Comparative analysis of European residency programs: benchmarking and harmonizing ophthalmology training in Europe

Anaya-Alaminos, Roberto; Rassmussen, Marie Louise; Fung, S.; Potić, Jelena; González‐Andrades, Miguel

doi:10.1038/s41433-022-02040-3

Cited by 12 publications

(12 citation statements)

References 18 publications

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“…The Portuguese ophthalmology residency program takes 4 years, and the residents are expected to perform several ocular surgeries. This is not the case throughout Europe, where some countries almost do not offer surgical training 22. In our center, trabeculectomy is usually performed by third-year and fourth-year residents.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Trabeculectomy Outcomes Performed by Residents in Training and Ophthalmologists

Lima-Fontes¹,

Faria-Pereira²,

Leuzinger-Dias³

et al. 2022

Journal of Glaucoma

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Précis: Resident-performed trabeculectomies present higher intraocular pressure and lower complete success rate at 1 year. Purpose: To compare the 1-year outcomes of ab externo trabeculectomy between residents in training and staff ophthalmologists. Patients and Methods: This retrospective study included all consecutive eyes submitted to ab externo trabeculectomy between January 2015 to June 2020. A 1-year complete success rate was considered using all the following criteria: intraocular pressure (IOP)≤21 mm Hg and ≥6mm Hg without ocular hypotensive medications; IOP reduction≥30%; without loss of light perception, phthisis bulbi, and further glaucoma surgery (excluding suture lysis and bleb needling). Results: One hundred and ten eyes from 99 patients were included. Thirty percent (n=33) of the trabeculectomies were performed by residents. There were no significant preoperative differences between groups, apart from age at surgery, which was higher in the residents' group (72.39±6.83 vs. 62.00±15.07 years, P<0.001), and visual field index (Humphrey Field Analyzer), which was lower in the ophthalmologists’ group (51.81±34.74% vs. 32.04±33.83%, P=0.013). IOP at 1-, 3-, 6 months, and 1 year after surgery was significantly higher in the resident’s group (P<0.05). Resident-performed trabeculectomies achieved a significantly lower complete success rate when compared with the ophthalmologists’ group (39.39% vs. 64.94%, P=0.013). The overall rate of the postoperative complications and reintervention did not differ between groups, but the occurrence of a shallow anterior chamber was more frequent in the residents’ group (15.15% vs. 4.05%, P=0.037). Conclusions: Resident-performed trabeculectomies present significantly higher postoperative IOP levels and a lower complete success rate when compared with staff ophthalmologists. It is, therefore, fundamental to adopt strategies to change this gap, improve patient safety, and strengthen resident confidence.

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Section: Discussionmentioning

confidence: 99%

“…This is not the case throughout Europe, where some countries almost do not offer surgical training. 22 In our center, trabeculectomy is usually performed by third-year and fourth-year residents.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Trabeculectomy Outcomes Performed by Residents in Training and Ophthalmologists

Lima-Fontes¹,

Faria-Pereira²,

Leuzinger-Dias³

et al. 2022

Journal of Glaucoma

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“…An online Google Form survey was conducted between September 2019 and July 2021, using a questionnaire adapted from a previous study conducted in Europe 11,12. We conducted this anonymous survey through Young Ophthalmologist (YO) leaders through the Asia-Pacific Academy of Ophthalmology (APAO) 13.…”

Section: Methodsmentioning

confidence: 99%

“…An online Google Form survey was conducted between September 2019 and July 2021, using a questionnaire adapted from a previous study conducted in Europe. 11,12 We conducted this anonymous survey through Young Ophthalmologist (YO) leaders through the Asia-Pacific Academy of Ophthalmology (APAO). 13 The questionnaire was conducted in English and consisted of 110 questions, which were categorized into 6 different sections that covered the basic aspects of training: (1) Personal Details, (2) Curriculum (of Training Program), (3) Working Conditions, (4) Qualifications and Further Education, (5) Degree of Satisfaction/Agreement, and (6) Competency.…”

Section: Participantsmentioning

confidence: 99%

Survey of Ophthalmology Training Experiences Among Young Ophthalmologists in the Asia-Pacific

Tsai

Yeo

Alaminos

et al. 2022

Asia-Pacific Journal of Ophthalmology

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Purpose: To describe ophthalmology training experiences across the Asia-Pacific (APAC). Design: Survey study. Methods: We utilized an anonymous online survey, which was previously validated and conducted in Europe, through Young Ophthalmologist leaders from the national member societies of the Asia-Pacific Academy of Ophthalmology (APAO) from September 2019 to July 2021. Responses were based on a 5-point Likert scale (where applicable) and data were analyzed using Microsoft Excel. Our main outcome measures were differences between regions, that is, Southeast Asia (SEA) and Western Pacific (WP); and seniority, that is, trainees/junior ophthalmologists and senior ophthalmologists. Results: We collated 130 responses representing 20 regions in the APAC region. The year of completion of ophthalmic training ranged from 1999 to 2024. The mean duration of training was 3.7±1.0 years. Most (98/130, 75%) indicated an interest for a common training standard across the APAC. Comparing SEA and WP trainees, both regions had similar working environments, but those in SEA reported significantly lower remuneration than their counterparts in WP ($600 vs $3000, P<0.05). WP trainees performed more phacoemulsification surgeries (76 WP vs 19 SEA), while SEA trainees conducted more manual small incision cataract surgeries (157 WP vs 1.5 SEA per duration of training). Senior ophthalmologists performed more cataract surgeries (210.9 senior ophthalmologists vs 40.1 junior ophthalmologists). Trainees had less confidence in medical competency areas such as interpreting an electroretinogram/visual evoked potential/electrooculogram (SEA=1.8, WP=2.1) and conducting an angiography (SEA=2.8, WP=3.4). Conclusions: Our study highlighted heterogeneity among ophthalmology training experiences in the APAC region, with the majority indicating an interest in a common training standard.

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“…7,8 Many surveys of residents and program directors have uncovered disparities between both training programs and the extent of surgical training between countries. [9][10][11][12][13][14][15][16][17][18] However, few studies have surveyed postgraduate ophthalmologists after exiting their residency program, nor have they specifically focused on CS training programs.…”

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confidence: 99%

Cataract surgical training in Europe: European Board of Ophthalmology survey

Dhubhghaill

Sanogo

Lefèbvre

et al. 2023

J Cataract Refract Surg

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Purpose: To survey recently graduated European ophthalmologists concerning CS training opportunities. Setting: Countries affiliated to the European Board of Ophthalmology (EBO). Design: Cross-sectional study of anonymous survey results. Methods: A 23-question online survey was emailed to candidates who sat the EBO Diploma examination as residents between 2018 and 2022. Results: Eight hundred twenty-one ophthalmologists from 30 countries completed the survey. The mean residency duration was 4.73 (SD 0.9) years. The mean reported number of entire CS procedures performed was 80.7 (SD 100.6) at the end of residency, but more than 25% of respondents (n=210) had received no live CS training during their residency. The self-confidence (scale, 1-10) to perform a simple case or challenging case, manage posterior capsular rupture, and realize a corneal stitch were rated 4.1, 3.2, 4.2, 2.4, respectively. We observed extensive variation in clinical exposure to CS and self-reported confidence to perform CS between European trainees. Females reported a mean of 18% fewer entire procedures than their male colleagues and were also less confident in their surgical skills (p<0.05). Trainees in residency programs longer than 5 years performed fewer procedures and were less confident than trainees in residences of shorter duration (p<0.001). The importance of fellowships to complete surgical education was rated 7.7 out of 10. Conclusions: CS training across European countries lacks harmony. Female ophthalmology trainees continue, as in other specialties, to experience apparent gender bias. European level recommendations seem necessary to raise and harmonize competency-based CS training programs and promote post-residency fellowship training programs.

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Comparative analysis of European residency programs: benchmarking and harmonizing ophthalmology training in Europe

Cited by 12 publications

References 18 publications

Comparison of Trabeculectomy Outcomes Performed by Residents in Training and Ophthalmologists

Comparison of Trabeculectomy Outcomes Performed by Residents in Training and Ophthalmologists

Survey of Ophthalmology Training Experiences Among Young Ophthalmologists in the Asia-Pacific

Cataract surgical training in Europe: European Board of Ophthalmology survey

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