DEC 2012

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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Page 34 of 72

32 EW FEATURE February 2011 ahead December 2012 Innovation: A look Residency training programs evolving by Erin L. Boyle EyeWorld Senior Staff Writer Residents at Wilmer Eye Institute use a surgical training simulator in the surgery lab, while faculty and trainees look on Source: Peter J. McDonnell, M.D. Residents are learning phaco and other ophthalmic surgeries and procedures W ith the population aging and more ophthalmologists needed to meet the demand, residents will need excellent surgical and interpersonal skills to form effective working partnerships, physicians AT A GLANCE ��� A total of 1,350 residents are in training programs in 2012 ��� 113 institutions around the country have ophthalmology residency programs ��� The minimum cataract surgery case amount suggested for residents during their residency is 86 ��� The Accreditation Council for Graduate Medical Education���s six Global Resident Competencies have established non-surgical skills for residents to learn say. New technologies, from femtosecond laser-assisted cataract surgery to microincisional glaucoma surgery, will also test comprehensive ophthalmology training for residents who do not go on to fellowships. As a result, ophthalmic residency training programs are evolving, focusing on both surgery and core competencies, with residents learning not only how to perform key surgical techniques but also about non-surgical skills, including patient care and communication. ���I think what people might remember about their residency program may be quite different from what���s actually happening right now,��� said Stephen McLeod, M.D., professor and chairman, Department of Ophthalmology, University of California, San Francisco. ���It used to be that people pretty much thought about establishing clinical competency, learning how to do cataracts, becoming a good comprehensive ophthalmologist, and then if you���re going to be subspecialty trained, you went on to your fellowship. I think that the whole dialogue has evolved so that medical knowledge, practice-based learning systems, practice profes- sionalism, interpersonal skills, and communication are the elements that one now thinks about in terms of how you frame what you teach residents,��� he said. Core competencies The Accreditation Council for Graduate Medical Education (ACGME), a private professional organization that accredits 8,887 residency programs across medical specialties in the U.S., established six Global Resi- dent Competencies, which residency training programs use to measure residents��� grasp of core non-surgical skills. The competencies are currently being implemented in the 113 ophthalmology residency programs around the country. According to the ACGME website, the core competencies were increased to six with the Outcome Project in 2002 and further implemented with the Milestone Project in 2008. ���It���s a new way of thinking about residency education,��� Dr. McLeod said. ���The [residency] program has to demonstrate how it specifically and formally addresses, promotes, and evaluates competencies in these six areas. I think that it recognizes that we���re living in a complex healthcare delivery system, and it���s more than just learning how to do cataract surgery.��� The competencies are professionalism, interpersonal and communication skills, medical knowledge, practice-based learning and improvement, patient care, and systems-based practice. Roger Steinert, M.D., professor of ophthalmology, University of California, Irvine, Calif., said the six core competencies are an excellent development in resident training. They help define expectations and goals through a well-structured process that holds training programs accountable for what they teach residents. ���When I was a resident, none of that stuff was particularly articucontinued on page 34 Speaker: Bedside care, hands-on medicine important O ne-on-one patient/physician relationships are vital in ophthalmology, where diagnoses can be missed if physicians do not develop an attentive, personalized approach to patient care. Abraham Verghese, M.D., gave the Opening Session Keynote Lecture at the Opening Session of the joint meeting of the American Academy of Ophthalmology and Asia-Pacific Academy of Ophthalmology. Dr. Verghese is professor, theory and practice of medicine, Stanford University School of Medicine, and senior associate chair, Department of Internal Medicine. ���I feel a special affinity to your specialty because I think in many ways, you are the last bastion of hands-on care where the patient/physician relationship is part and parcel with your examining them,��� he said. Dr. Verghese outlined how technology has altered the patient/physician relationship. ���Have we lost anything in the process? I would submit to you that we���ve lost a couple of things. First of all, if we don���t train physicians to go to the bedside ��� to diagnose things like uveitis, which no machine on earth is going to diagnose for you ��� we lose the ability to diagnose the ���low-hanging fruit.������ Editors��� note: Dr. Verghese has no financial interests related to his comments.

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