Lecture: Residency Best Practices Symposium with Ophthalmology Foundation and Orbis International

[Clare] Hello, and welcome to the Residency Best Practices Symposium, a collaboration between the Ophthalmology Foundation and Orbis International, hosted on Cybersight. It is my pleasure to introduce this session’s components and our esteemed speakers and panelists. My name is Clare Szalay Timbo, I am the Associate Director of Orbis International. I want to thank Alcon Foundation for their support to make events like this possible.

Our symposium structure today has three parts. The first section will introduce best practices in residency education given the challenges we all face with COVID-19. These talks will be by Dr. Karl Golnik and Dr. Maria Montero. The second section will introduce practical resources readily available to support faculty, much like yourselves, by talks by Dr. Helena Filipe and myself. The third and final section will introduce a panel discussion on what’s next in residency education with doctors Eduardo Mayorga, Dr. Ciku Mathenge, and Dr. Karl Golnik. And then we will follow up with a short Q&A period, answering questions that you shared to us in the Q&A section on the webinar.

It’s my pleasure to introduce Dr. Karl Golnik, the Professor and Chairman of the Department of Ophthalmology at the University of Cincinnati and the Cincinnati Eye Institute. Dr. Golnik also currently serves as the Secretary for International Relations for the International Joint Commision on Allied Health Personnel in Ophthalmology. And he is the Ophthalmology Foundation’s Chair for Education.

My colleague, Dr. Maria Montero, joined the Orbis Flying Eye Hospital team originally in January 2017 as a staff ophthalmologist and was recently promoted to the Associate Director of Clinical Services on the hospital. She oversees the ophthalmology, nursing, biomedical engineering departments, as well as patient care, staffing, research, and training on the Flying Eye Hospital. She is a specialist in anterior segment of the eye and in simulation training.

Dr. Helena Filipe practices as a Consultant of Ophthalmology at the Department of the Cornea and Ocular Surface at the West Lisbon Hospital Center in Portugal. She serves as the Ophthalmology Foundation as the Chair for the Simulation Subcommittee and as the Chair for the CPD Subcommittee. She also serves the Association for Research in Vision and Ophthalmology at ARVO on the Professional Development and Education Committee.

Dr. Eduardo Mayorga is an Educational Consultant for the Eye Department at the Austral University Hospital in Buenos Aires, Argentina. He serves as the director for E-learning for the Pan American Association for Ophthalmology and serves as the Chair of the Education Technology Subcommittee at the Ophthalmology Foundation.

And finally, Dr. Wanjuku, also known as Ciku, Mathenge, is a Consultant Ophthalmologist and Medical Retina Specialist at Dr. Agarwal’s Eye Hospital in Rwanda. She is also the Residency Program Director at the Rwanda International Institute of Ophthalmology, known as RIIO. And the Professor of Ophthalmology at the University of Rwanda.

Thank you all so much for being here, panelists and speakers. It’s my pleasure now to hand it over to Dr. Karl Golnik for his session.

[Karl] Greetings. Welcome, everyone, it’s good to be here. Thank you for the invitation from Orbis and organizing this webinar. You’ve already heard the Ophthalmology Foundation’s name mentioned a few times. And many of you may be wondering, what is the Ophthalmology Foundation? And so my objectives are a couple things. One, I just want to describe briefly what the Ophthalmology Foundation is about, it’s a new group. And describe our two main online initiatives.

The mission of the Foundation is to support ophthalmic education internationally in order to improve global eye care. And there are two main ways of doing this: helping ophthalmologists become better teachers and providing training opportunities through sponsoring fellowships. We have a special focus on low-resource and underserved countries.

We have a board of directors and I list all the members here. There are many well-known ophthalmologists and leaders of ophthalmic industries. You can see that our executive leaders, our president Dave Pyott, Jim Mazzo, and Bruce Spivey.
And you can learn more about foundation at OphthalmologyFoundation.org, which will have explanations about a lot of the other things that we’re doing. We’re doing quite a bit more than what I’m going to tell you about.

And as I mentioned, we have two main initiatives, one is fellowships. We work with the IOFF in Germany and offer three, six, and 12 month fellowships, somewhere in the 70-80 per year range. And these you can apply for if you’re a young ophthalmologist, someone decided that young in this context meant 40 years of age or less. There might be some debate depending on your age.

I did want to just mention this. Because this is something that just came by from the University of Edinburgh, this has got nothing to do with the Ophthalmology Foundation, so beg my indulgence, or your indulgence. But there is a two-year Master of Surgery program that’s available through the University of Edinburgh, the David and Molly Pyott Foundation Scholarship. They give 12 per year and they’re looking for people interested in this. It’s an online experience for ophthalmology masters.
The second initiative and the initiative that really we’re here about today, is education. And our goal isn’t so much to teach people about neuro ophthalmology or cornea diseases, it’s to try to improve the training ability of ophthalmic educators to enhance the skill of ophthalmology. To improve global eye care and in particular to improve residency training.

I’m going to talk about two of our online series. And these are really, the Ophthalmology Foundation is kind of a spin off of the International Council of Ophthalmology. All of us on this, or most of us on the Ophthalmology Foundation education side, used to work with the ICO. And the ICO’s philosophy had changed a bit so we formed this group, that’s really how it came about. But we’re doing a lot of the same things we used to do. But because of COVID, we’ve had to, of course, change our educational methods. What we’re talking about here is really more training of trainers, but the principles are relevant to resident education as well.

We have our first offering which is the teaching skills for ophthalmic educators. This is open to anybody around the world, whether you’re a resident and are going to be a teacher or are teaching right now. And these are monthly modules that are online, but they’re not just a webinar or not just a narrated recording or even a live webinar. They consist of several parts. Each one of these are monthly and they are ultimately recorded. So you can sign up for this any time you like, but they’re monthly modules. At the beginning of the month, people that are registered get an announcement that there are, the short, narrated lectures are available. These are usually three, 10-15 minute lectures, pretty short. You can access these at any time during the month. And then there is homework. And at the end of the month there’s a live webinar with the speakers for that month to discuss the homework and to answer any questions the participants might have. We started this in July 2021.

And here’s just an example from the Homework Forum, this is how it works. There’s a question and then here is an answer, there is an answer given from someone who’s name I blanked out here for anonymity. And then Eduardo, who’s on this webinar, here is answering, or responding, to the participant’s answer to the question. And you can see a very detailed answer from Eduardo. And trying to help that participant with understanding and learning of the module.

Here are the topics. And you can see there’s a wide variety. These are all, again, monthly. July was applying adult learning principles, giving effective feedback, et cetera, I won’t read all of these out. But you can see that there’s a variety of things aimed at ophthalmic educators and those residents, since I know there’s a bunch of residents on the webinar, some of you will be teaching. These are always to improve your teaching abilities. Again, you can sign up for any one of these, you don’t have to do them in order, there’s no sequence, you can do module two and module six if you want. You can do them all and so on. That’s sort of where we are right now.

For March, we just started a professionalism and communication skills module. I’m sorry, just ending. And then we’ll have the three remaining through the end of June. And then we’ll be going on to six more modules in the series. And, again, each of these are organized in the same manner. And then our plan is to translate these modules into other languages, French, Spanish, and Portuguese. If anyone would like to help with that, we would love volunteers. This Ophthalmology Foundation is completely a volunteer group and we’re always interested in enlisting ophthalmologists who want to help with our mission.

And this is just the QR code which has been on each of the preceding slides. This will take you to a place where if you want to you have to register, which simply means provide your name and email address and so on and you can start the online series at any point you would like to. And please, if you’re interested, go ahead. If there are questions, let me know, I’ll give you my email address at the end.

The other program we’re doing, again, because of our mission is aimed at ophthalmic educators but in specific regions of the world. This is something we used to do as a two-day face-to-face meeting. But because of the pandemic, we’ve modified this. We now do an initial online training and then follow up meetings face-to-face, hopefully, we haven’t done one face-to-face yet, but hopefully they will be face-to-face, two-day meetings when it’s safe to continue, to really expand on the online training that we’re doing initially. Very importantly, the program content and the number of meetings is based entirely on the needs of the participants. We’re in contact with groups of people, I’ll give you an example in a moment, and what we teach and what we do is all based on what the group thinks they need.

Our initial program has been taking place now in Malaysia. We started our first program, it was in late 2021, but we just had follow up sessions in February and March of 2022. Malaysia has five big universities that are teaching in the country and they have a committee, a conjoint committee of these universities, so there were a total of about 60-70 ophthalmic educators on each of these meetings. And lots of discussion, these are very interactive. I think you’ll hear a little bit more about webinars in our activity later on.
And we have other courses that we’re planning in regions. These, again, are for regions or countries where they want to improve their residency education.

If you’re interested in this type of course, contact me. These are not something that just anybody can sign up for. These are things that have to be organized well in advance by groups of people.

In summary, we’ve adapted some of our types of training to be pandemic-proof, I guess, if you will. We’re hoping, of course, that as the pandemic is winding down we will continue these programs. But I think that even when we’re hopefully back to normal, whatever that means, and we’re heading more face-to-face meetings, we’ll still be employing some of these principles of the online basic education, followed by, hopefully, face-to-face live sorts of teaching interventions. I thank you for your attention.

[Maria] Hi, everybody. I’m Dr. Maria Montero and I’m the Associate Director of Clinical Services for the Flying Eye Hospital. Today I want to talk to you a little bit about virtual wet lab/simulation trainings and the lessons that we at Orbis have learned.
I want to remind everybody what simulation actually is. Simulation is when you replicate a clinical or surgical skill in a controlled environment. This is without the human factor. And what do you gain from this? You gain from this a safe, stable environment where you can manage complications and of course no patients are harmed doing this procedure.

I’m going to play a little video about our Flying Eye Hospital and our simulation center.

[Narrator] In 2018, Orbis International launched the Flying Eye Hospital Simulation Center. The Simulation Center provides ophthalmologists, nurses, and anesthesiologists with clinical and surgical training in a risk-free environment. Research shows that complications and clinical errors present more frequently early in the learning curve of an eye care professional. Simulation training changes this. It improves health outcomes and patient safety by significantly reducing complication rates and medical errors among health professionals.
The end result, safe, high quality patient care.

[Thomas] We can really shift the learning curve in our surgeons using simulation, especially structured simulation. We can make it so those first cases that surgeons have are less risky to our patients.
[Narrator] Using virtual reality and high fidelity eye models, Orbis trains ophthalmologists and residents in basic and advanced cataract surgery, surgical and medical retina, indirect ophthalmoscopy, pediatric strabismus, trauma, cornea suturing, and minor operations.
High fidelity mannequins are used to train anesthesiologists on basic safety principles applied to perioperative care, delivery of safe anesthesia, and the management of critical events during pediatric ophthalmic surgery. Nurses are trained using a combination of high fidelity mannequins and simulation roleplay to improve skills in the pre and post-operative care of patients, infection control, instrument sterilization, basic life support, scrub and circulating in the operating room. All simulation is supported by pre learning delivered through the Orbis telemedicine platform, cybersight.org.

Simulation training has many advantages for Orbis Flying Eye Hospital projects including training twice the number of eye health professionals, improving the effectiveness of hands-on training with live patients, familiarizing participants with facilities, equipment, supplies and instruments before conducting live surgery, and allowing for more focused attention on learners.

As with all Flying Eye Hospital projects, anything taught on the plane is transferred to our partner hospitals. This helps them establish their own simulation centers and training programs. With the Simulation Center, Orbis is helping the next generation of eye health professionals get the skills they need to provide the care that patients deserve.

[Maria] In all of our simulation courses, we have objectives and you should too. Our first objective is to always, of course, that the learner is actually learning a surgical technique. But not only that, but also how to use the instruments and how to set up their surroundings during the procedure. Also, we like to assess the competency of the surgeon so that we can be more confident when they move on to real-life patients. Also, of course, to reduce the complication rate. And as you’ve seen in the video, we like to train the entire eye care team, not only ophthalmologists or training ophthalmologists but our anesthesiologists, training anesthesiologists, and nurses and environments.
I want to show you a little bit how the simulation looks like aboard our plane. First we have in the cockpit our classroom where we do a flipped classroom session before every day. Then in the laser room, which is behind it, we have the Eyesi, which is set up for phaco. We can either do the basic or the advanced course.

Then we also have a set up to try argon laser, panretinal ablation, and macular grid. We also have the virtual reality indirect simulator where we can set up clinical settings. We set up two different tables, we set up one to try and practice small cataract surgery simulation. And we have another station for glaucoma where we can teach trabs and valves.

Inside our OR, we set up everything as it would in the real life surgery. We set up the microscope, we set up the phaco, and we teach how to set this up. The only thing that is artificial is the plastic eyes. But everything else is set up like it would in real life. This gives the residents, or the learners, the ability to improve their skills in a real-life scenario setting.

We also set up two stations for strabismus surgery. And another one for trauma to practice scleral or corneal wounds.

As you’ve seen, our lovely anesthesiologist team are also teaching other anesthesiologists with scenario-based learning. They teach them about equipment safety, how to set up the operating room, basic ophthalmology general anesthetics, and they practice anesthesia emergencies as well.

And our nurses are teaching other nurses as well with simulation, with scenario-based learning. They teach them about pre op care, post op care, how to handle instrument cleaning, sterilization and packaging, and also about basic life support.
We like to teach our partners as well, how to create their own simulation centers so that this project is also sustainable. We teach them everything from choosing the right room for the wet lab, just in the instruments, the machines, the microscopes, the tables, stools, which eyes are better. And of course, one of the most important things, we help them create their own curriculum so that they have a structured plan to train their residents.

In our Flying Eye Hospital by itself, alone by itself, we have delivered six one-week simulation projects in Peru, Barbados, Mongolia, Jamaica, Chile, and the last one being in Ft. Worth back in March 2020. But of course that year when the pandemic hit we had to switch everything to virtual. We put on our thinking hats and we even switched our in-program with live patients projects to virtual. We moved on to that and we delivered 17 virtual training courses. We delivered 93 live sessions with a total of 851 enrollments with eye care professionals delivered in over five languages.

Like the video I showed before, we do everything, every project, every course, we have some pre-learning material on Cybersight. On Cybersight we have this pre-learning material where the learners see the lectures. We are not wasting any time with PowerPoint presentations, teaching and talking about the technique, and how we talk about how to make a trabeculectomy or what is it for. We focus on the teaching, we focus on the skill that we’re trying to teach. We ask the learners to have this material already done and learned and come to us for our live sessions with the mentors with questions.

Last year we had 10 virtual courses delivered to over 34 countries. And we delivered traditional lectures, a virtual hands-on simulation course where we shipped artificial eyes overseas. And we had the entire simulation course with a mentor live on our platform, Cybersight, through Zoom. We practiced side-to-side with our residents how to make the steps, how to take each step. Then with our eyes and ourselves and the mentors also with our artificial eyes so that we could see each other.

For this year, we’re aiming to have some projects back to in-person, regular trainings like in the past. We’re going to have two projects like that. But since we saw that these virtual trainings are a real success and this is the way to the future, and this helps us a lot to reach a lot more people, we’re still going to keep the virtual trainings going. And we’re going to deliver one in Ethiopia and we’re going to do another virtual wet lab in Vietnam for trabeculectomies as well.

What we have learned about these virtual trainings and virtual wet labs with Orbis. First of all, we have to be very clear. You have to be very clear whenever you set up a course, you have to be able to communicate exactly what the goals are for the partners, what they want to learn, what their objectives are, what they expect to learn from this course. You need to know what people you’re going to train. Who are your trainees, what year they’re one, what are their best skills or worst skills? How many surgeries they’ve had? So that you really can focus on what they need to learn. We also like to know how their wet lab is set up. We want to know everything. How the wifi is set up, what consumables they have, which eyes are available to get, which microscopes, which stools, which machines? If there’s going to be a phaco machine, if they know to use it or not. You need to know their surroundings.

Like I said before, we do a lot of pre-learning and I highly recommend this because then you’re focusing on the skill that you want to transfer all by itself and the learners already know the theory of it, you’re not wasting any time discussing the theory. They already know this. And if they have any questions, then you create more dynamic session with the trainees where they ask you questions and then you focus on that instead of going over what the procedure is and what it is for.

Another very important point for us is how to choose a mentor. When you choose a mentor we say that maybe a lot of people can be an ophthalmologist but not a lot of people can teach ophthalmology. And especially not a lot of people can teach virtually ophthalmology. And then we take it up even a notch more with training virtual wet labs in simulation in ophthalmology. That’s a very specific set of skills that we need in a mentor. They have to be able to transfer this knowledge through a platform, virtually.

You need to also send this mentor the material. Like I said, if the trainees that you’re going to teach virtually have certain type of eyes, then you want the mentor to have the exact same type of eyes, the same instruments. So that they know how to answer questions like why do I feel like the capsulorhexis is feeling a little tight? The cornea got opaque, I got a lot of bubbles. The mentor is also an expert on these eyes and they can answer how to set up these eyes, troubleshooting everything.
A timeline, you need a specific timeline to meet your objectives and your expectations so that you follow up on them.

And of course, always, ask for feedback. If it’s real-life training, if it’s virtual training, always ask for feedback whether you’re the mentor or the mentee, you always need some feedback to be able to improve, otherwise you’re never going to improve on your skills and your trainings.

And that’s it for me. This is my contact information and thank you very much.

[Helena] Thank you so very much, it’s an honor and privilege to be here today sharing the experience regarding the Faculty Development Program on Curriculum Design. Thank you so very much, Orbis, Cybersight. And so very much the Ophthalmology Foundation for the opportunity to be sharing these thoughts.

This is basically about describing the program that has been available at the Cybersight platform. And that can be started to be described as when, for instance, having an invitation to set up a course or a curriculum for learning experience educators should think or advise to think and to approach that program that they are about to set up.

First, whom and what will my learning activity impact? Who will be our target learners? What will be our goals and objectives? What content and strategies will we/I utilize? What learning resources will we be needing? And finally, how would I, or we, as a planning committee know about the learners have actually learned or not? And these are the six steps of curriculum design that can has approach.

The goal of this program is that upon its completion, participants will be better able to apply effective educational strategies that are useful to design, implement, and evaluate any program in simulation-based training in ophthalmology or other as well.
The objectives that come associated are that by the end of the program the learners could be better able to, I know, and this is one component of, or one domain of a competency in the area of knowledge in the cognitive area to describe how to conduct a needs assessment based on a gap analysis. Describe how to write goals and objectives, select the most appropriate educational strategies, and to describe the concept and the principles of assessment and evaluation.

And regarding the second component, I do, to apply the learning principles to teach effectively and ideally to have this draft on an efficient simulation session/program. And finally, in regards of the third component of the competency, I feel to appraise the role of reflection in simulation-based learning. This is so much connected with simulation-based education because the whole program just sprung up from this need of two communities that we will share in a minute who were looking for expanding or creating their own programs on simulation-based education.

This is the whole content and the modules that composed this whole program that is available on Cybersight. And as we can see, most of the modules are concentrated on teaching learning and teaching strategies for the one and two steps, the first and second steps are just one module and a module for implementation. And then last one, the sixth step regarding assessment and evaluation also with a module. Two other modules, a module zero or O because it is kind of crossing all modules, applying adult learning principles. And the last module regards a guided tour through the Cybersight online courses.

This is the faculty. We are very, very happy to work with all who would like to enhance their skills and knowledge and competence in designing program’s curricula.

There are two ways of participating in this program. One is a self-based mode, the program as we have seen is composed of 10 modules. Each module is around two hours and a half of engagement and it can be called a course. Because after we have seen or watched this recorded lecture for each module and have read some curated readings with a pre-quiz, post-quiz, and received the feedback of participants, a certificate of participation course will be automatically awarded.

And the other way is the mentor-assisted mode. It’s exactly composed of the same 10 modules, the same pre and post-quiz regarding each course or each module with a feedback survey. Also based on a recorded lesson and curated readings but has also this written activity and to be finalized by a webinar in each module. And across all the 10 modules an applied assignment is proposed for this group working as a community on the course. And for those who will be willing, a reflective report submittance can be accepted also and can allow us to award these three types of certificates of participation for those who have demonstrated some participation, some level of participation during the course. Certificates of completion for all those who have completed all the tasks have been proposed and commendation for those who have been willing to hand in their reflective reports after the course has ended.

Allow me just to be a little bit more specific in terms of this mentor-assisted mode of participating in the program on curriculum development skills is because the CPD subcommittee of the Ophthalmology Foundation is committed to focus on good practices in education with continuing professional development. But also in mentorship. And this has become as a need, a growing need of groups of mentees sharing the same goal for creating programs, so called group mentoring, facilitated by group mentoring, which in a very summarizing way is a combination of group facilitation with peer mentoring.

This is exactly what in some way we live as professionals in medicine. We have these communities of practice or very great community of practice. But usually we define some groups of interest and we have this domain, this area of shared interest. In this case would be the common goal of this group of mentees. And by establishing and creating relationships to build a safe and supportive environment, we can, as a group as a community, develop practice in terms of advancing the project that we tend to be united.
And this is exactly what happened with the Congolese Society of Ophthalmology and the Mozambican College of Ophthalmology. The two professional organizations we have worked with and have the experience of running this program as a mentor-assisted program. All of these, both of these societies were interested in developing programs, a curriculum on simulation-based education.

And this is our experiences and some data that we could gather for the Congolese Society of Ophthalmology with the pre-test and post-test. As we can see there were increasing in learning development, in competence. We can say also there was also in competence because the group, as we said before, the mentor-assisted mode of participating in this program, asked for the groups to develop this applied assignment. And in this case there were sessions based on any step of the cataract surgery they would like to work on and develop this session as a workshop based on the six steps model of developing curriculum. And they did that, and they present that also in the digital environment. This is just to say that this started before the pandemic. We held that these experiences actually during the pandemic as well. You can also see that there was satisfaction and well acceptance and welcoming of the program.

For the Mozambican College of Ophthalmology also we could see that there were learning improvement also. There were competence improvement exactly doing the same applied assignment that we proposed and explained before. And there were at least two differences that each of the participants presenting their simulation-based sessions digitally could find between the first version that they were invited to start created at the fourth module to the last version they came up at the end during all the course. And as you can see, there were also very good acceptance and welcoming of the course in terms of feedback of the participants.

And if these latter examples of mentor-assisted mode as we can see have had mentoring, not only from the side of the faculty, of course, but also shared with leaders of the professional societies who work exactly as mentors on their side. So regional mentors. But at some part of the time what we could see were that there were these mentoring support among all the members of the community. For the self-paced mode, and all this data that I am sharing with you and thank a lot for the Ophthalmology Foundation faculty and also Orbis for making this be possible, was collected by October 2020. And we had at this time for the self-paced mode, 19 completions of the whole program for the whole modules and about 405 enrollees. And a close look at the pre-test and the post-test we can see that there were different statistical significant difference in terms of the results. And also very good feedback on the side of these participants whom we didn’t have the opportunity of creating this community of practice and know a little bit more.

These two pilot mentor-assisted programs and one self-paced mode could allow us to conclude that they were well-received by the ophthalmologists’ educators, that competence improvement in curriculum design applied to simulation-based education had occurred, especially we can speak about competence because there were this show how to do in terms of this digital learning environment so it was improved with two professional societies, organizations we worked with. There was formation of virtual communities of ophthalmologist educators that are still going on right now, supported mainly by WhatsApp. And technology can support the communities of practice and assist faculty development in under-resourced settings. Even navigating uncertain and difficult times as the pandemic has been proved to us. And group mentoring can play a key part in the learning process including the establishment of longitudinal educational project.

Thank you so very much for hearing me and any questions, any comments will be very welcome. Thank you so very much.

[Clare] It’s my pleasure to talk to you all today about a tool that Orbis has published that focuses on residency education. We call it our Orbis Residency Assessment Tool. For those of you who joined late, again, my name is Clare Szalay Timbo. I’m the Associate Director of Clinical Services at Orbis International.

To just provide some context as to why Orbis specifically focuses on residency education, I wanted to provide you areas of where we work and focus to really understand how best we support our partners and stakeholders. When we think about residency education at Orbis, we focus not just on the current faculty who are teaching and providing support to learners, but also on our future trainers. Meaning residents themselves who are going to be the trainers of tomorrow. We do this in a number of ways. First off by supporting current faculty. But providing workshops and trainings on best practices in residency education. With, of course, the support of our global team of volunteer faculty, experts in their own rights on various topics who can share their knowledge and skills with current faculty. We also advise on curricula and training plans and shed light on areas of improvement for partners on where they can really invest resources and time to improve their education programs.

As you heard from my colleague, Dr. Montero, Orbis spends a lot of time investing in simulation because we believe in this to be a powerful training modality. We do this by creating wet lab training resources such as curricula and other helpful materials. We support with implementing wet lab activities both virtual and in-person, given COVID-19 challenges. And of course we support with the set ups of simulation spaces. We have a comprehensive simulation manual that goes over how to set up different spaces in your own institution.
And lastly, we do this by applying and modeling best practices ourselves. As Dr. Filipe mentioned, the creation of the Faculty Development course on Cybersight has been instrumental in providing resources for faculty and those who teach and is applicable for our global audience in the self-paced version. We also have webinars on relevant topics and additional resources available through our Cybersight library including textbooks and manuals. We implement and pilot methods that we want to test out with partners through our Flying Eye Hospital and globally through our country program teams with invested partners that we have had for many years. And last, but not least, we focus on virtual training and utilizing a blended learning approach always when applicable.

The Orbis Residency Assessment Tool began as an idea and a concept from actually our partners in Latin America and the Caribbean. One of our program managers spoke to the clinical training team in 2020 asking if we had any type of tool that would support her partner in Peru to really go through comprehensively and prepare for their hospital accreditation process. We didn’t at the time, but we had thoughts and ideas. And thus began the journey to create the Residency Assessment Tool. Which was carried out by our technical specialist, Amelia Geary, who’s an international training expert. She designed the tool in early 2021 and we were able to launch and fully publish it alongside the annexes in the fall of 2021.

Since that was just a few months ago, we then started to pilot using this tool with partners including a workshop and orientation session that we led earlier this month with our partners in Vietnam. And really where we focused the workshop was to spend time with our partners to understand when using this tool what came up for them and areas for improvement and how they could prioritize what needs to be done in order to improve their education program. Orbis also has current plans to pilot using this tool with other partners including those in India in April and potentially in Zambia, as well, in the near future.

I want to explain a little bit about the Residency Assessment Tool and its purpose. It is designed to be a self assessment. Meaning that it can be used by partners and stakeholders on their own or with support. And the questions are very basic, meaning they’re yes or no or Likert scale, so it’s easy to fill out. It can be utilized both in structured settings or informally. And it can be done as a group, individually, or by a committee together collectively. Overall, it comprehensively covers all elements of a residency program to give a holistic assessment of where the program is at any given point of time. Again, it can be used over and over again throughout changes that are happening through the program to understand where things have improved or where things need to change.

Now I’m going to briefly speak to the sections. The first section titled Mission and Outcomes, really presents the six key components of the residency education program developed by the Accreditation Council for Graduate Medical Education, also known as ACGME. The second section titled Education Program measures curricula and the standards of practices of residents currently available at the institution. The third section, Trainees and Faculties, looks at the numbers of how many trainees are available versus how many faculty are there, to see if there are adequate numbers for support and mentoring.

The fourth section, Assessment of Trainees, looks at how residents are assessed, the frequency and the use of such assessments, as well as the types of feedback provided and at what times. The fifth section, Training Settings and Educational Resources, focuses on what’s available in terms of equipment, materials, and other educational resources such as journal clubs, subscriptions to libraries, et cetera. Section six, Evaluation of the Training Process, indicates if there is a current evaluation process as part of the education program and if there’s any types of feedback mechanism readily available. And last but not least, section seven, Developing Teaching and Facilitation Skills in Residents, really reviews opportunities for how faculty can build residency skills in becoming teachers and lecturers themselves.
Here’s an example of the section six, just to give you a taste again of the way that the questions are worded and how to do the assessment yourself. Again, using the Likert scale, it gives you clear examples to demonstrate exactly what the answers might be. If you’re on the lower side, the one or two score, then you have room for improvement in that area. And it also gives you guidance in the scores for three and four as to what might be best practices. If you are scoring in the higher end, the three or four section, then you know that this is an area where you’re already doing your best and you can focus on other priorities and put resources towards other initiatives to produce the changes you’d like to see.

I’m also going to highlight what is included in the annexes of this tool. As I mentioned before, the tool references the ACGME, so we included the milestones as well for ophthalmic residency training programs as a global reference. To give you an idea of what types of knowledge, skills, attributes and other achievements residents need to achieve and be competent in by the end of their training. The second annex just identifies a simple two station fundamental wet lab that you can set up including essential equipment and consumable and instruments. As well as an ideal tech set up if you want to digitialize your wet lab. And last but not least, the third annex shows an artificial model eye review from our Flying Eye Hospital ophthalmologist team who’ve gone through and used all the various different types of model eyes out there and provide reviews as to which models are best and for which type of sub-speciality procedures.

This tool lives in our Cybersight library and is readily available at the moment in English. If you go to our main Cybersight webpage and click on the little search key and type in Residency Assessment, it will bring you right up to the page that you can download the manual through yourself. We are also translating this currently into Vietnamese and we hope to have it available in other languages as well as applicable to your settings.

I’d like to just share with you all now a partner testimonial from our recent workshop in Vietnam. This is from the Associate Professor Dr. Kim Bao Giang who’s the Director of the Center for Assessment and Quality Assurance at Hanoi Medical University. She said, and I quote, “I think that this Residency Assessment Tool is useful not only for the Department of Ophthalmology, but also for other departments in both undergraduate and post-graduate programs. I hope that, in the coming time, we will have a more concrete plan to implement the tool realistically and regularly.”

I wanted to highlight specifically now the type of support Orbis can provide to partners when using the Residency Assessment Tool. We are certainly available to provide orientation calls on how to walk through and use the tool in your context and setting. We can organize workshop sessions with volunteer faculty who will go over the results with you and your teams and offer practical solutions to any challenges or areas in the tool where you want to improve your program specifically. Thirdly, we’ll support with requests for additional resources for those of our long-standing partners and work with you to see what is possible in the coming years. And lastly, Orbis is always willing to share any relevant training materials, products, and courses available to anyone at any time as relevant to what you need to support your residency program.

I want to thank you for your time today and mention that please you can add any questions you have to the Q&A. We are now going to move on to the third section of our session today. I’d like to invite back on Dr. Karl Golnik, Dr. Eduardo Mayorga, and Dr. Ciku Mathenge.
This third session, what we really wanted to do was talk about what’s next in residency training. We’ve all gone through the challenges of COVID for the last two years, but there are still best practices that are relevant for what will become the new normal once we resume life post-pandemic. I’d like to ask Dr. Mayorga, if you could please share your suggested best practices when it comes to virtual webinar delivery.

[Eduardo] As I said good morning. I would share you some tips on best practices on webinars. I see most of you, from the call we did at the beginning, are mostly involved as participants in webinars and not that much as speakers and as admins. I think that everybody, no matter how proficient we are in running webinars, should get more knowledge on this. One of the things we are lacking today is residency programs sharing what they do for training their residents. I recognize that every residency program records online all the lectures and then share them on a pool to other places and countries that cannot get access to some of these lectures.

I have a pre-recorded lecture so I’m moving it due to address time constraint. Good morning, I’m Dr. Eduardo Mayorga. I’m a consultant in medical education in the Austral University Hospital in Buenos Aires. I am the director for E-learning for the Pan American Association of Ophthalmology, and I am a member of the education committee of the Ophthalmology Foundation. I have no conflict of interest to this.

The objectives of this presentation are that by the end of the presentation, participants will be able to list all the main factors you must take care of when you’re preparing a webinar and access a mind map with links to multiple training resources. Finally apply all these several recommendations to improve user satisfaction when you run your own webinars.

Many times I get this question, which webinar software should I use? Well, there are a lot of webinar software. Personally I use Zoom and the examples I give here will be mostly on Zoom. In the past I’ve tried BlueJeans, I’ve tried Webex, and maybe some other ones that doesn’t appear here. But Zoom is the one I like best. Meet from Google is another one you can also use. I suggest using Zoom, it is the one that is most used and has a lot of features that others do not have.

I will be talking for us describing what you will find in the mind map and talk a little bit about equipment, how to look your best in the camera, how to start interactivity and why use it, some topics about security, and how to record and edit in post-production of your webinar. Because of time constraints, I will only be covering the four points here. But you will be sent a link that will allow you to take a look at these last two points on your own after the webinar.

The first thing is the mind map. This I will go into detail later, but basically in this mind map you will find all pratica, all the information you need to set up a webinar on Zoom. It has three areas. One for presenters, one for hosts, and some miscellaneous recommendations. As you open the branches, more branches open, and at the end of all the branches, you will find links to specific instructions on how to do what appears in the branch.

Equipment. Use always a cable connection. Wifi connections are not as stable as with cable. Always plug in a cable that comes from the router into your computer. Make sure the speed you have is good enough. There are many places you can test it, this is a good link. It’s www.speedtest.net. This will allow you to see how fast your internet is at the time of the presentation.

I recommend using two monitors. I usually use my laptop with which I handle all the different windows. I use the second screen to share. This way people do not see everything else you have on your screen. This is what you see here is my phone. I always recommend connecting a device like your phone to the same webinar as a participant. This will allow you to check what participants are seeing on their screens. The other thing this phone is used for is for in case you lose connection in the computer. I do not connect my phone to the wifi. I take away wifi and I keep the phone on data so if there is a loss of power or a loss of the connection, my phone will still keep me connected to the webinar. You must remember to make this participant in the phone a co-host because if not, if your connection drops or the webinar will drop.
There are some things that you can do for your image to appear better. In the mind map you will get a link to a very good presentation on YouTube for this person, it’s all the recommendations. But basically, remember to use a background, either an image or blur so that things happening behind you do not appear. Also you have to work a little bit with illumination. Lighting is different if you have it from the top, as you can see you get a lot of shadows. Or if you have it from the front, like in this case and in my case. You can use a lamp behind your computer to get this illumination or a window. And there are special devices like these that connect to your computer to get power and provides the light you need. This is the kind of device I use. You can see the set up here with the light. Sometimes I move the light here so it goes straight into my face.

Another tip if you’re wearing glasses to avoid reflections, in this case I think my reflections are not very high, but if you’re wearing glasses, you may want to tip your glasses a little bit forward and that way no reflections are shown. Try to position your camera at the same level of your eyes, if not you will be getting an image from bottom up that do not look good. Especially if you’re using a phone, people used to hold it below their eyes and the faces do not look nice on screen.

Interactively is something you have to plan for in every webinar you give. In this case, because you’re not all connected to the webinar, I will not be able to give an example of how it works. But probably you have all seen it. It’s very important to add interactivity because it helps evoke when you ask a question, it helps evoke previous knowledge on your participants and this will determine the learner’s knowledge. Because of the answer you will then know how much they know about the topic and it will help them identify false assumptions when you give the correct answer. But most important for having people answer questions makes them connect the new knowledge you’re giving them with the old one they had.

Zoom has different ways to generate interactivity but the one we use most is the multiple choice that you have to set beforehand. You’ll see this later and you’re able to set up the question, participants just tick on this, and then you can share and comment on the results. There are two type of questions, you can set up single choice and multiple choice. Multiple choice allows them to choose more than one answer, for example if you set up the names of several animals, tick the two animals you like the best. They can do this.

The chat is another useful tool when you make open-ended questions. During your interactivity you make an open-ended question you can either let people answer using their microphones or using the chat window. When you do open-ended questions try to make sure they are short answer open-ended questions so it’s easier for them to put an answer into the chat. And the chat has the advantages over the microphone that people simultaneously are giving an answer and things go faster. I usually use the microphone when I want people to answer a longer question that has a longer answer or give their opinion on some of the topics we are doing.

Breakout rooms are also a very handy way to generate interactivity. What breakout rooms allows you, like in face-to-face meetings, is that if you have a big group, you can split it down into smaller groups where everybody when you send them to their room they just meet in this case, for example, in a room of four. All these now are divided into four rooms of four, they discuss among themselves and when we bring them back they take a turn one room at a time, they can give their conclusions of the discussions.

You may wonder why after giving all these tips about interactivity we haven’t used them at all during this session, except for the initial poll. The reason is that most of these presentations were information, just information was presented on what we do and how we do it. But if we were working on something we want learners to learn for later to apply, that is where you should plan for having interactivity. Remember, usually planners do not leave time for this. You get one presentation after the other. It’s better to have less content covered but with more interactivity with the learners than just go through one presentation after another. As I said before, the security topics covered here and the recording post-production and a deeper explanation of the mind map, you will be able to get when Clare sends you the link to the complete presentation. Thank you very much.

[Clare] Thank you, Dr. Mayorga. Those are very helpful hints. In fact, I was just trying the glasses suggestion myself.

[Karl] Clare?

[Clare] Yeah, go ahead!

[Karl] Can I speak with just a comment, two comments.

[Clare] Please do.

[Karl] One, the reason I look so good is because I heard Eduardo’s presentation in another meeting and I bought one of those little lights, so you can’t see it, but it’s up in front of me, so that’s why I look so good today. And the other is that we used the breakout rooms extensively in the Leaders in Education Program that I described with Malaysia. I think we had eight breakout rooms and we’d send people there and they would discuss things and then we’d come back in the large group and then we’d have the reports from the breakout rooms. It really worked very well, I thought. And I highly recommend it, as Eduardo said, depending on what you’re trying to teach and the right venue, very effective to use those. Thanks.

[Clare] Agreed, thank you. Dr Mathenge, I’d like to ask you now, based on your experience as a residency education leader, what have been the challenges and successes given COVID-19 at RIIO?

[Ciku] Sure, thank you, Clare. And thanks for inviting me to this session. I have just two slides which I’ll use to answer your question. RIIO is a small institution and at the time when COVID broke out we actually had only two batches of residents admitted then. And the COVID response in Rwanda was very, very swift. We had a total lockdown after identifying one case of COVID. And the lockdown was thorough. It was so thorough that we had to hang around to make sure no one is out of their house and making announcements about people staying indoors. Because RIIO is small and we’re independent, we were not affected by anybody’s rules in terms of the academic calendar. We decided that we would keep going. We didn’t stop our calendar. What we decided to do during the total lockdown was to catch up on our didactic teaching. That was a time to catch up on all those things like neuro ophthalmology, sorry Karl, we really had intensive lectures then.

It was really useful for my residents because they became very familiar with online platforms and we used Zoom, we used Google Meet and we used Teams. We’ve settled on Zoom. As a department, we invested on a paid Zoom platform and everybody knows how to access it and how to keep it secure. At the beginning there were challenges of people’s internet connections. And what I challenged them to do is to use the points that they would normally use as their transport money to come to RIIO, instead to convert that to buying better internet packages for their homes. After that things worked really well.

What we’ve learned after COVID is that it’s actually much easier to keep doing all didactics on Zoom. Because I usually have residents spread out between us and before when you’re getting outside of a center, you basically missed the lectures. But now there’s absolutely no reason for you to miss. Even when I have residents rotating in other countries, as I sometimes do, they still have to attend all the lectures.

Of course we made sure all our residents were safe. They are all triple vaccinated. And we facilitated that by bringing the vaccination program into our clinic and all get the vaccines. Despite that, two of them did catch COVID somewhere between their second and third doses. But we had a lot of scenario planning around what happens if someone is positive, what will the rest of us do, where do we go for testing, do we resume clinic? So we worked out all those scenarios.

In using Zoom, my residents are now very familiar with doing polls, they are familiar with breakout rooms. In fact, it was interesting listening to Eduardo because when we were doing the new recruitment for the new batch of residents, I had applications from different countries and also an interviewing panel from different countries. And using breakout rooms on Zooms really helped us to manage that interview process.

During the COVID time, clinics were slow, of course. Total lockdowns we had sort of partial lockdowns. But we continued with emergency surgery and we considered bilateral cataracts to be emergencies. What we did is we negotiated with police that we could give our patients who needed care, like post ops or people who are on care after corneal transplants, to have a specific letter that they could use to navigate police checkpoints as they came for us. We kept using that letter even now just for helping patients access care even after the lockdowns are over.

We had to continue doing exams and we converted our exams to an online platform. We initially tried some commercially available platforms, they were a bit cumbersome. Later we just went to Google Forms and we found that works very well. Again, no matter where you are rotating, you do not miss an exam. We’ve managed to do that and I think we’ll continue doing that, even when we have residents in sessions, we no longer print out exam papers. We will put them either on a Google form, it helps me because marking is easy, I can fit the Google form with all the answers before and I can therefore give them their marks immediately after the exam. Those are some of the practices that we will continue.

As you’ll see in the next slide, once we came back to the clinic, if I could have the next slide. Social distancing has become the norm so we see patients with our masks on, we have discussions. I don’t know, for some reason keeping one meter apart has just become automatic. We continue all our didactics online. Just before COVID we had sent some residents to do some wet lab training in South Africa and when they came back we were able to set up a five station wet lab station within our facility. And we’ve been able to take advantage of some of this virtual material that’s available. We set it up exactly the way that they had it set up in South Africa. And thanks to Orbis we’ve managed to get the same kind of set up.

Another thing I’ve done is identified online resources that I make mandatory for my residents. A lot of them are on Cybersight, others are courses on future learning, others are courses on other platforms. At the beginning of the academic year I give them a list, like this one here, and I tell them these are online courses that you must do over the course of this year. And a lot of them are self-paced, but some are webinars that they must attend. And what I expect from them is the certificates of attendance from those courses. And that means that even if for some reason we have to break, they still have stuff that they can keep doing, even when we are not in session. In brief, that’s what we’ve learned from COVID.

[Clare] Thank you, Dr. Mathenge. Such practical, realistic options. I appreciate that. Dr. Golnik, I wanted to ask you if you could speak as well to opportunities around international accreditation and share a little bit about that process because I know that’s something the Ophthalmology Foundation is working on.

[Karl] Yes, thanks. Before I’d just like to comment briefly on Ciku’s talk. One of the reasons to get a paid subscription, if you’re doing lots of Zoom webinars, is that if you don’t have a paid subscription, the webinar only lasts 45 minutes. And then it just stops. I recently was involved in a webinar as an invited guest speaker and it just stopped after 45 minutes. And everyone had to re-login. So don’t do that.

And the other thing is that in the U.S., we’ve also last year and the year before, have converted our interview process for residents totally by Zoom. And it used to be that these poor applicants would have to travel from all across the United States, spend a lot of money, hotel rooms, planes, everything, and now the last two years it’s been totally virtual. The downside, of course, is the applicants don’t get to see our physical plant, our program in that sense, but they still get to interact with all the residents and of course we do the interviews. And there was just a survey sent out to all of the U.S. programs about what should we do in the future? Do you want to just leave this way forever? Which I think makes a lot of sense, giving the applicants an option to come to look at the program in person if they like, but not a mandatory you have to spend thousands of dollars to come and see our program and do these interviews at some 15 programs or whatever number of interviews they’re going to.

Thanks, Clare, for the question about the accreditation. I want to talk just a little bit about accreditation and what the Ophthalmology Foundation is planning. Just to make sure we’re on the same page, we talk about accreditation and we talk about certification. In general, we like to use the word certification for individuals. That means that an individual has passed an exam, they’ve passed a board exam or something like that. They are certified. But when we use the term accreditation, that should be applied to the same type of evaluation process but for a program, a training program. Individuals are certified, programs are accredited.

And the definition, and there’s many definitions I suppose, but one definition is of accreditation is a review process that determines if a training program meets defined standards of quality. If a program is accredited, it means the curriculum and quality have been evaluated and judged to meet the standards of that profession.

And really the purpose of accreditation are many. Number one, protect the public. Make sure that the doctors that we’re creating are good. Protecting the resident and their education. Make sure that the program is adequate to actually train the resident. So it protects the resident’s education. Hopefully, and we think, it improves patient care, it can set the bar for a country or region. The bar, here’s the bar, well you want to make sure the bar is high enough to be adequate, but not too high that you can’t attain it. And really, bottom line of accreditation ultimately is that it should drive program improvement. Everybody’s program can be improved.

What the Ophthalmology Foundation is doing is we’ve taken the World Federation for Medical Education’s Standards for Quality Improvement. These are standards that are published, they’ve been out for many decades, but the most recent revision is from 2015. We’re taking these standards, which are meant for different branches of medicine, to take the general standards and then revise them for use in your specialty. Of course, we’re revising these for ophthalmology.

And from these standards we are creating international training program accreditation guidelines. And these guidelines will cover all aspects of residency training from how do you train the residents, how do you know the residents are doing what they should do, how do you evaluate your faculty, how do you evaluate your program, do you have the right resources? How many surgical cases are the residents doing, are they meeting minimum numbers? The guidelines include all aspects of training.

And we are just about finished with these accreditation guidelines. I’d like to thank Ciku, who’s on the accreditation committee, and then Eduardo who’s helping to review our final draft from the committee which is going through that process at the moment. We’re now looking for three programs to pilot this process and one program that’s volunteered is the Magrabi ICO Cameroon Eye Institute. But we’re looking for two other programs, so if anyone is interested in their program possibly undergoing a pilot accreditation. The pilot accreditation, by the way will be free, whereas ultimately the process won’t be free, there will be some charge, of course, to cover our expenses. This is not a money making proposition, but it is expensive to undergo this kind of accreditation process.

That’s what we’re doing right now. We certainly believe that accreditation is crucial to maintaining good resident education and producing good ophthalmologists. And these national accreditation guidelines are meant to be just that, a standard, a bar to attain for programs around the world. Obviously a very voluntary process.

[Clare] To wrap up here, I just want to thank everyone again, all the panelists and speakers. We so appreciate your time and expertise on this important topic. And thank you, as well, for your continued dedication to supporting not just the faculty but the trainers of tomorrow as well.