In Search of a "Metric System" for Measuring Faculty Effort: A Qualitative Study on Educational Value Units at U.S. Medical Schools.

PURPOSE: Faculty at academic health centers (AHCs) are charged with engaging in educational activities. Some faculty have developed educational value units (EVUs) to track the time and effort dedicated to these activities. Although several AHCs have adopted EVUs, there is limited description of how AHCs engage with EVU development and implementation. This study aimed to understand the collective experiences of AHCs with EVUs to illuminate benefits and barriers to their development, use, and sustainability. METHOD: Eleven faculty members based at 10 AHCs were interviewed between July and November 2022 to understand their experiences developing and implementing EVUs. Participants were asked to describe their experiences with EVUs and to reflect on benefits and barriers to their development, use, and sustainability. Transcripts were analyzed using thematic analysis. RESULTS: EVU initiatives have been designed and implemented in a variety of ways, with no AHCs engaging alike. Despite differences, the authors identified shared themes that highlighted benefits and barriers to EVU development and implementation. Within and between these themes, a series of tensions were identified in conjunction with the ways in which AHCs attempted to mitigate them. Related to barriers, the majority of participants abandoned or paused their EVU initiatives; however, no differences were identified between those AHCs that retained EVUs and those that did not. CONCLUSIONS: The collective themes identified suggest that AHCs implementing or sustaining an EVU initiative would need to balance benefits and barriers in light of their unique context. Study findings align with reviews on EVUs and provide additional nuance related to faculty motivation to engage in education and the difficulties of defining EVUs. The lack of differences observed between those AHCs that retained EVUs and those that did not suggests that EVUs may be challenging to implement because of the complexity of AHCs and their faculty.

Optometric Brain Injury Curriculum in Federal Residency Training Programs: A Consensus Report.

INTRODUCTION: Brain injury often impacts the visual system. Diagnosis and treatment of visual system problems related to brain injury is a field with less settled science and more variation in practice than most specialty fields. Most optometric brain injury residency programs are in federal clinics (VA and DoD). A consensus core curriculum has been created that will allow some consistency while facilitating program strengths. MATERIALS AND METHODS: Kern's curriculum development model and a focus group of subject matter experts were used to reach consensus in producing a core curriculum to provide a common framework for brain injury optometric residency programs. RESULTS: A common high-level curriculum was developed with educational goals through consensus. CONCLUSIONS: In a relatively new subspeciality without a firm foundation of settled science, a common curriculum will help provide a common framework to facilitate clinical and research progress in this field. The process sought out expertise and community building to help improve the adoption of this curriculum. This core curriculum will provide a framework for educating optometric residents in the diagnosis, management, and rehabilitation of patients with visual sequelae because of brain injury. It is intended to ensure that appropriate topics are covered while allowing for flexibility according to each program's strengths and resources.

Measuring Teaching Efforts in a Medical School Department or Division: A Scoping Review.

PURPOSE: The desire to measure faculty's teaching productivity has led many medical school departments to create academic productivity metrics and evaluation systems to track clinical and/or nonclinical teaching efforts. The authors investigated these metrics and their impact on teaching productivity and quality in the literature. METHODS: The authors performed a scoping review using keywords to query three publication databases. A total of 649 articles were identified. The search strategy resulted in the screening of a total of 496 articles after the removal of duplicate articles, of which 479 were excluded. A total of 17 papers met the criteria. RESULTS: Four of the 17 institutions exclusively measured clinical teaching productivity, and all four reported 11-20% gains in teaching or clinical productivity. Four of the six institutions that tracked only nonclinical teaching productivity shared quantitative data and experienced a variety of gains from measuring teaching productivity that centered on greater participation in teaching. The six institutions that monitored both clinical and nonclinical teaching productivity provided quantitative data. The reported effects ranged from greater learner attendance at teaching events to increases in clinical throughput and teaching hours per faculty member. Five of the 17 institutions tracked quality using qualitative measures, and none of these institutions observed a decrease in teaching quality. CONCLUSIONS: Setting metrics and measurement of teaching seems to have had a generally positive effect on amounts of teaching; however, their impacts on the quality of teaching are less clear. The diversity of metrics reported makes it difficult to generalize the impact of these teaching metrics.

Prevalence of Eye and Vision Disorders in the Military Health System, Fiscal Year 2018.

INTRODUCTION: Eye and vision disorders are estimated to impact 7.08 million people in the United States, including 1.62 million under the age of 40. This study uses the Vision and Eye Health Surveillance System (VEHSS) case definitions to assess the burden of eye and vision disorders in a universally insured, nationally representative population. MATERIALS AND METHODS: This retrospective, cross-sectional study applied the VEHSS case definitions to TRICARE claims data collected from the Military Health System Data Repository and Defense Enrollment Eligibility Reporting System during 2018. Beneficiaries aged 0-64 years during the fiscal year 2018 were identified with inpatient and outpatient codes matching to the VEHSS diagnostic case definitions, which were organized into 17 categories of eye and vision disorders classified by the ICD-10. Beneficiaries were recorded only once per category but allowed to match to multiple categories. Analyses included descriptive statistics of patient demographics and prevalence of eye disorders. RESULTS: We identified 4,548,897 TRICARE Prime/Plus beneficiaries (54.86% men and 45.14% women), of whom 22.93% were diagnosed with at least one disorder in 2018. Of those with a diagnosis, the majority were men (50.13%), adults (74.91%), and of or sponsored by a senior enlisted rank (57.83%), used as socioeconomic proxy. Disorders of refraction and accommodation were most prevalent, followed by infectious and inflammatory diseases. Potentially preventable and treatable conditions, including amblyopia and strabismus, infectious and inflammatory disease, and diabetic complications, affected up to 22% of those with vision disorders. CONCLUSIONS: This study represents the first use of VEHSS measures in a universally insured, socioeconomically diverse population. Identification of potentially treatable or preventable conditions indicates significant opportunity to mitigate the burden of eye and vision disorders in the Military Health System.

Cost-utility analysis of telemedicine and ophthalmoscopy for retinopathy of prematurity management.

OBJECTIVE: To evaluate the cost-effectiveness of telemedicine and standard ophthalmoscopy for retinopathy of prematurity (ROP) management. METHODS: Models were developed to represent ROP examination and treatment using telemedicine and standard ophthalmoscopy. Cost-utility analysis was performed using decision analysis, evidence-based outcome data from published literature, and present value modeling. Visual outcome data were converted to patient preference-based time trade-off utility values based on published literature. Costs of disease management were determined based on 2006 Medicare reimbursements. Costs per quality-adjusted life year gained by telemedicine and ophthalmoscopy for ROP management were compared. One-way sensitivity analysis was performed on the following variables: discount rate (0%-7%), incidence of treatment-requiring ROP (1%-20%), sensitivity and specificity of ophthalmoscopic diagnosis (75%-100%), percentage of readable telemedicine images (75%-100%), and sensitivity and specificity of telemedicine diagnosis (75%-100%). RESULTS: For infants with birth weight less than 1500 g using a 3% discount rate for costs and outcomes, the costs per quality-adjusted life year gained were $3193 with telemedicine and $5617 with standard ophthalmoscopy. Sensitivity analysis resulted in ranges of costs per quality-adjusted life year from $1235 to $18,898 for telemedicine and from $2171 to $27,215 for ophthalmoscopy. CONCLUSIONS: Telemedicine is more cost-effective than standard ophthalmoscopy for ROP management. Both strategies are highly cost-effective compared with other health care interventions.

Redesign of the Columbia University Infobutton Manager.

BACKGROUND: The Infobutton Manager (IM) is an application that provides clinical users with context-specific links to health information resources. Usage of the first version (IM-1) suggested that the user interface was suboptimal. METHODS: We conducted a laboratory-based observational study of IM-1, use, applied standard user interface design techniques to address observed problems, developed a new version (IM-2), conducted a second observational study and analyzed log files of the actual use of IM-1 and IM-2. RESULTS: Modifications to the IM resulted in a reduction of "perusal time" (time between evocation of the IM and selecting a topic) from 11.13 to 5.92 seconds. However, evaluation of 14 months of usage logs did not show an appreciable effect on the perusal time or the rate at which users selected a topic once the IM was evoked. CONCLUSIONS: Laboratory analysis of the IM was evoked. CONCLUSIONS: Laboratory analysis of the IM guided redesign that led to improved performance in the laboratory, but did not address factors that are influencing use.