The Role of Technology in Ophthalmic Surgical Education During COVID-19.

Purpose of Review: To describe the effect of COVID-19 on ophthalmic training programs and to review the various roles of technology in ophthalmology surgical education including virtual platforms, novel remote learning curricula, and the use of surgical simulators. Recent Findings: COVID-19 caused significant disruption to in-person clinical and surgical patient encounters. Ophthalmology trainees worldwide faced surgical training challenges due to social distancing restrictions, trainee redeployment, and reduction in surgical case volume. Virtual platforms, such as Zoom and Microsoft Teams, were widely used during the pandemic to conduct remote teaching sessions. Novel virtual wet lab and dry lab curricula were developed. Training programs found utility in virtual reality surgical simulators, such as the Eyesi, to substitute experience lost from live patient surgical cases. Summary: Although several of these described technologies were incorporated into ophthalmology surgical training programs prior to COVID-19, the pandemic highlighted the importance of developing a formal surgical curriculum that can be delivered virtually. Novel telementoring, collaboration between training institutions, and hybrid formats of didactic and practical training sessions should be continued. Future research should investigate the utility of augmented reality and artificial intelligence for trainee learning.

Redrawing vitreoretinal surgical training program in the COVID-19 era: Experiences of a tertiary care institute in North India.

Purpose: The COVID-19 pandemic has brought medical and surgical training to a standstill across the medical sub-specialties. Closure of outpatient services and postponement of elective surgical procedures have dried up opportunities for training vitreoretinal trainees across the country. This "loss" has adversely impacted trainees' morale and mental health, leading to feelings of uncertainty and anxiety. Therefore, there is an urgent need to redraw the surgical training program. We aimed to describe a systematic stepwise approach to vitreoretinal surgical training. Methods: We introduced a three-pronged approach to vitreoretinal surgical training comprising learn from home, wet lab and simulator training, and hands-on transfer of surgical skills in the operating room in our institute. Results: Encouraging results were obtained as evaluated by feedback from the trainees about the usefulness of this three-pronged approach in developing surgical skills and building their confidence. Conclusion: The disruption caused by the COVID-19 global pandemic should be used as an opportunity to evolve and reformulate surgical training programs to produce competent vitreoretinal surgeons of the future.

Rapid Pivot of CURE Wet Lab to Online with the Help of Instructor Communities.

The pivot to remote and hybrid learning during the Covid-19 pandemic presented a challenge for many in academia. Most institutions were not prepared to support this rapid change, and instructors were left with the burden of converting a traditional face-to-face course into multiple modalities with very limited preparation time. When institutional support is lacking, we posit that instructor communities of practice can help provide the resources needed to meet the instructional demands. Tiny Earth, a course-based-undergraduate research experience (CURE) and international network of instructors and students, responded to the instructional challenges of the pandemic by leveraging its large community of instructors to create several smaller working groups to form focused communities of practice. Using the pedagogical principles of backward design and scientific teaching, one working group, the Tiny Earth Pivot Group (Pivot Group) generated a course map of remote learning activities and simulated learning resources to fulfill the Tiny Earth learning objectives and maintain the essential tenets of a CURE. Additional working groups were created to disseminate the resources collated and created by the Pivot Group to the greater community. In terms of Tiny Earth, the community structure provided the means for instructors to rapidly pivot their course materials to multiple modalities while upholding the student CURE experience. Harnessing the hallmarks of communities of practice-collective workpower toward common purpose, diversity of perspectives, and ongoing evolution-coupled with high-structured course design allows instructors flexibility and adaptability in meeting the changing modalities of higher education.

Impact of COVID-19 on Academic Activities of Ophthalmology Postgraduates: A Cross-sectional Survey

Introduction: Academics amid the lockdown in Coronavirus Disease-19 (COVID-19) outbreak have experienced massive reforms worldwide. This survey was conducted after the lockdown to evaluate its effect on academic activities in ophthalmology. Aim: To assess the effect of lockdown and related restrictions on ophthalmology postgraduate (PG) training programmes. Materials and Methods: An online cross-sectional survey using google forms was designed and sent to postgraduates of Opthamology Department across India through various social media platforms for one week. A total of 45 questions were included, related to opthalmology practice, clinical opportunities, surgical training and online teaching. Data was entered in Microsoft Excel software and descriptive statistics was used to describe the results. Results: A total of 84 postgraduates were surveyed, of whom majority were from Karnataka (n=41) followed by Kerala (n=35). 38 (45.2%) participants observed a reduction in Outpatient Department (OPD) patients and 78.6% decline in Operation Theatre (OT) procedures, 74 (88.10%) trainees required almost a month to restart OT and most of them 81 (96.54%) wore an N95 mask while operating. Nearly, 72 (85.7%) got Reverse Transcription-Polymerase Chain Reaction (RT-PCR) test as an additional investigation for all of their patients. Majority of the responders, 81 (96.4%) felt that the webinars were helpful. Conclusion: This survey shows that majority of the ophthalmology postgraduates (mainly in Karnataka and Kerala) felt that the COVID-19 lockdown adversely affected their curriculum learning, especially the surgical training. Most of them benefited from the webinars and other online teaching programmes. Regulatory bodies should take a note of the issue and appropriate guidelines should be set up to optimise the training loss due to this pandemic.

Formalin-assisted training eyes for ophthalmic wet lab practice.

The foundation of an ophthalmologists' microsurgical career begins in the wet lab. Training on donor cadaveric, animal like goat or pig eyes provide the most realistic surgical environment, however, the availability of a donor's eyes for practice is limited. This scarcity is further escalated in this current coronavirus disease 2019 pandemic where eye donations have decreased. Even among those eyes which find their way into the wet lab, quite a few would have collapsed significantly making training difficult. Therefore, we looked at ways to salvage these collapsed globes. We describe a novel way of salvaging the collapsed eyeballs by injecting formalin in slow boluses into the vitreous cavity. The longer maintenance of the globe integrity without necessitating repeated injections facilitates better quality of surgical training and optimal utilization of these eyes.

A simple do-it-yourself model of phacoemulsification for resident training.

COVID-19 has immensely affected the training of ophthalmology residents; wet-lab training thus becomes of utmost importance. A simple cost-effective model for cataract surgery training of residents becomes the need of this hour. Hence, we aim to describe a new 'Do It Yourself' model with easily available material for beginners.

Reworking protocols of ophthalmic resident surgical training in the COVID-19 era - Experiences of a tertiary care institute in northern India.

PURPOSE: Coronavirus Disease 2019 (COVID-19) pandemic has negatively impacted medical professionals in all fields of medicine and surgery in their academic, clinical and surgical training. The impact of surgical training has been described as 'severe' by most ophthalmology residents worldwide due to their duties in COVID-19 wards, disruption of outpatient and camp services. METHODS: Ophthalmic surgery demands utmost accuracy and meticulousness. Fine motor proficiencies, stereoscopic skills and hand-eye coordination required can only be achieved by practice. So, a multileveled structured wet-lab teaching schedule was prepared for the residents and implemented to bridge this gap between theory and practice at our tertiary care institute. A semester-wise training schedule was made with the proper distribution of wet-lab and simulator training. Surgeries like phacoemulsification, scleral buckling, pars plana lensectomy and vitrectomy, trabeculectomy and intravitreal injections were practised by the residents on the goat eyes. Simulator training was provided for phacoemulsification and vitrectomy to increase the hand-eye coordination of the residents. RESULTS: Residents noticed improvement in their surgical skills and ambidexterity post wet-lab and simulator training . It also increased their confidence and provided essential surgical skills required to be used in the operation theater later. CONCLUSION: It is imperative that wet-lab training be included in the residency training programme in this COVID-19 era.

Essentials of setting up a wet lab for ophthalmic surgical training in COVID-19 pandemic.

Wet labs are an extremely important training tool, especially in times of a global COVID-19 pandemic, where surgical training can be minimal. They help the trainee learn and practice in a risk-free environment, without an imminent of a complication or failure, also allowing them the chance to execute the steps of a surgery repeatedly. We summarize all the key ingredients required from setting up a wet lab to improve the surgical skill of the trainees. The review also discusses various eyeball fixating devices, preparation of the eye for various types of ocular surgeries, and the role of simulation-based training in today's scenario.