Dr. Parikshit Gogate, G06928,
Dr. Partha Biswas
Parikshit Gogate, Partha Biswas
Abstract
Purpose: To know the perception of young ophthalmologists about their dissertation and academics during residency training in order to improve the research output during present residency programs in India
Methods: A survey was conducted by Academic and Research Committee of the All India Ophthalmological Society, the world’s second largest ophthalmic professional’s organization, in 2014-16 of young ophthalmologists (those who completed residency between 2005-2012) to gauge usefulness of dissertation or thesis during post-graduate residency.
Results: There were 1005 respondents of whom 531 fulfilled inclusion criteria. On a scale of 0-10; residents rated level of supervision of their dissertation as adequate (mean 5.9/10, SD 3.1, median 6). The level of infrastructure available was for dissertation rated as 5.9/10 (median 7, SD 3.1), 6.2/10 was the score that residents said about value added by the dissertation (median 7). The dissertation was presented at local (33.5%), state (28.1%), national (15.4%) and international (4%) level respectively. Students, not supervisors, did most of the local and state level presentations. It was published in some form at local 210(39.5%), state (140, 26.4%), national (94, 17.7%) and international (39, 7.3%) level respectively.
Conclusion: Peer reviewed publications from Indian residency training dissertations were few. Residents felt dissertation added value to their training but there was a huge range amongst the responses.
Introduction
In post graduate training, it is expected that the student indulges in same form of research to collate existing knowledge and if possible create new knowledge paradigms. Post graduate medical education is no exception to this. But surgical and medical residency training have high demands on the resident’s energy and time in terms of patient care, documentation and learning the subject in depth. Thus dissertation, thesis or the research projectduring the residency is just one of the priorities of the student. These postgraduate students are the foot soldiers for many of the serious research projects of their faculty.
There have been few studies from India about resident feedback about their teaching methods.[1-3] Numerous studies from USA and Canada have focused on journal clubs and wet labs a teaching method.[4-8] But there have been no studies, to the best of our knowledge, looking at dissertations and thesis done by ophthalmic residents in published literature.The aim of the study was toknow the perception of young ophthalmologists about their dissertation and academics during residency training. It would help improve the research output during present residency programs in India and help frame guidelines to for better academic schedules during residency training.
Methods
All IndianUniversities and the National Board of Examination (NBE, New Delhi) for medical education have a thesis or dissertation compulsory for a three year medical postgraduate degree course. The twoyear diploma course is exempt from thesis in some Universities. Both degree and diploma pass outs were included in the study. The All India Ophthalmological Society (AIOS) commissioned a survey of all young ophthalmologists about what they felt regarding their residency program. Ophthalmologists with a minimum of two to maximum of ten years of experience afterthe completion of their residency, those who had completed their residency training Between 2005-2012 were included. These were chosen as the ophthalmologists would have the perspective, after working independently for a few years, but were still ‘fresh’ enough to remember their training days (Young Ophthalmologists).The survey results were collected through survey monkey and written questionnaires.
The project was discussed and approved by the governing council of the All India Ophthalmology Society in its mid-year meeting in 2014.A semi-structured questionnaire was first validated with three independent researchers and a small pilot run for two weeks. The questionnaire (appendix A) was e-mailed and posted to all the participants. The questionnaire was part of a survey monkey link with a forwarding letter requesting the respondents about what was expected from them. A postal, e-mail and telephonic reminder were sent after each week. In early 2015 heads of institutions of excellence, senior office bearers of the AIOS and veteran and serving Professors were asked to forward the survey link to their former students and residents as a reminder. The participants would have to fill certain demographic details but would not have to disclose their identity, if they so desired. The data was entered into Excel worksheets and statistical package for social sciences (SSPS version 16).
They were asked whether their dissertation was presented or published. If so at what level: local, state, national or international? Were they the presenters or first authors of the same or were their supervisors or significant seniors presenting their research?
The data was entered into Excel worksheets and statistical package for social sciences (SSPS version 16) was used for data analysis. Mean, standard deviation and median of the responses was considered.
Results:
While 4212potential subjects were contacted repeatedly over a period of 17 months, we had 1005 respondents who answered the complete survey.Of the sample, 531 (52.8%) met the inclusion criteria of >2 and<10yrs of post residency (Young Ophthalmologists). The mean age of the 531 young ophthalmologists was 32.6years (SD 4, range 25-56 years, median 32) and 325 (61.2%) were males.
299(56.3%) had their degrees as Master of Surgery (MS), 31(5.8%) as MD, 162 (30.5%) as Diplomate of the National Board (DNB) while 114 (21.5%) were Diploma in Ophthalmic Medicine and Surgery(DOMS/ DO). Many had more than one degree.
Young ophthalmologists were asked to rate the level of supervision they had, the level of infrastructure (instruments, equipment, library) and the value that the dissertation added to their residency on a scale of 0-10. The results are given in table 1.
92 (25.2%) did not submit their research proposal to an ethical committee while the rest did apply for and get ethicsclearance. On being asked if the dissertation made them well versed in research methodology, 138/359 (38.4%) replied in affirmative, 45/359(12.5%) said ‘No’ and 176/359 (49%) reported ‘to some extent’.
Table 2 shows where the young ophthalmologists’ dissertation study was presented and/or published.
Discussion
Most training programs had a structured teaching schedule and most residents had submitted their proposal to an ethics committee. But this was not universal. Young ophthalmologist’s rated their support for the dissertation as high (in terms of infrastructure and supervision) but almost a third felt that it was very inadequate.
Canadian ophthalmology residents were allowed to attend at least one conference every year which was paid for by the department. [3] While the All India Ophthalmological Society keeps special concessional rates for ophthalmologists in training, most have to bear their travel and stay expenses. The scenario of resident presentations and publications may change as the Medical Council of India (MCI) and many fellowships admission offices are asking for presentations and publications. While the number of residents presenting oral and poster presentation may increase, peer reviewed publications would need greater quality in the research work done.But if we calculate the percentage of publications on the denominator of 365, the respondents who completed the questionnaire and not 531, the total number of young ophthalmologists, the percentage of oral and poster presentations and publications is quite respectable.
Many programs were excellent, scored 9 or 10 by their residents, but there were other’s where the support for academics and research wasrudimentary. The challenge is to bridge this gap and make residency training excellent all over the country, something only standardization and uniformity would do. The higher speciality training program in UK is consistent because it defines clear goals in training and puts forth an explicitly outlined curricular that advances these goals and conducts regular assessments of the trainees, achievement of these goals.[9,10,11]In the United States, the Accreditation Council for Graduate Medical Education (ACGME) tried to establish a program that formally defined a set of learning competencies, stresses graduated and progressive responsibility and provided frequent evaluation and feedback.[5] The need of the hour is a culture of innovation and knowledge sharing that looks at the resident as a creative doctor-in-training whose skills have to be sharpened and mind fostered for better patient care, rather than a passive student whose duty is to serve the department and absorb knowledge in the process.
Limitations of the study: The results are based on young ophthalmologists responses, which may have recall bias. The individual responses may have been conditioned by respondent’s prejudices and the demographic information provided by the respondents was not verified.
There was a huge variation in the given to the residents to undertake their research during the residency.
References
1.Gogate P, Deshpande M, Dharmadhikari S. Which is the best method to learn ophthalmology? Resident doctors perspective of ophthalmology training. Indian J Ophthalmology. 2008;56(5):409-12.
2.Ajay K,Krishnaprasad R. Feedback of final yearophthalmology postgraduates about their residency ophthalmology training in SouthIndia. Ind J Ophthalmol 2014 Jul;62(7):814-
3.Ajay K,Krishnaprasad R,Divya DS. Ophthalmic surgical training in Karnataka and Southern India: Present status and future interests from a survey of final-year residents. Ind J Ophthalmol 2015 Apr;63(4):306-11
3. Le K, Bursztyn L, Rootman D, Harissi-Dagher M.National survey of Canadian ophthalmology residency education. Can J Ophthalmol 016 Jun;51(3):219-25.
4. McDonnell PJ, Kirwan TJ, Brinton GS, Golnik KC, Melendez RF, Parke DW 2nd, et. al.Perceptions of recent ophthalmology residency graduates regarding preparation for practice. Ophthalmology 2007 Feb;114(2):387-91
5. Lee AG, Boldt HC, Golnik KC, Arnold AC, Oetting TA, Beaver HA, Olson RJ, Zimmerman MB, Carter K.Structured journal club as a tool to teach and assess resident competence in practice-based learning and improvement. Ophthalmology 2006 Mar;113(3):497-500.
6.Mullen SJ, Sabri K. Role of journal club in Canadian ophthalmology residency training: a national survey of program directors. Can J Ophthalmol 2016 Jun;51(3):226-31
7. White CA, Wrzosek JA, Chesnutt DA, Enyedi LB, Cabrera MT.A novel method for teaching key steps of strabismus surgery in the wet lab. JAAPOS 2015 Oct;19(5):468-70.
9. Ryg PA, Hafler JP, Forster SH.The Efficacy of Residents as Teachers in an Ophthalmology Module. J Surg Edu 2016 Mar-Apr;73(2):323-8
10.Curriculum for ophthalmic specialist training (internet) 2014. The Royal College of Ophthalmologists. Available from http://curriculum.rcophyh.ac.uk/
11.Dhalival S, Ayyala RS. Post-graduate training program in ophthalmology in India: idealstic vs realistic. J Clinical Ophthalmology & Research 2015;3(1):36-40
Table 1: Young ophthalmologist’s perception of their dissertation / thesis
| Dissertation | Lowest percentage (score 0-3) | Top Percentage (score 7-10) | Range of actual responses | Mean | Std Dev | Median |
| Level of supervision | 23.9% | 44.8% | 0-10 | 5.9 | 3.1 | 6 |
| Infrastructure for dissertation | 21.8% | 53.1% | 0-10 | 6.4 | 3.1 | 7 |
| Value added by dissertation | 20.8% | 51.5% | 0-10 | 6.2 | 3.7 | 7 |
Lowest percentage: Those who rated 0-3 on a scale of 0-10.
Top percentage: Those who rated 7-10 on a scale of 0-10.
Table 2: Levels at which the dissertation study was presented and published
|
Level |
Presented (oral) | Presented (poster) | Published by | ||||
| Self | Supervisor | Other | Self | Supervisor | other | ||
| Local | 178(33.5%) | 23(4.3%) | 5(0.9%) | 114(21.5%) | 17(3.2%) | 6(1.1%) | 210(39.5%) |
| State | 149(28.1%) | 22(4.1%) | 15(2.8%) | 95(17.9%) | 15(2.8%) | 10(1.9%) | 140(26.4%) |
| National | 82(15.4%) | 18(3.4%) | 5(0.9%) | 88(16.6%) | 13(2.4%) | 4(0.8%) | 94(17.7%) |
| International | 21(4.0%) | 13(2.4%) | 6(1.1%) | 36(6.8%) | 12(2.3%) | 7(1.3%) | 39(7.3%) |