Parental Leave Policy for Ophthalmology Residents: Results of a Nationwide Cross-Sectional Study of Program Directors.

BACKGROUND: Many residents become parents during residency and the adequacy of parental leave is integrally related to resident wellness. OBJECTIVE: To understand current parental leave policies in ophthalmology residency programs and program director perceptions of the impact of parental leave on trainees. DESIGN: Cross-sectional study. SETTING: Multicenter among all U.S. ophthalmology residency programs. PARTICIPANTS: Ophthalmology residency program directors during the 2017 to 2018 academic year. RESULTS: Sixty-eight percent (82/120) program directors participated in this study. The majority of programs had written maternity leave policies (89%) and partner leave policies (72%). The typical duration of maternity leave taken ranged from 4 to 6 weeks while typical partner leave duration taken ranged from 1 day to 2 weeks. Residents who take leave may need to extend training at 72% of programs. Program directors perceived that parental leave negatively impacts resident scholarly activities and surgical skills and volume. Male program directors, relative to female program directors, perceived that becoming a childbearing parent negatively impacts resident dedication to patient care. Program directors raised concerns including local support and policy, extension of residency, impact on residents, impact on programs, consistency and fairness, and desire for national policy change. CONCLUSIONS: Parental leave practices vary significantly among ophthalmology training programs with residents typically taking less leave than permitted. Program directors are challenged to accommodate parental leave while balancing resident training and wellness for all trainees in their program.

Anxiety in patients undergoing cataract surgery: a pre- and postoperative comparison.

PURPOSE: Reducing surgery-related patient anxiety without under-emphasizing surgical risk is challenging for even the most experienced surgeon. The purpose of this study is to identify specific anxieties faced by patients in hopes of better informing the preoperative surgeon-patient dialogue. SETTING: Comprehensive and specialty ophthalmology clinics at the University of California, San Francisco. DESIGN: A prospective, survey-based study in which a pre- and postoperative questionnaire was administered to patients undergoing routine phacoemulsification. The surgeon was masked to patient enrollment and questionnaire responses. MATERIALS AND METHODS: A 36-item questionnaire on patient anxiety was developed from existing literature, building on the validated Surgical Fear Questionnaire. Patients were eligible if they were aged >18 years and willing to participate. Patients were excluded if having more than phacoemulsification alone or if unable to respond in English, and were retroactively excluded if there were complications during surgery. The primary outcome was self-reported anxiety on an 11-point Likert scale. RESULTS: Sixty-one patients were included for analysis. Preoperatively, patients reported greatest anxiety around the operation itself and becoming blind. Reflecting postoperatively, patients reported the greatest anxiety for the operation itself. Statistically significant decreases were greatest for anxiety about the operation failing (p<0.001) and becoming blind (p<0.001). No decrease was observed for the operation itself (p=0.1). CONCLUSION: More effort must be made to specifically discuss the steps of the operation itself and the expected visual outcomes to alleviate patient anxiety. The authors hope these data can provide insight for surgeons into patient anxiety surrounding cataract surgery and help strengthen the patient-physician relationship.

A simulator to explore the role of haptic feedback in cataract surgery training.

Phacoemulsification cataract surgery, a minimally invasive technique to remove a cloudy lens from the eye, is one of the most commonly performed surgical procedures in the western world. Conventional training for this procedure involves didactic lectures and practice on pig and human cadaver eyes, none of which allow trainees to form an accurate predictive model of human tissue behavior during surgery. A virtual environment simulator for capsulorrhexis, one of the first steps in cataract surgery, has been developed that allows a trainee to use surgical instruments to excise a circle of tissue on the anterior side of the lens capsule through tearing. The simulator invokes a deformable mass-spring-damper mesh model of the tissue that can be grasped and torn via shearing. A novel algorithm for mesh division and maintenance enables realistic tearing behavior. The trainee controls tool motion using a 3-degree-of-freedom haptic device, and haptic feedback is provided from the virtual tissue. Although the haptic feedback in a real capsulorrhexis procedure is below the human threshold of haptic sensing, this simulator enables an experiment to determine the effectiveness of "haptic training wheels" -- the idea of haptic training for a task without haptic feedback.