Impact of the COVID-19 pandemic on ophthalmology training in the Philippines: A nationwide cross-sectional study among trainees

Objective@#This study was designed to assess the impact of the COVID-19 pandemic on ophthalmology training from the perspective of ophthalmology residents and fellows in the Philippines. @*Methods@#A 55-item online survey on the COVID-19 pandemic’s impact on ophthalmology training was sent to 168 ophthalmologists-in-training from March 15, 2021 to April 19, 2021. Participants from all ophthalmology training programs in the Philippines were selected via random sampling and proportional allocation.@*Results@#A total of 158 ophthalmologists-in-training (138 residents and 20 fellows) completed the survey. The areas of ophthalmology training that were found to be most disrupted during the COVID-19 pandemic were surgical training (95%), clinical activity (94%), and in-person interaction with consultants in the out-patient department (94%) and operating room (85%). In contrast, trainees found an increase in didactic teaching activities (75%) and research activities (39%). Overall, 78% of the trainees felt that the pandemic had a negative impact on their ophthalmology training. The aspects which were most frequently found to be negatively impacted by the pandemic were mental health (70%), followed by technical skills (69%), and clinical skills (61%). No major differences were found on the impact of COVID-19 on training when compared across year levels and across institutions compared by location (National Capital Region vs. non-National Capital Region) and funding type (government vs. private funding). Ninety-nine percent (99%) of institutions shifted most of their didactic teaching activities to online platforms. Surgical video conferences and simulator training or skills labs were thought to be helpful to surgical training by 89% and 81% of the trainees, respectively. Majority of trainees attended to patients via telemedicine averaging 40% of their clinic consults. However, only 16% reported confidence in handling their patients through telemedicine.@*Conclusion@#The COVID-19 pandemic has had an overall negative impact on ophthalmology training in the Philippines. It caused significant disruption in trainees' clinical and surgical activities, and affected their mental health. Despite this, the situation provided an opportunity to boost trainees' theoretical knowledge. Majority are receptive to new technology-based learning tools to preserve the effectiveness of their training. Efforts to re-evaluate current training programs are needed to ensure sustainability and quality of ophthalmology training in the Philippines.

Pandemic challenge accepted: The Philippine Board of Ophthalmology shifts to online administration of its certifying examinations

@#The ongoing global COVID-19 pandemic triggered a series of events that resulted in the disruption of the delivery of various certifying examinations including that which was given by the Philippine Board of Ophthalmology (PBO). This paper shares the experience of the PBO using digital technology in administering its first ever online delivery of its certifying examinations. Online platform requirements used for delivering the examination are enumerated, online proctoring described, as well as the conduct of oral panel examinations and skills evaluation via video submission. Challenges encountered, feedback reported by both examinee and examiner, lessons learned from this endeavor, and future directions are discussed.

Operating Room Efficiency for General Anesthesia Cases in the Department of Ophthalmology in a Public Tertiary Hospital

@#Objective. To determine operating room efficiency for elective ophthalmologic surgeries requiring general anesthesia in a public tertiary institution based on standard efficiency parameters. Methods. Prospective observational cross-sectional study of randomly selected elective cases requiring general anesthesia from April 2019 to June 2019 in the Department of Ophthalmology of the Philippine General Hospital. A single third-party observer recorded operating room milestones from which efficiency parameters were determined and compared with local and international guidelines and efficiency benchmarks. Results. A total of fifty cases from the Retina, Plastic, Orbit, Glaucoma, and Motility services were observed. None started on the specified start time of 6:30 a.m., with surgeries starting an average of 52 ± 11.90 minutes after. Across subspecialties, median surgical preparation time was statistically significant (χ2: 12.01, p: 0.02), with the Retina and Orbit services having the most extended duration. Across age groups, pediatric cases had lower mean anesthesia preparation times (t: 2.15, df: 48, p: 0.04) and median trans-out lag times (χ2: 4.56, p: 0.03) than adults. Overall, more than 60% of cases reached targets for induction and surgical lag time. Turnaround for adult and pediatric patients was 75 ± 22.77 minutes and 71 ± 14.91 minutes, respectively. Benchmarking analysis showed that the first case on time, entry lag, and exit lag were below the 50th percentile while the room turnover time was above the 95th percentile. Conclusion. Ensuring efficiency requires a multidisciplinary team approach. This research can guide administrators in determining interventions to increase operating room efficiency.

Andragogic principles in case-based discussion among medical interns in a tertiary hospital

Background@#Andragogy, the theory of adult learning is relevant to medical education especially in the clinical internship learning context. It focuses on the students, faculty, and patients interacting together while developing competencies as future practitioners. Medical interns are active adult learners, enhancing their development of knowledge, skills, and positive attitudes, and pursuing professionalism as they participate in case-based discussions (CBD).@*Objectives@#The study sought to identify the basic principles of andragogy while medical interns participate in case-based discussions including the end-of-course satisfaction. It also determined the selected demographic factors associated with the andragogic principles. @*Methodology@#Respondents included 80 interns by convenience sampling who rotated at the Department of Ophthalmology and Visual Sciences in a tertiary referral hospital. The study used a combination of descriptive quantitative and qualitative research design. A valid instrument using the Adult Learning Principles Design Elements Questionnaire (ALPDEQ) was used to measure the medical intern's andragogic orientation as well as end-of-course satisfaction. A direct, non-participant observation of case-based discussions conducted at the department was done by the researcher and research associate. @*Results and Conclusion@#The occurrence of andragogic principles specifically motivation, experience, need to know, readiness, and self-directedness was observed during the conduct of case-based discussion. There was no association between principles of andragogy and demographic factors such as age, gender, civil status, medical school, preparatory medical course, and place of origin. CBD is an effective learning strategy, which provides medical interns adequate venues to be self-directed and apply the principles of andragogy in a workplace-based setting.

Methotrexate for sympathetic ophthalmia: A report of 3 cases

@#OBJECTIVE: To describe the visual and clinical outcomes of 3 patients with sympathetic ophthalmia treated with a combination of systemic steroids and methotrexate. METHODS: This was a small, descriptive case series. RESULTS: We reported 3 cases of post-traumatic sympathetic ophthalmia treated with steroids and methotrexate. Two patients had inciting eyes with no light perception on presentation, while one had a best-corrected visual acuity (BCVA) of counting fingers. The initial BCVA of the sympathizing eyes ranged from 20/20 to 20/50. Control of ocular inflammation was achieved using methotrexate (12.5 to 15 mg weekly) in addition to oral steroids and topical therapy. The final BCVA of the sympathizing eyes ranged from 20/20 to 20/30, indicating that good visual outcomes were attainable with steroids and methotrexate as part of the maintenance regimen. None of the patients developed adverse side-effects from methotrexate. CONCLUSION: This small case series demonstrated the effectiveness and safety of methotrexate for control of intraocular inflammation in sympathetic ophthalmia.

Correlation of the in-training examination in ophthalmology with the written certifying examination of the Philippine Board of Ophthalmology

Objective@#This study determined the correlation between the performance in the Philippine Board of Ophthalmology (PBO) written qualifying examinations and the Ophthalmology In-Training Proficiency Examinations (OPEX).@*Methods@#PBO written certifying examinations and the OPEX scores of residency graduates covering the years 2005 to 2010 and 2004 to 2009 respectively were retrieved for this study. ANOVA statistical test compared OPEX scores through residency (Y1, Y2, Y3, and Y4) and determined if the number of times the OPEX was taken reflected significant differences in the PBO scores of the different groups. Pearson’s test determined the correlation between OPEX and PBO written examination scores. @*Results@#Of the 165 subjects included in the study, 5 took the OPEX four times during their residency, 87 thrice, 39 twice, and 34 once. Mean OPEX scores for the different levels of residency training was observed to be statistically different from each other (p < 0.001). Mean PBO scores improved with increase in the number of times that OPEX was taken during residency (p < 0.001). Significant positive correlation was observed between the PBO scores and OPEX scores for all year levels of residency, average OPEX scores and terminal OPEX scores (r = 0.57 to 0.73, p < 0.0001) with the highest correlation noted between terminal OPEX and PBO scores. Based on the number of OPEX taken, significant correlation was strongest for the group with three OPEX taken (r = 0.73, p < 0.001). @*Conclusions@#There is a positive correlation between residents’ performance in the OPEX to their future performance in the written certifying examinations of the PBO.