|Year : 2018 | Volume
| Issue : 3 | Page : 137-141
Transition to ophthalmology residency program and the role of basic science course
Moustafa Sameer Magliyah1, Saad Hamdan AlEnezi2, Abdullah M AlFawaz3
1 Department of Ophthalmology, Prince Mohammed Medical City, Riyadh, Saudi Arabia
2 Department of Ophthalmology, Majmaah University, Al Majmaah, Saudi Arabia
3 Department of Ophthalmology, King Saud University, Riyadh, Saudi Arabia
|Date of Web Publication||4-Jan-2019|
Dr. Moustafa Sameer Magliyah
7880 Al Amir Ahmad-Madinat Al Ummal, Unit No.: 1, Al Khubar 34441-4537
Source of Support: None, Conflict of Interest: None
| Abstract|| |
BACKGROUND: Residency training is a difficult and a highly stressful task, especially at the beginning of the training. The aim of this study is to assess the roles of the Basic Science Course (BSC) and independent preparation on the transition to ophthalmology residency in Saudi Arabia.
METHODOLOGY: A cross-sectional study was conducted among ophthalmology program residents. The questionnaire was administered to 100 residents. Responses were analyzed for association using univariate analysis.
RESULTS: Nearly 88% of residents were satisfied with their knowledge exposure during the BSC, while 67% thought that the majority of the BSC was dedicated to theoretical lectures. Surgical exposure was limited to attending surgeries for 38% of residents before joining residency programs, and 91% thought that there was little time dedicated for hands-on surgical skills training during the BSC, while only 11% thought that their surgical exposure was beneficial. Almost half of the beginning residents were accompanied by senior colleagues during their initial calls. More than 50% of residents felt that their transition to ophthalmology residency was more stressful than the transition to internship.
CONCLUSION: The knowledge exposure from the BSC was helpful to facilitate the transition to ophthalmology residency program, especially for the ones who prepared well before. Improvement in surgical skills training should be aimed to further facilitate transition to ophthalmology residency program.
Keywords: Basic Science Course, ophthalmology, residency, transition
|How to cite this article:|
Magliyah MS, AlEnezi SH, AlFawaz AM. Transition to ophthalmology residency program and the role of basic science course. Middle East Afr J Ophthalmol 2018;25:137-41
|How to cite this URL:|
Magliyah MS, AlEnezi SH, AlFawaz AM. Transition to ophthalmology residency program and the role of basic science course. Middle East Afr J Ophthalmol [serial online] 2018 [cited 2019 Apr 26];25:137-41. Available from: http://www.meajo.org/text.asp?2018/25/3/137/249326
| Introduction|| |
Residency training is a difficult and a highly stressful task, especially during the transition from medical school to residency training. New residents encounter many new challenges, including an abrupt increase in responsibility, managing uncertainty, working as a team, and potential difficulty with socialization in the program., This stress subsequently conveys an increased risk of depression and anxiety, which affects 35% of 1st-year residents across all medical specialties. Depression and anxiety, in turn, can eventually contribute to early physician burnout.,
Several techniques have been described to reduce the emotional strain at the beginning of residency training. At an individual level, seeking social support, being problem-focused, and avoiding self-blame were identified as successful techniques in reducing the burden of this transition.
Trainees have also indicated that program-level interventions could be helpful in reducing stress. These interventions include close supervision during the first calls, facilitated personal discussions with colleagues and supervisors, and giving residents enough time for adequate engagement with friends and family. In addition, several preparatory courses have been organized by residency programs for trainees at the beginning of their residency programs in surgery, and medicine,, resulting in increased preparedness and easier adaptation to postgraduate training. Preparatory courses in ophthalmology residency programs represent a major contributing factor to compensate for the little contribution made by medical schools and internship as they help to bridge the gap in knowledge and clinical orientation and by doing so easing the stress of transition to ophthalmology residency among the beginning residents.
In Saudi Arabia, there are an increasing number of applicants preferring ophthalmology residency programs each year. All newly accepted residents in ophthalmology residency programs have to attend a 2-month Basic Science Course (BSC) in Riyadh, during which they have theoretical lectures, weekly activities, and calls.
Unfortunately, there are few studies in the literature assessing the transition to ophthalmology residency programs and the impact of preparatory programs. Therefore, it was important to focus on this area, looking for improvement. The aim of this study was to look at the transition to ophthalmology residency program in Saudi Arabia and assess the role of BSC in facilitating this transition.
| Methodology|| |
A cross-sectional study was conducted among Saudi ophthalmology program residents. All residents who finished their 1st year of ophthalmology residency program between 2014 and 2017 were contacted, and the data were collected using a structured survey. Questions were adapted from a previous study done by Thomas et al., with some modifications to make them compatible with the postgraduate medical education in Saudi Arabia. The questionnaire was checked for validity and reliability using the Cronbach's alpha and reliability analysis. Responses were analyzed for association using the univariate analysis.
All categorical data were represented using frequency with percentage. Association was tested using Chi-square test. All statistical analysis was done using the Statistical Package for the Social Sciences (SPSS) version 20.0. A probability value (P value) <0.05 was considered significant.
| Results|| |
Reliability statistics showed the value of Cronbach's alpha coefficient for the whole scale as 0.798. In addition, the reliability for the subscales had a range of 0.721–0.810. Based on these measures, it was concluded that the data collection tool was reliable and valid for the assessment of the transition to ophthalmology residency and the role of BSC.
Among the 105 ophthalmology residents who were contacted, 100 responded to the survey, making a response rate of 95.2%. [Table 1] shows the survey questions and the proportions for each choice. About 70% of the residents used textbooks for independent preparation before starting ophthalmology residency. Most of the residents (61%) had 2–4-week ophthalmology exposure during medical school, and only 18% had >4-week exposure. Almost all of the residents (99%) had ophthalmology lectures during their undergraduate studies, while 87% of them attended ophthalmology clinics. The majority of the respondents were accepted directly after internship (78%). Nearly 67% thought that the majority of the BSC content was dedicated for lectures. Almost 91% thought that they had little hands-on exposure during the BSC. About 74% thought that there was no enough time for relationship building with mentors.
|Table 1: Survey responses of 100 ophthalmology residents across the Saudi Arabia|
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Nearly 81% of residents wished for more discussions regarding gonioscopic examination. The most stressful rotation to begin the residency with was the retina rotation for 62% of the residents, while 77% of residents opted for the general ophthalmology rotation to begin with.
Almost 74% of residents indicated that calls were the most stressful part of their transition and 64% felt that the BSC examination preparation was very stressful.
| Discussion|| |
This study which involved 95.2% of the ophthalmology program residents who have passed their 1st year of residency looked at the measures taken by residents and ophthalmology residency programs to facilitate the transition and integration to ophthalmology residency programs during 1st year of ophthalmology residency.
This study showed that there was a very good orientation during BSC in terms of knowledge and theoretical exposure for resident beginners, unlike clinical work, problem-based learning, and hands-on surgical skills.
As continuous efforts are made to improve ophthalmology residency programs in Saudi Arabia, virtual reality phacoemulsification simulators,,,,,,,, were introduced to all ophthalmology program residents in Riyadh, Alkhobar, and Jeddah. Suturing courses and wet laboratories also were offered to residents at the beginning of their residency programs. Earlier exposure of ophthalmology residents to such facilities during BSC is recommended to bridge the gap in hands-on training and surgical exposure among beginning residents and to give them more confidence and facilitate their transition to ophthalmology residency programs further.
Common consultation cases and basic eye examination represent two subjects which should have been discussed more extensively during the BSC, with more practice needed on gonioscopy, indirect ophthalmoscopic examination, and dilated fundus examination with the aim to facilitate transition to ophthalmology residency. It would be advisable to expose beginning residents to indirect ophthalmoscopy simulator earlier as it is found to have/play an important part in familiarizing residents with indirect ophthalmoscopy examination.
The satisfaction of residents about the anterior segment examination and the neuro-ophthalmologic examination makes them comfortable with starting their residencies, although preferred initial rotation would have been general ophthalmology or the emergency room and that could be explained by the nature of cases they face during these rotations. The calls and BSC examination were the biggest burdens for residents at the beginning of their residencies.
The percentage of residents who were not attached in their first calls is expected to decrease in the coming years because part of them is in newly established ophthalmology residency programs. For the BSC examination, although it represented a burden on beginning residents, most of the residents felt that it was beneficial, but the level of benefit varied from one resident to another. Reading and doing more clinical rotations would be advised before ophthalmology residency for interns and newly accepted residents to facilitate their transition to ophthalmology. The current duration and timing of the BSC seemed not to be a problem for almost half of the beginner ophthalmologists. About 47% of ophthalmologists were happy with taking the BSC at the beginning of the 1st year, and nearly one-third (29%) of the residents preferred to split the 2 months into 1 month at the beginning of the 1st year and one at the beginning of the 2nd year.
| Conclusion|| |
The knowledge exposure during BSC satisfied most of the residents and was very beneficial during their transition to ophthalmology residency program. The contribution of ophthalmological surgical skills training during the BSC was not enough to facilitate this transition. Another helpful measure that could facilitate the transition to ophthalmology residency program is the attachment to senior colleagues in the first calls during the early months of the residency program.
The main limitations of this study were the retrospective nature and the difficulty to assess the transition among 1st-year residents in the middle of their transition because of the workload and the absence of quantitative methods.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Brennan N, Corrigan O, Allard J, Archer J, Barnes R, Bleakley A, et al.
The transition from medical student to junior doctor: Today's experiences of tomorrow's doctors. Med Educ 2010;44:449-58.
Flynn SP, Hekelman FP. Reality shock: A case study in the socialization of new residents. Fam Med 1993;25:633-6.
Schneider SE, Phillips WM. Depression and anxiety in medical, surgical, and pediatric interns. Psychol Rep 1993;72:1145-6.
Hurst C, Kahan D, Ruetalo M, Edwards S. A year in transition: A qualitative study examining the trajectory of first year residents' well-being. BMC Med Educ 2013;13:96.
Teunissen PW, Westerman M. Opportunity or threat: The ambiguity of the consequences of transitions in medical education. Med Educ 2011;45:51-9.
Paice E, Rutter H, Wetherell M, Winder B, McManus IC. Stressful incidents, stress and coping strategies in the pre-registration house officer year. Med Educ 2002;36:56-65.
Antonoff MB, Swanson JA, Green CA, Mann BD, Maddaus MA, D'Cunha J, et al.
The significant impact of a competency-based preparatory course for senior medical students entering surgical residency. Acad Med 2012;87:308-19.
Meier AH, Henry J, Marine R, Murray WB. Implementation of a web- and simulation-based curriculum to ease the transition from medical school to surgical internship. Am J Surg 2005;190:137-40.
Laack TA, Newman JS, Goyal DG, Torsher LC. A 1-week simulated internship course helps prepare medical students for transition to residency. Simul Healthc 2010;5:127-32.
Mushin IC, Matteson MT, Lynch EC. Developing a resident assistance program. Beyond the support group model. Arch Intern Med 1993;153:729-33.
Thomas AS, Redd T, Hwang T. Improving the transition to ophthalmology residency: A survey of first-year ophthalmology residents. J Clin Acad Ophthalmol 2016;08:e10-8.
Thomsen AS, Bach-Holm D, Kjærbo H, Højgaard-Olsen K, Subhi Y, Saleh GM, et al
. Operating room performance improves after proficiency-based virtual reality cataract surgery training. Ophthalmology 2017;124:524-31.
Waqar S, Williams O, Park J, Modi N, Kersey T, Sleep T, et al.
Can virtual reality simulation help to determine the importance of stereopsis in intraocular surgery? Br J Ophthalmol 2012;96:742-6.
Solverson DJ, Mazzoli RA, Raymond WR, Nelson ML, Hansen EA, Torres MF, et al.
Virtual reality simulation in acquiring and differentiating basic ophthalmic microsurgical skills. Simul Healthc 2009;4:98-103.
Feudner EM, Engel C, Neuhann IM, Petermeier K, Bartz-Schmidt KU, Szurman P, et al.
Virtual reality training improves wet-lab performance of capsulorhexis: Results of a randomized, controlled study. Graefes Arch Clin Exp Ophthalmol 2009;247:955-63.
Pokroy R, Du E, Alzaga A, Khodadadeh S, Steen D, Bachynski B, et al.
Impact of simulator training on resident cataract surgery. Graefes Arch Clin Exp Ophthalmol 2013;251:777-81.
McCannel CA, Reed DC, Goldman DR. Ophthalmic surgery simulator training improves resident performance of capsulorhexis in the operating room. Ophthalmology 2013;120:2456-61.
Bergqvist J, Person A, Vestergaard A, Grauslund J. Establishment of a validated training programme on the eyesi cataract simulator. A prospective randomized study. Acta Ophthalmol 2014;92:629-34.
Gonzalez-Gonzalez LA, Payal AR, Gonzalez-Monroy JE, Daly MK. Ophthalmic surgical simulation in training dexterity in dominant and nondominant hands: Results from a pilot study. J Surg Educ 2016;73:699-708.
Roohipoor R, Yaseri M, Teymourpour A, Kloek C, Miller JB, Loewenstein JI, et al.
Early performance on an eye surgery simulator predicts subsequent resident surgical performance. J Surg Educ 2017;74:1105-15.
Singh P, Deuchler S, Schaefer H, Fassbender S, Kohnen T, Koch FH. Indirect ophthalmoscopy: Training with conventional hardware versus the eyesi® indirect ophthalmoscopy simulator. Invest Ophthalmol Vis Sci 2014;55:279.