Abstract: The highly competitive offer of medical training programs and schools, globalization and constant mobility of physicians and medical students (MS), and the commitment to society to deliver competent physicians, demands the definition of performance standards. This would allow to make their performances comparable no matter where they studied or which textbook did they used as reference, to have evaluation mechanisms that guarantee mastery of the integral evaluation of the performance. Assessment has been the key in the teaching-learning process as this obtains a formative and summative element, at different moments, from the extent to which the students have acquired knowledge, skills and attitudes. The progress of the learner must be enhanced with effective feedback on their performance and self-direction of the results obtained in each of the mechanisms established. If, traditionally, this has been considered as the accreditation of compliance with a standard, the evaluation also functions in an integral way as a formative process that identifies advances and deficiencies in the training of residents that allows the definition of actions and strategies for improving the operation of the programs. Different assessment mechanisms are associated with the areas of competence domain, some of the most common tools are: theoretical exams, checklists and rubrics, portfolio, projects and challenges. However, the importance of defining standards which are perceived as fair and designed according to the learning objectives remains a priority to guarantee the credibility of the evaluation agencies and institutions. Some strategies to assure credibility include the involvement of expert and trained evaluators, allowing the process to be carried out with transparency and diligence, and the principles employed should be supported by educational research.
Abstract: Graduate medical education (GME) has shifted its curricula from process-oriented approach to outcomes-oriented models. Program and faculty evaluation are methods by which educational curricula may adjust the teaching and learning environment to meet the needs and fills the gaps in GME. The measurement of educational outcomes is an essential for assessing teaching effectiveness in a shifting health care environment. In addition to trainee, program, and faculty evaluations, annual program review (APR) and evaluation and navigational changes made by the program education committee are essential to maintain effectiveness of an educational curriculum in a contemporary graduate medical training program.
Abstract: The goal of ophthalmology residency training is to produce competent ophthalmologists. Appropriate assessments must be employed to ensure this goal is met. Valid and reliable workplace-based assessments are designed to assess competence in the many domains required of a good ophthalmologist. These assessments increase standardization and objectivity as compared to simple observational feedback. When used appropriately, workplace based assessments not only provide measures of competence but also facilitate effective formative feedback and enhance learning.
Abstract: Cataract surgery is arguably the most commonly performed operation in ophthalmology. Surgical skills transfer from experienced surgeons to resident surgeons is complicated by the fact that the teaching surgeon primarily acts as an observer rather than directly performing the procedure. Therefore, wet lab and simulator training are utilized to reduce the learning curve of the novice surgeons, which establishes tissue awareness, dexterity and muscle memory required to perform each step of the procedure, safely. Access to a wet lab and simulator environment is accomplished by establishing a surgical training curriculum in residency programs. In the operating room, topical anesthesia is a safe alternative for teaching cataract surgery. There are three well-described approaches to teaching individual steps of cataract surgery: forward, “backwards”, and deconstructed step-by-step instruction. Simulator training can be incorporated prior to live patient experience or integrated concurrently with learner presence in the operating room. The trend towards a competency-based instruction model has necessitated appropriate evaluation tools that include Objective Assessment of Skills in Intraocular Surgery (OASIS), Global Rating Assessment of Skills in Intraocular Surgery (GRASIS), and the International Council of Ophthalmology’s Ophthalmology Surgical Competency Assessment Rubrics (ICO-OSCAR). We review the literature on trends in surgical teaching in ophthalmology, with the focus on cataract surgery instruction to the novice surgeon.
Abstract: The teaching of professionalism, a key aspect of medical competence that regulates physician’s behavior towards patients, colleagues, society, and self, should be included in the curriculum of every training program. Studies suggest a variety of formats to teach and evaluate professionalism in residents, being role modeling, reflection, case discussions, and 360-degree assessments the most commonly used. However, little is published about the need to train faculty for teaching and evaluating professionalism, or how to improve institutional culture, so that principles that are indicated to teach in theory are also fulfilled in practice.
Abstract: Training in residency programs is highly competitive, it requires the formation of competent physicians that achieve the performance standards that were declared for their technical skills, attitudes and interpersonal abilities. The use of simulation and technology on the medical education has increased considerably. Particularly in ophthalmology the simulators used are: live models from animal or cadavers, mannequins, wet laboratories, simulated patients, part-task moles, laser or surgical models, and more recently, virtual reality (VR). VR places a person in a simulated environment that has a specific sense of self-location, where the participant interacts with the objects within the setting. Teaching with VR refers to the use of the available resources in technology and visualization of structures to improve the educational experience of medical students, residents and physicians in professional continuous development programs. Several authors highlight the benefits of assessing trainees with the tools, they argue that the key contribution of this model is in the formative assessment. Rather than evaluating and putting a score on student’s grades, VR provides a powerful experience for the acquisition of skills. A conclusion is the need to develop studies to document the effects that it has on knowledge, skills and behaviors, and to patient related outcomes.
Abstract: The outcomes of modern ophthalmic surgery, especially cataract surgery, continue to improve and patients now realistically expect an excellent and speedy outcome with good vision and few complications. Social and regulatory demands for greater transparency and accountability in medicine have increased, highlighting a fundamental ethical tension in medical education—balancing the needs of trainees (who have not yet mastered the technique) to gain experience by performing surgery, with patient safety and the needs of the public to be protected from risk. Patient safety and well-being are the paramount considerations in any training program and must be the first consideration in program design. A variety of different educational strategies, each implemented with the aim of improving operative skills assessment and teaching, has recently been described in the literature. Effective use of these educational tools, combined with a structured approach to teaching and providing meaningful feedback, could improve outcomes, decrease complications and improve the quality and efficiency of surgical training in ophthalmology. Supervisors must assess their teaching style and communication, as being a good surgeon does not necessarily make a good trainer. Open disclosure must be given to patients about who will be performing the surgery, and communication during surgery between supervisors and trainees must be clear, respectful and appropriate.
