Keywords
ophthalmology - student - workshop - perceptions
Resident physicians assume considerable responsibility for the clinical education
of medical students during the third and fourth years of medical school. Resident
roles range from supervising students during patient interaction to providing performance
feedback and engaging in bedside teaching. Research suggests that quality interactions
between residents and medical students increase medical students' perception of the
quality of education.[1] Positive experiences with resident physicians as teachers have been associated with
clerkship satisfaction.[1]
Furthermore, effective resident–student interaction has been noted to influence medical
students' career decisions.[2] For example, longitudinal studies of surgery clerkships suggest that medical students
exposed to surgical residents who were good clinical teachers and role models were
more likely to pursue a surgical residency than students who worked with less-effective
residents.[2] Work by Whittaker et al suggests that students often consider residents (rather
than attending physicians) as their primary teachers.[3]
In addition to clerkships, another avenue through which residents can engage medical
students is through small-group skills' sessions. Clinical skills' sessions may be
appropriate for medical students at various stages, whereas clerkships are limited
to medical students in their third and fourth years. Quillen and Cantore have shown
that clinical skills' workshops improve medical students' knowledge and examination
skills.[4] However, this work does not examine the impact of such workshops on medical students'
attitudes toward ophthalmology.
Our Study
To our knowledge, no published research has been done on the effects of resident intervention
on preclinical students' perceptions of ophthalmology during the medical school years.
Engagement of preclinical students is an important objective. Ophthalmology is a competitive
field; average board examination scores of incoming ophthalmology residents exceed
the national average. Furthermore, applications to ophthalmology residency programs
are due earlier than applications for most other medical specialty residencies in
the United States. This earlier timeline increases the significance of exposing medical
students to ophthalmology early in their education. This may allow students to seek
ophthalmology clinical and research opportunities, solidifying their interests and
building a robust application for residency. The curriculum of many medical schools
focuses on classroom instruction during the first 2 years and only allows for limited
exposure to clinical practice. Additionally, many students do not get exposure to
ophthalmology during the clinical years; studies suggest that less than 18 to 30%
of U.S. medical schools required an ophthalmology rotation.[5]
[6]
The goal of our study was to evaluate the impact of a resident-led, hands-on ophthalmology
small-group workshop on students' interest and perception of the field.
Methods
A 2-hour workshop on clinical skills was conducted in November 2018 at the Outpatient
Clinic of Department of Ophthalmology, University of Cincinnati. The University of
Cincinnati is a public, state-funded school in southwestern Ohio. The College of Medicine
has a class size of approximately 170 students per year.
The workshop was designed by medical students who were members of the Ophthalmology
Interest Group in collaboration with ophthalmology resident physicians, specifically
three postgraduate second year (PGY-2), two postgraduate third year (PGY-3), and two
postgraduate fourth year (PGY-4) residents from the Department of Ophthalmology, University
of Cincinnati. There were 26 student attendees; 15 were first year medical students
and 11 were second year medical students. Participating students were self-selected
via e-mails sent to the first and second year student bodies, and all students who
responded were enrolled. The workshop commenced with an introductory lecture by a
senior resident. The content of the lecture was a collaborative decision of the students
in the Ophthalmology Interest Group and residents. Care was taken to emphasize information
that would be relevant to preclinical students who are at the beginning of their careers
and who have limited knowledge of the day-to-day practice of ophthalmology. The resident
instructor outlined the role of ophthalmologists in health care delivery, the residency
training process, and the importance of networking and mentoring for students interested
in the field. Additionally, the resident instructor discussed a day in the life of
an ophthalmology resident and included examples of eye pathologies encountered, and
reasons for choosing a career in ophthalmology. Time was allotted for informal conversation,
student questions, and resident answers.
The instructive portion of the workshop was standardized and consisted of a resident
teaching groups with four to five students. The instructor covered basic skills related
to direct ophthalmoscopy and slit lamp examination. Prior to beginning the clinical
part of the workshop, the instructors taught students which structures, for example,
the macula, optic nerve, retinal blood vessels and anterior chamber components, would
be examined. These clinical ophthalmology skills were chosen based on evidence from
work by Byrd et al,[5] who determined that workshops centered on these skills led to increased student
knowledge. Each student was given the opportunity to practice using the diagnostic
instruments on resident instructors, each of whom had a single pupil dilated. Throughout
the course of the clinical skills workshop, the resident instructors guided students
on their examination technique, evaluating their skill, and offering feedback. The
interactive format of the workshop allowed for residents to informally discuss the
field of ophthalmology throughout the session.
To assess the impact of the workshop and of the residents' engagement, preworkshop
and postworkshop surveys were administered to the students ([Table 1]). The surveys were administered through an online survey link. Students were given
a randomized ID number to match their preworkshop and postworkshop responses. Each
survey question was answered via a Likert's scale of 1 through 5. Student's paired
sample t-test was used to assess differences between responses given before and after the
workshop. Two students did not respond; ultimately, responses from 24 students was
analyzed.
Table 1
Student survey
|
Question
|
Answer choices
|
Mean score presurvey
|
Mean score postsurvey
|
Significance
|
|
Year
|
M1/M2
|
|
|
|
|
ID number
|
|
|
|
|
|
Rank your interest in ophthalmology (1 = not very interested, 5 = very interested)
|
1/2/3/4/5
|
3.5
|
3.79
|
0.0498
|
|
Rate how comfortable you are using a direct ophthalmoscope (1 = not very comfortable,
5 = very comfortable)
|
1/2/3/4/5
|
2
|
2.91
|
0.000458
|
|
Rate how comfortable you are using a slit lamp (1 = not very comfortable, 5 = very
comfortable)
|
1/2/3/4/5
|
1.42
|
3.08
|
1.303 × 10−7
|
|
How likely are you to approach a resident for career advice/networking? (1 = not very
likely, 5 = very likely)
|
1/2/3/4/5
|
2.79
|
3.83
|
4.65 × 10−6
|
|
How likely are you to take an ophthalmology clerkship? (1 = not very likely, 5 = very
likely)
|
1/2/3/4/5
|
3.79
|
3.95
|
0.218
|
|
How likely are you to attend the Secrets of the Match Lunch Talk? (1 = not very likely,
5 = very likely)
|
1/2/3/4/5
|
3.95
|
4.355
|
0.00247
|
|
How interested would you be in receiving career advice specific to preparing for a
possible career in ophthalmology, from a medical school upperclassman or resident?
(1 = not very interested 5 = very interested)
|
1/2/3/4/5
|
4.167
|
4.167
|
1
|
Abbreviations: M1, first year medical student; M2, second year medical student.
Institutional review board (IRB) nonhumans study exemption status was granted in 2017
for this study by the University of Cincinnati Institutional Review Board. All patients
were aware of potential participation in quality improvement research and consented
to participation.
Results
The score for average interest in ophthalmology rose significantly after the workshop
(p = 0.049; [Table 1]). The average level of comfort using a direct ophthalmoscope rose significantly
(p = 0.0046; [Table 1]) as did the average level of comfort using a slit lamp (p = 1.303 × 10−7; [Table 1]). Importantly, when asked how likely they were to approach a resident for career
advice/networking, students' average score rose significantly after the workshop (p = 4.65 × 10−6; [Table 1]). Students' likeliness to attend the Secrets of the Match Lunch Talk, a yearly talk
held at the College of Medicine to discuss the Ophthalmology Match, increased as well
(p = 0.002; [Table 1])
Discussion
Beneficial resident–student interactions have been noted to positively impact clinical
students' perceptions of certain surgical fields, such as obstetrics/gynecology.[1] Our study indicates that this may hold true for preclinical students in ophthalmology
as well. During the small-group workshop, students had hands-on interaction with ophthalmological
tools and were instructed directly by resident physicians. Furthermore, resident physicians
spoke about their interests and experiences in the field, both to the group as a whole
and to the students in small groups and individually. The fact that students' average
interest in ophthalmology, likelihood to seek further information regarding the Ophthalmology
Residency Match Process, and likelihood of approaching a resident physician for career
advice rose significantly after the workshop affirms the positive effect of resident-led
interventions on students' perceptions of the field.
Resident-led educational sessions may be an effective method of fostering student
interest in the field of ophthalmology. The sparking of interest and encouragement
of students to seek out further education in ophthalmology is important, given the
early ophthalmology match and that the overall rate of required ophthalmology clinical
rotations is falling nationwide.[6] Studies show that ophthalmological educational experiences outside formal rotations
are also limited. Due to the limited ophthalmology education opportunities in medical
schools, medical students and primary care doctors may be inadequately trained to
handle ophthalmic problems and lack proper understanding of ocular anatomy and eye
examination skills. However, active medical student educational programs can improve
students' knowledge levels.[7] Moreover, Resident-led interventions could help encourage preclinical students to
take the initiative in seeking out such learning opportunities in ophthalmology, which
may help them further bolster their awareness and encourage them to engage in ophthalmology
elective rotations.
Future direction for this work could explore the relationship between preclinical
workshops and the role of resident near-peer mentoring of medical students. Our study
supports the concept that clinical skills' workshops are a good vehicle for introducing
students to the specialty of ophthalmology and an opportunity to meet mentors. Mentoring
relationships are a valuable asset in many fields and have been associated with positive
motivational and career outcomes and personal and professional growth.[8] Mentors provide academic knowledge, as well as implicit knowledge pertaining to
professionalism and ethics, emotional support, and encouragement.[9] In previous research, medical student participation and training at extracurricular
volunteer eye clinics facilitated their ophthalmoscopy skills and tonometer skills.[5] Data from the current study also support the notion that extracurricular workshops
are helpful in teaching students about the field in a hands-on manner. The participation
of residents as the exclusive teachers in these small-group workshops might be structured
to serve as an important link between workshops and long-term influence on medical
student career paths. Mentoring has been shown to be beneficial to students, particularly
in regard to helping them understand the role of professional competence in physician
identity. It has also been proposed that when students explore clinical realities
with the mentor, they are motivated to increase their knowledge.[10] Our study did not assess longitudinal resident–student mentoring relationship; however,
it did demonstrate that students benefitted from interactions with residents in a
small-group environment. Therefore, it is possible that small-group workshops, such
as ours, may be a good springboard for the development of longer term mentoring relationships.
Conclusion
Our study supports that resident-led workshops for medical students serve as a good
educational strategy for increasing preclinical medical student interest in ophthalmology.
Resident-led ophthalmology clinical skills workshops are efficacious methods of introducing
preclinical students to the field and of positively impacting their perceptions of
ophthalmology. This type of small-group workshop may serve as a platform for facilitating
positive resident–student interaction during the early years of medical school education
and also serve as an extracurricular strategy for introducing students to potential
resident mentors.
