from the perspective of trainers and residents.[45] This study, using a previous questionnaire [Appendix 1] [and a few additional questions - Appendix 2] aimed to elicit final-year ophthalmology residents’ feedback regarding their residency training, and to compare responses with similar studies done earlier.

Subjects and Methods

This study was conducted at the 4-day annual ophthalmology postgraduate teaching program for final-year postgraduate students, in February 2013, at Hubli, Karnataka, South India.

On day 2 of the program, students were briefed about the proposed study, and a consent form [which also contained information about the study - Appendix 3] was distributed. As mentioned in the form, the questionnaire used in the brief report, “which is the best method to learn ophthalmology? Resident doctors’ perspective of ophthalmology training” published in Indian Journal of Ophthalmology, Vol. 56 (5), authored by Gogate et al. [Appendix 1], was given to the students, and with a few additional questions [Appendix 2]. Students could refuse to participate in the study by simply not returning the forms. Since the study was planned as feedback of ophthalmology postgraduate students, name, age, and gender were not solicited. This also ensured confidentiality. The students were requested to only write the name of their state.

The questionnaire contained questions with rating scales between 0 and 4 about various methods of teaching, and questions about their surgical training. There were also open-ended questions about exams, instruments; library, camps, eye-bank and topics that they felt needed more coverage. In this survey, we added questions related to orientation programs and preferred methods of initial training.

By day 4 of the program, completed forms were collected for analysis of feedback.

Results

Seventy-nine ophthalmology final-year residents participated in the teaching program. Twenty-eight (35.4%) were males. Sixty-four students were from Karnataka (81.01%), 14 from other South Indian states and one from North India (Delhi). Therefore, this study's results were more representative of the experience from Karnataka state and South India.

Twenty-five students were from Government Medical Colleges (31.6%) and 35 from private colleges (44.3%). These students were final year residents of Master's degree or Diploma in Ophthalmology. Nineteen students (Diplomate National Board degree) were from other hospitals (24.1%).

Forty-nine (of the 79) students returned completed forms (62.02%). Of these, 21 forms had name of college/city, or state mentioned - 16 among them were from Karnataka.

Forty-eight students (97.95%) believed that an orientation program was necessary when they enter residency. Only 10 students (20.40%) had received such a program. Among these, four were conducted by departmental heads/professors, and six by others. Five students felt that the program gave an adequate picture of what to expect as an ophthalmology resident.

Thirty-nine students (79.59%) felt that early months of ophthalmology residency should involve training in diagnostics. Of these, 12 (30.76%) felt that such training should be imparted by senior faculty and 17 (43.58%) preferred junior faculty.

Thirty-two students (65.30%) felt that refraction training is best done by an ophthalmologist, and 10 (20.40%) felt that a refractionist is better.

All 49 students felt that frequent exams/mock tests were needed - 15 students wanted exams every month.

Forty-six students desired specific training to handle instruments. 29 students felt that training is needed for handling outreach camps, and eye-bank calls. Almost all students desired better library facilities, with access to recent/latest journals and online journals as priority.

Squint was the topic cited most often as requiring more coverage, followed by refraction and oculoplastics.

The mean and median scores given by the students for six modalities of teaching are in Table 1.

Table 1

Improving student satisfaction with their residency training can be one of the goals for postgraduate trainers in ophthalmology

Table 2 shows the results of surgeries needed to be seen, assisted and performed, to become accomplished and how many were done so far.

Table 2

The range of postgraduates’ responses to number of surgeries seen, needed to assist, needed to perform and actually done so far. Most of the outliers come from same 2 to 3 feedback forms

Discussion

The study produced a feedback of 49 final-year ophthalmology postgraduate students.

Practically every student felt an orientation program was necessary and few had received such a program. Most preferred diagnostic training initially and notably, majority wanted junior faculty to conduct such training.

More students desired refraction training is done by ophthalmologists, than refractionists. The authors inferred that ophthalmologists would better understand a trainee ophthalmologist's requirement.

Case presentation with demonstration, and Wet-lab learning were the most preferred methods of training. Didactic lectures without PowerPoint were less popular, similar to the published IJO study,[5] emphasizing that monologues with less interaction were not considered ideal. In an Iranian resident survey in 2010, journal club was found to be the most satisfying tool for teaching competency in general ophthalmology.[6] In this survey, the journal club was not voted so useful.

Majority wanted training in more aspects of ophthalmology, including camps, eye-bank calls and handling of instruments. The students also wanted more frequent examinations/mock tests, for regular evaluation.

A large difference existed between the number of surgeries students felt they should ideally perform and the number of surgeries they had done so far. Most had performed manual cataract, pterygium and dacryocystectomy surgeries only, again similar to the published IJO study, where median for manual cataract surgery was 19, dacryocystectomy was one, and all other surgeries was zero.[5] Implementation of a structured surgical curriculum will help alleviate this perceived deficiency in ophthalmology training programs.[7]

A Canadian study on ophthalmology residents’ satisfaction reported 85% satisfaction with the residency program and similar satisfaction with their surgical experiences.[8] Our study demonstrates a contrast from this study.

The IJO study by Gogate et al. had concluded that the residency program in ophthalmology was not up to expectations of postgraduate students in many teaching centers in Maharashtra. Seven years later, in a different Indian state, our survey has produced similar results.

Thomas and Dogra had concluded that drastic changes in training and patient care were needed in most Medical College Ophthalmology Departments.[2] We can conclude from this survey that students felt the need for better training across all aspects of ophthalmology training. As Thomas and Dogra had mentioned, “training and eye care in teaching departments should conform to modern standards and follow preferred practice patterns”.[2]