814
Indian Journal of Ophthalmology
Vol. 62 No. 7
Feedback of final year ophthalmology postgraduates about their residency ophthalmology training in South India
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.
K. Ajay, R. Krishnaprasad
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.
1
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. Key words: Ophthalmology, residency training, satisfaction
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.[1,2] 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.[4,5] This study, Access this article online Quick Response Code:
Website: www.ijo.in DOI: 10.4103/0301-4738.138628
Department of Ophthalmology, M.S. Ramaiah Medical College, Bengaluru, 1Department of Glaucoma, Strabismus and Oculoplasty services, M.M. Joshi Eye Institute, Hubli, Karnataka, India Correspondence to: Dr. K Ajay, 233, 18 th Main Road, 6 th Block, K o r a m a n g a l a , B e n g a l u r u ‑ 5 6 0 0 9 5 , K a r n a t a k a , I n d i a . E‑mail: [email protected] Manuscript received: 05.09.13; Revision accepted: 21.04.14
Subjects and Methods
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
July 2014 Brief Communications
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 2 shows the results of surgeries needed to be seen, assisted and performed, to become accomplished and how many were done so far. Table 1: Improving student satisfaction with their residency training can be one of the goals for postgraduate trainers in ophthalmology Modality of teaching
Mean Median
Didactic lectures with power point
2.47
3
Didactic lectures without power point
2.00
2
Seminar-one person presenting, others participating 2.59
3
Case presentation, with demonstration on a patient
3.79
4
Wet lab, learning on animal eyes Journal club
3.20 2.20
3 2
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 Type of surgery
Conventional ECCE
Seen
Ideally should assist
Ideally should perform
Actually done so far
0-500
0-100
0-200
0-65
Manual SICS
50-8000
10-2000
50-2000
0-1200
Phacoemulsification
0-5000
0-1000
10-500
0-120
Pterygium
0-2000
5-600
8-1000
0-300
Dacryocystectomy
0-3000
1-400
5-100
0-300
Dacryocystorhinostomy
0-1000
0-400
0-100
0-200
Squint
0-100
0-100
0-100
0-5
Ptosis
0-100
0-100
0-50
0-10
Entropion, ectropion Trabeculectomy
0-400 0-400
0-100 0-100
0-100 0-100
0-30 0-30
ECCE: Extra capsular cataract extraction, SICS: Small incision cataract surgery
815
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]
Acknowledgment We thank all the postgraduate students who filled up the feedback forms and participated in the study. We are grateful to staff and students of Dr. M. M. Joshi eye hospital, Hubli, for help and support provided in the logistics of conducting the study. We are extremely grateful to Mrs. Arati Kshirasagar, English language proof‑reader and transcriptionist, and Madam Mrs. Mona Ryall, English teacher
816
Indian Journal of Ophthalmology
and Head of Department, Bethany School, Bengaluru, for assistance rendered in editing and proof‑reading of article.
Appendix
Please tick the appropriate choice at the end of the question:
Downloaded From: Gogate P, Deshpande M, Dharmadhikari S. Which is the best method to learn ophthalmology? Resident doctors’ perspective of ophthalmology training. Indian J Ophthalmol [serial online] 2008 [Last cited on 2013 Jun 21];56:409‑12. Available from: http://www.ijo.in/text. asp?2008/56/5/409/42419. 1. What do you think should be the ideal system of teaching and training an ophthalmologist? Please rate the following methods on a scale of 0 (worst or useless as a teaching aid) to 4 (excellent or the best way to teach). • Didactic lectures with power point useful in a scale of • Didactic lectures without power point useful in a scale of • Seminar ‑ one person presenting, others participating • Case presentation, with demonstration on a patient • Wet lab, learning on animal eyes • Journal club. 2. The following table has four columns for each type of surgery. Please enumerate how many surgeries you have seen so far, how many you think one should assist and how many you think a trainee surgeon should perform to be considered an accomplished surgeon in that particular type of surgery. In the last column please enumerate how many surgeries of that type you have actually done so far.
You seen so far
• What more is needed to improve our library facilities? • Any topic which you feel needs to be covered more.
Appendix 2: Extra Questions Added
Appendix 1: Questionnaire
How many have
Vol. 62 No. 7
How many should One ideally assist
How many should One ideally do
How many
Have you done so far
• Conventional extracapsular cataract extraction • Manual small incision cataract surgery • Phaco • Pterygium • Dacryocystectomy • Dacryocystorhinostomy • Squint • Ptosis • Entropion, ectropion • Trabeculectomy. 3. Open ended questions: • Do you think group discussion is helpful? • Bimonthly exams: Are they needed? How frequently should tests be held? • Mock OSCE tests/viva voce ‑once a year/twice a year. Please suggest moderators • Do you need specific training to handle instruments like perimeter, HRT, fundus camera, B‑scan, UBM, Specular Microscope, Nd: YAG laser? • Do you need any kind of training to handle outreach camps? • Do you need any kind of training to handle eye bank calls?
• Do you believe that an orientation program/lecture is necessary when you enter ophthalmology residency? YES/NO 2. Did you receive an orientation program/lecture when you entered ophthalmology residency? YES/NO If YES, • Who conducted the orientation program/lecture? • Did you feel that the lecture gave you an adequate picture of what to expect as an ophthalmology resident? 3. Do you think that the first 2-3 months of ophthalmology residency training should involve ophthalmic diagnostics training, such as slit lamp examination techniques, refraction, gonioscopy, tonometry, squint evaluation, indirect ophthalmoscopy with indentation, lacrimal syringing or these techniques can be learnt “on the job” without the need for spending time on initial diagnostic training? 3a. Prefer diagnostic training initially: Prefer direct posting to OPD/ward for “on the job” learning If preferring diagnostic training initially, You would prefer such training to be imparted by • Your Fellow Senior Resident • Junior Faculty • Senior Faculty. 4. Is refraction training best imparted by refractionist/ optometrist or by ophthalmologist? • Optometrist/Refractionist • Ophthalmologist.
Appendix 3: Consent cum information form Dear Doctor, You may agree that ophthalmology postgraduate training across India differs both in content and in perceived quality. Methods and modalities to improve ophthalmology residency training is a question regularly debated by teachers and ophthalmic consultants alike. We are attempting to understand the concepts involved and those which may need improvisation, in an effort to improve PG training. We are providing a questionnaire with certain questions to you. We request you to kindly answer these questions to help us in improving the standards of teaching and learning. The information given by you will be maintained with utmost confidentiality. If you so wish, you can write your name, and your college name, at the end of the questionnaire. The feedback will not be traced back to you. If you do not wish to be named, kindly write the name of the state in which your medical college is located. (E.g. Karnataka, Maharashtra, Andhra Pradesh etc.). Part of the questionnaire is from the brief communication article “which is the best method to learn ophthalmology? Resident doctors’ perspective of ophthalmology training” published in Indian Journal of Ophthalmology, Vol. 56,
July 2014 Brief Communications
Issue 5 (September-October 2008), authored by Parikshit Gogate, Madan Deshpande and Sheetal Dharmadhikari. Thank you for your kind co‑operation.
References 1. Grover AK. Postgraduate ophthalmic education in India: Are we on the right track? Indian J Ophthalmol 2008;56:3‑4. 2. Thomas R, Dogra M. An evaluation of medical college departments of ophthalmology in India and change following provision of modern instrumentation and training. Indian J Ophthalmol 2008;56:9‑16. 3. Gogate PM, Deshpande MD. The crisis in ophthalmology residency training programs. Indian J Ophthalmol 2009;57:74‑5.
817
best method to learn ophthalmology? Resident doctors’ perspective of ophthalmology training. Indian J Ophthalmol 2008;56:409‑12. 6. Mostafaei A, Hajebrahimi S. Perceived satisfaction of ophthalmology residents with the current Iranian ophthalmology curriculum. Clin Ophthalmol 2011;5:1207‑10. 7. Rogers GM, Oetting TA, Lee AG, Grignon C, Greenlee E, Johnson AT, et al. Impact of a structured surgical curriculum on ophthalmic resident cataract surgery complication rates. J Cataract Refract Surg 2009;35:1956‑60. 8. Zhou AW, Noble J, Lam WC. Canadian ophthalmology residency training: An evaluation of resident satisfaction and comparison with international standards. Can J Ophthalmol 2009;44:540‑7.
4. Murthy GV, Gupta SK, Bachani D, Sanga L, John N, Tewari HK. Status of speciality training in ophthalmology in India. Indian J Ophthalmol 2005;53:135‑42.
Cite this article as: Ajay K, Krishnaprasad R. Feedback of final year ophthalmology postgraduates about their residency ophthalmology training in South India. Indian J Ophthalmol 2014;62:814-7.
5. Gogate P, Deshpande M, Dharmadhikari S. Which is the
Source of Support: Nil. Conflict of Interest: None declared.
Orbital cellulitis in a neonate of the tooth bud origin : A case report Poonam Lavaju, Badri Prasad Badhu, Basudha Khanal1, Bhuwan Govinda Shrestha Orbital cellulitis is a serious, yet uncommon infection in neonates. It can result in significant sight and life threatening complications. Most commonly, it occurs secondarily as the result of a spread of infection from the sinuses. Orbital cellulitis, secondary to dental infection is rare. We hereby report a case of orbital cellulitis secondary to dental infection in a 15‑day‑old neonate without any systemic features. Key words: Odontogenic orbital cellulitis, orbital cellulites, tooth bud abscess
Orbital cellulitis in neonates is a potentially lethal condition that can result in significant complications including blindness, cavernous sinus thrombosis, meningitis, subdural Access this article online Quick Response Code:
Website: www.ijo.in DOI: 10.4103/0301-4738.138296
Department of Ophthalmology, 1Department of Microbiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal Correspondence to: Dr. Poonam Lavaju, Associate Professor, Department of Ophthalmology, B. P. Koiral Institute of Health Sciences, Dharan, Nepal. E‑mail: drpoonamlavaju @yahoo.com Manuscript received: 18.08.13; Revision accepted: 11.02.14
emphysema and brain abscess. [1] Orbital cellulitis is usually a complication of infection in the paranasal sinuses (60‑80%)[2,3] and is infrequently the result of an infection of dental origin (2‑5%).[4,5] To our knowledge only one case of a neonate with orbital cellulitis secondary to dental infection has been reported. We hereby report a case of orbital cellulitis in a 15‑day‑old neonate without systemic features, secondary to the tooth bud abscess.
Case Report A 15‑day‑old female neonate patient was brought with history of a sudden onset proptosis of the left eye for three days. There was no history of trauma, fever or any systemic complaints. She was delivered normally at full term without any significant antenatal or postnatal complications. She was exclusively breastfed. Vital signs including pulse, temperature, and respiratory rate were within normal limits. Ocular examination revealed an axial proptosis of the left eye with limited ocular movements in all directions [Fig. 1]. The left eyelid was swollen and inflamed. Anterior segment examination was normal. Pupillary reaction and fundus examination were also normal. The right eye was normal. Systemic examination revealed no abnormalities except the presence of a tooth bud abscess in the left maxillary alveolar ridge with overlying facial swelling [Fig. 2]. Hematological investigations showed the following results: Hemoglobin‑ 14.5 gm%, PCV‑ 57.4%, total leucocyte count‑ 17,000/mm3, neutrophils‑ 52%, lymphocytes‑ 48%, platelet count‑ 483,000/mm3, urea‑ 28 mg/dl, creatinine‑ 0.8 mg/dl. Microbiological examination of the urine was normal. Blood and urine culture revealed no organisms. Microbiological investigation of both conjunctival and oral swabs grew Staph aureus that was sensitive to amikacin, vancomycin, ofloxacin, gentamicin, cefotaxime, co‑trimoxazole and resistant to penicillin and cefalexin. CT scan of the head and orbit showed a dense soft tissue
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Indian Journal of Ophthalmology
Vol. 62 No. 7
Feedback of final year ophthalmology postgraduates about their residency ophthalmology training in South India
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.
K. Ajay, R. Krishnaprasad
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.
1
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. Key words: Ophthalmology, residency training, satisfaction
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.[1,2] 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.[4,5] This study, Access this article online Quick Response Code:
Website: www.ijo.in DOI: 10.4103/0301-4738.138628
Department of Ophthalmology, M.S. Ramaiah Medical College, Bengaluru, 1Department of Glaucoma, Strabismus and Oculoplasty services, M.M. Joshi Eye Institute, Hubli, Karnataka, India Correspondence to: Dr. K Ajay, 233, 18 th Main Road, 6 th Block, K o r a m a n g a l a , B e n g a l u r u ‑ 5 6 0 0 9 5 , K a r n a t a k a , I n d i a . E‑mail: [email protected] Manuscript received: 05.09.13; Revision accepted: 21.04.14
Subjects and Methods
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
July 2014 Brief Communications
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 2 shows the results of surgeries needed to be seen, assisted and performed, to become accomplished and how many were done so far. Table 1: Improving student satisfaction with their residency training can be one of the goals for postgraduate trainers in ophthalmology Modality of teaching
Mean Median
Didactic lectures with power point
2.47
3
Didactic lectures without power point
2.00
2
Seminar-one person presenting, others participating 2.59
3
Case presentation, with demonstration on a patient
3.79
4
Wet lab, learning on animal eyes Journal club
3.20 2.20
3 2
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 Type of surgery
Conventional ECCE
Seen
Ideally should assist
Ideally should perform
Actually done so far
0-500
0-100
0-200
0-65
Manual SICS
50-8000
10-2000
50-2000
0-1200
Phacoemulsification
0-5000
0-1000
10-500
0-120
Pterygium
0-2000
5-600
8-1000
0-300
Dacryocystectomy
0-3000
1-400
5-100
0-300
Dacryocystorhinostomy
0-1000
0-400
0-100
0-200
Squint
0-100
0-100
0-100
0-5
Ptosis
0-100
0-100
0-50
0-10
Entropion, ectropion Trabeculectomy
0-400 0-400
0-100 0-100
0-100 0-100
0-30 0-30
ECCE: Extra capsular cataract extraction, SICS: Small incision cataract surgery
815
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]
Acknowledgment We thank all the postgraduate students who filled up the feedback forms and participated in the study. We are grateful to staff and students of Dr. M. M. Joshi eye hospital, Hubli, for help and support provided in the logistics of conducting the study. We are extremely grateful to Mrs. Arati Kshirasagar, English language proof‑reader and transcriptionist, and Madam Mrs. Mona Ryall, English teacher
816
Indian Journal of Ophthalmology
and Head of Department, Bethany School, Bengaluru, for assistance rendered in editing and proof‑reading of article.
Appendix
Please tick the appropriate choice at the end of the question:
Downloaded From: Gogate P, Deshpande M, Dharmadhikari S. Which is the best method to learn ophthalmology? Resident doctors’ perspective of ophthalmology training. Indian J Ophthalmol [serial online] 2008 [Last cited on 2013 Jun 21];56:409‑12. Available from: http://www.ijo.in/text. asp?2008/56/5/409/42419. 1. What do you think should be the ideal system of teaching and training an ophthalmologist? Please rate the following methods on a scale of 0 (worst or useless as a teaching aid) to 4 (excellent or the best way to teach). • Didactic lectures with power point useful in a scale of • Didactic lectures without power point useful in a scale of • Seminar ‑ one person presenting, others participating • Case presentation, with demonstration on a patient • Wet lab, learning on animal eyes • Journal club. 2. The following table has four columns for each type of surgery. Please enumerate how many surgeries you have seen so far, how many you think one should assist and how many you think a trainee surgeon should perform to be considered an accomplished surgeon in that particular type of surgery. In the last column please enumerate how many surgeries of that type you have actually done so far.
You seen so far
• What more is needed to improve our library facilities? • Any topic which you feel needs to be covered more.
Appendix 2: Extra Questions Added
Appendix 1: Questionnaire
How many have
Vol. 62 No. 7
How many should One ideally assist
How many should One ideally do
How many
Have you done so far
• Conventional extracapsular cataract extraction • Manual small incision cataract surgery • Phaco • Pterygium • Dacryocystectomy • Dacryocystorhinostomy • Squint • Ptosis • Entropion, ectropion • Trabeculectomy. 3. Open ended questions: • Do you think group discussion is helpful? • Bimonthly exams: Are they needed? How frequently should tests be held? • Mock OSCE tests/viva voce ‑once a year/twice a year. Please suggest moderators • Do you need specific training to handle instruments like perimeter, HRT, fundus camera, B‑scan, UBM, Specular Microscope, Nd: YAG laser? • Do you need any kind of training to handle outreach camps? • Do you need any kind of training to handle eye bank calls?
• Do you believe that an orientation program/lecture is necessary when you enter ophthalmology residency? YES/NO 2. Did you receive an orientation program/lecture when you entered ophthalmology residency? YES/NO If YES, • Who conducted the orientation program/lecture? • Did you feel that the lecture gave you an adequate picture of what to expect as an ophthalmology resident? 3. Do you think that the first 2-3 months of ophthalmology residency training should involve ophthalmic diagnostics training, such as slit lamp examination techniques, refraction, gonioscopy, tonometry, squint evaluation, indirect ophthalmoscopy with indentation, lacrimal syringing or these techniques can be learnt “on the job” without the need for spending time on initial diagnostic training? 3a. Prefer diagnostic training initially: Prefer direct posting to OPD/ward for “on the job” learning If preferring diagnostic training initially, You would prefer such training to be imparted by • Your Fellow Senior Resident • Junior Faculty • Senior Faculty. 4. Is refraction training best imparted by refractionist/ optometrist or by ophthalmologist? • Optometrist/Refractionist • Ophthalmologist.
Appendix 3: Consent cum information form Dear Doctor, You may agree that ophthalmology postgraduate training across India differs both in content and in perceived quality. Methods and modalities to improve ophthalmology residency training is a question regularly debated by teachers and ophthalmic consultants alike. We are attempting to understand the concepts involved and those which may need improvisation, in an effort to improve PG training. We are providing a questionnaire with certain questions to you. We request you to kindly answer these questions to help us in improving the standards of teaching and learning. The information given by you will be maintained with utmost confidentiality. If you so wish, you can write your name, and your college name, at the end of the questionnaire. The feedback will not be traced back to you. If you do not wish to be named, kindly write the name of the state in which your medical college is located. (E.g. Karnataka, Maharashtra, Andhra Pradesh etc.). Part of the questionnaire is from the brief communication article “which is the best method to learn ophthalmology? Resident doctors’ perspective of ophthalmology training” published in Indian Journal of Ophthalmology, Vol. 56,
July 2014 Brief Communications
Issue 5 (September-October 2008), authored by Parikshit Gogate, Madan Deshpande and Sheetal Dharmadhikari. Thank you for your kind co‑operation.
References 1. Grover AK. Postgraduate ophthalmic education in India: Are we on the right track? Indian J Ophthalmol 2008;56:3‑4. 2. Thomas R, Dogra M. An evaluation of medical college departments of ophthalmology in India and change following provision of modern instrumentation and training. Indian J Ophthalmol 2008;56:9‑16. 3. Gogate PM, Deshpande MD. The crisis in ophthalmology residency training programs. Indian J Ophthalmol 2009;57:74‑5.
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best method to learn ophthalmology? Resident doctors’ perspective of ophthalmology training. Indian J Ophthalmol 2008;56:409‑12. 6. Mostafaei A, Hajebrahimi S. Perceived satisfaction of ophthalmology residents with the current Iranian ophthalmology curriculum. Clin Ophthalmol 2011;5:1207‑10. 7. Rogers GM, Oetting TA, Lee AG, Grignon C, Greenlee E, Johnson AT, et al. Impact of a structured surgical curriculum on ophthalmic resident cataract surgery complication rates. J Cataract Refract Surg 2009;35:1956‑60. 8. Zhou AW, Noble J, Lam WC. Canadian ophthalmology residency training: An evaluation of resident satisfaction and comparison with international standards. Can J Ophthalmol 2009;44:540‑7.
4. Murthy GV, Gupta SK, Bachani D, Sanga L, John N, Tewari HK. Status of speciality training in ophthalmology in India. Indian J Ophthalmol 2005;53:135‑42.
Cite this article as: Ajay K, Krishnaprasad R. Feedback of final year ophthalmology postgraduates about their residency ophthalmology training in South India. Indian J Ophthalmol 2014;62:814-7.
5. Gogate P, Deshpande M, Dharmadhikari S. Which is the
Source of Support: Nil. Conflict of Interest: None declared.
Orbital cellulitis in a neonate of the tooth bud origin : A case report Poonam Lavaju, Badri Prasad Badhu, Basudha Khanal1, Bhuwan Govinda Shrestha Orbital cellulitis is a serious, yet uncommon infection in neonates. It can result in significant sight and life threatening complications. Most commonly, it occurs secondarily as the result of a spread of infection from the sinuses. Orbital cellulitis, secondary to dental infection is rare. We hereby report a case of orbital cellulitis secondary to dental infection in a 15‑day‑old neonate without any systemic features. Key words: Odontogenic orbital cellulitis, orbital cellulites, tooth bud abscess
Orbital cellulitis in neonates is a potentially lethal condition that can result in significant complications including blindness, cavernous sinus thrombosis, meningitis, subdural Access this article online Quick Response Code:
Website: www.ijo.in DOI: 10.4103/0301-4738.138296
Department of Ophthalmology, 1Department of Microbiology, B.P. Koirala Institute of Health Sciences, Dharan, Nepal Correspondence to: Dr. Poonam Lavaju, Associate Professor, Department of Ophthalmology, B. P. Koiral Institute of Health Sciences, Dharan, Nepal. E‑mail: drpoonamlavaju @yahoo.com Manuscript received: 18.08.13; Revision accepted: 11.02.14
emphysema and brain abscess. [1] Orbital cellulitis is usually a complication of infection in the paranasal sinuses (60‑80%)[2,3] and is infrequently the result of an infection of dental origin (2‑5%).[4,5] To our knowledge only one case of a neonate with orbital cellulitis secondary to dental infection has been reported. We hereby report a case of orbital cellulitis in a 15‑day‑old neonate without systemic features, secondary to the tooth bud abscess.
Case Report A 15‑day‑old female neonate patient was brought with history of a sudden onset proptosis of the left eye for three days. There was no history of trauma, fever or any systemic complaints. She was delivered normally at full term without any significant antenatal or postnatal complications. She was exclusively breastfed. Vital signs including pulse, temperature, and respiratory rate were within normal limits. Ocular examination revealed an axial proptosis of the left eye with limited ocular movements in all directions [Fig. 1]. The left eyelid was swollen and inflamed. Anterior segment examination was normal. Pupillary reaction and fundus examination were also normal. The right eye was normal. Systemic examination revealed no abnormalities except the presence of a tooth bud abscess in the left maxillary alveolar ridge with overlying facial swelling [Fig. 2]. Hematological investigations showed the following results: Hemoglobin‑ 14.5 gm%, PCV‑ 57.4%, total leucocyte count‑ 17,000/mm3, neutrophils‑ 52%, lymphocytes‑ 48%, platelet count‑ 483,000/mm3, urea‑ 28 mg/dl, creatinine‑ 0.8 mg/dl. Microbiological examination of the urine was normal. Blood and urine culture revealed no organisms. Microbiological investigation of both conjunctival and oral swabs grew Staph aureus that was sensitive to amikacin, vancomycin, ofloxacin, gentamicin, cefotaxime, co‑trimoxazole and resistant to penicillin and cefalexin. CT scan of the head and orbit showed a dense soft tissue
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