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7. Replacement of lecture format with focused reading, online audio/visual didactic materials, and seminars with measured outcomes for resident training

Drs. Ramulu and Quigley

Teaching resident ophthalmologists in training is a primary focus of the GCE, but current methods inadequately incorporate advances in technology and are out-of-step with how young doctors now learn. We are developing modern teaching approaches and studying the outcomes of these new teaching methods. We anticipate that our new, evidence-based methods for teaching will serve as a model for how to best train doctors both within and beyond Johns Hopkins. The program has been developed with initial collaboration with Dr Harry Goldberg of the Johns Hopkins Medical School Dean’s office.

Project 1: First, we will transform passive, lecture-format education by making residents into active participants. Daily lectures often conflict with the other responsibilities of trainees, so that only a minority attend. Faculty too infrequently update their lectures, fueling the perception that there is nothing new. Learning styles vary among students, so single approaches fail to encompass help for some.

To make teaching information more accessible and interactive, we are testing elimination of lectures and replacing them with a single intensive weekly 3 hour learning session. Lectures slides with overlying audio have been pre-recorded by GCE faculty and posted online to be viewed prior to the learning session, and passwords identify which residents accessed the material. The in-class learning session will be an interactive interchange using clinical case material on the relevant subject. Trainees will be given an opportunity to “order tests” or ask for more information about the patient’s history or exam findings. They will then meet in small groups mixing individuals with differing levels of clinical experience, and finally reviewed with faculty.

To improve the surgical teaching of resident physicians, the GCE instituted an introductory wetlab experience for all residents beginning their glaucoma rotation. Residents review faculty surgical videos, view slides on instruments and sutures, then spends 3 hours of one-on-one time with a faculty member performing operations on pig eyes under operating microscope conditions.

Learning will be assessed through objective responses to a pre-test and post-test at the sessions. We will then compare the improvement in post-test scores for lectures given in the classic format, to the improvement seen with the new learning format. For this program, educational software that permits each student to be assessed during the sessions is commercially available and we seek funding to purchase and implement this using each student’s own laptop or wireless device. The cost is estimated at $100,000.

Project 2: The American College of Graduate Medical Education has called for objective evaluation of resident knowledge and performance, yet few specialties have actual methods to accomplish this important goal. The GCE has 3 methods to assess resident performance. First, residents complete an oral exam involving management of 6 clinical cases. Second, the GCE performed actual chart review on resident-managed glaucoma patients at Wilmer and Bascom Palmer Institute, comparing the care to faculty patient charts. Third, GCE faculty has developed online modules for education in the diagnostic and management skills needed in glaucoma care. The present 4 modules teach and assess skills in gonioscopy, disc and nerve fiber layer exams, and visual field test interpretation. Each takes one hour to conduct and has a pre- and post-test to assess learning and progress.

To extend this educational initiative, we are seeking funds for a research coordinator to evaluate the quality of learning and to support the effort to evaluate and publish research on resident learning and care. While we have studied whether tests are or are not performed, the more important question is whether tests or examinations, when performed, are interpreted correctly. New web-based modules are needed on glaucoma surgery, laser treatment, and medical management. Each of these costs approximately $25,000 in time and materials/programming. A commercial firm (Eyemaginations, Inc, Towson MD) is licensed to market these, and license fees will ultimately pay for the program and provide income in the long-term.  Once modules for glaucoma are constructed, the framework to expand to all ophthalmic subspecialties is ready to use. A research coordinator for this program requires $50,000 per year.

 

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