A survey of perceived training differences between ophthalmology residents in Hong Kong and China

Alvin L Young, Vishal Jhanji, Yuanbo Liang, Nathan Congdon, Simon Chow, Fenghua Wang, Xiujuan Zhang, Xiaofei Man, Mingming Yang, Zhong Lin, Hunter G L Yuen, Dennis S C Lam, Alvin L Young, Vishal Jhanji, Yuanbo Liang, Nathan Congdon, Simon Chow, Fenghua Wang, Xiujuan Zhang, Xiaofei Man, Mingming Yang, Zhong Lin, Hunter G L Yuen, Dennis S C Lam

Abstract

Background: To study the differences in ophthalmology resident training between China and the Hong Kong Special Administrative Region (HKSAR).

Methods: Training programs were selected from among the largest and best-known teaching hospitals. Ophthalmology residents were sent an anonymous 48-item questionnaire by mail. Work satisfaction, time allocation between training activities and volume of surgery performed were determined.

Results: 50/75 residents (66.7 %) from China and 20/26 (76.9 %) from HKSAR completed the survey. Age (28.9 ± 2.5 vs. 30.2 ± 2.9 years, p = 0.15) and number of years in training (3.4 ± 1.6 vs. 2.8 ± 1.5, p = 0.19) were comparable between groups. The number of cataract procedures performed by HKSAR trainees (extra-capsular, median 80.0, quartile range: 30.0, 100.0; phacoemulsification, median: 20.0, quartile range: 0.0, 100.0) exceeded that for Chinese residents (extra-capsular: median = 0, p < 0.0001; phacoemulsification: median = 0, p < 0.0001). Chinese trainees spent more time completing medical charts (>50 % of time on charts: 62.5 % versus 5.3 %, p < 0.0001) and received less supervision (≥90 % of training supervised: 4.4 % versus 65 %, p < 0.0001). Chinese residents were more likely to feel underpaid (96.0 % vs. 31.6 %, p < 0.0001) and hoped their children would not practice medicine (69.4 % vs. 5.0 %, p = 0.0001) compared HKSAR residents.

Conclusions: In this study, ophthalmology residents in China report strikingly less surgical experience and supervision, and lower satisfaction than HKSAR residents. The HKSAR model of hands-on resident training might be useful in improving the low cataract surgical rate in China.

References

    1. WHO World Blindness Maps. . Last accessed 12th August 2013.
    1. Resnikoff S, Felch W, Gauthier TM, Spivey B. The number of ophthalmologists in practice and training worldwide: a growing gap despite more than 200,000 practitioners. Br J Ophthalmol. 2012;96(6):783–7. doi: 10.1136/bjophthalmol-2011-301378.
    1. WHO. Blindness as a public health problem in China; Global Initiative for the Elimination of Avoidable Blindness. Fact Sheet. Geneva. Switzerland; World Health Organization. 2013. . Last accessed 12th August 2013.
    1. Zhao J, Ellwein LB, Cui H, Ge J, Guan H, Lv J, et al. Prevalence of vision impairment in older adults in rural China: the China Nine-Province Survey. Ophthalmology. 2010;117(3):409–16. 16 e1.
    1. Murthy G, Gupta SK, John N, Vashist P. Current status of cataract blindness and Vision 2020: the right to sight initiative in India. Indian J Ophthalmol. 2008;56(6):489–94. doi: 10.4103/0301-4738.42774.
    1. IAPB Western Pacific Country Profiles.. Last accessed November 16, 2013.
    1. Wikipedia’s table of per capita income by country: . Last acessed: January 30, 2014.
    1. Li EY, Liu Y, Zhan X, Liang YB, Zhang X, Zheng C, et al. Prevalence of blindness and outcomes of cataract surgery in Hainan Province in South China. Ophthalmology. 2013;120:2176–83.
    1. Li Z, Song Z, Wu S, Xu K, Jin D, Wang H, Liu P. Outcomes and barriers to uptake of cataract surgery in rural northern China: the Heilongjiang Eye Study. Ophthalmic Epidemiol. 2014;21(3):161-8
    1. Zhao Y, Hu Y, Smith JP, Strauss J, Yang G. Cohort profile: the China Health and Retirement Longitudinal Study (CHARLS) Int J Epidemiol. 2012;43:61–8. doi: 10.1093/ije/dys203.
    1. Challenges in blindness prevention: only 36 % ophthalmologists being able to perform cataract surgery. . Last accessed at November 16, 2013.
    1. Resnikoff S, Pascolini D, Etya'ale D, Kocur I, Pararajasegaram R, Pokharel GP, Mariotti SP. Global data on visual impairment in the year 2002. Bull World Health Organ. 2004;82(11):844–51.
    1. Zhao J, Sui R, Jia L, Fletcher AE, Ellwein LB. Visual acuity and quality of life outcomes in patients with cataract in Shunyi County, China. Am J Ophthalmol. 1998;126(4):515–23. doi: 10.1016/S0002-9394(98)00274-8.
    1. Zhao J, Ellwein LB, Cui H, Ge J, Guan H, Lv J, et al. Prevalence and outcomes of cataract surgery in rural China the China nine-province survey. Ophthalmology. 2010;117(11):2120–8.
    1. Mori T, Hatano N, Maruyama S, Atomi Y. Significance of “hands-on training” in laparoscopic surgery. Surg Endosc. 1998;12(3):256–60. doi: 10.1007/s004649900646.
    1. Huang W, Ye R, Liu B, Chen Q, Huang G, Liu Y, et al. Visual outcomes of cataract surgery performed by supervised novice surgeons during training in rural China. Clin Exp Ophthalmol. 2013;41(5):463–70.
    1. Lam PTH. The challenges of ophthalmic training and accreditation in Hong Kong. Hong Kong J Ophthalmol. 2007;11(1):3–6.
    1. China University Rankings. . Last accessed Novemebr 16, 2013 [in Chinese].
    1. Curriculum Training. Hong Kong: The College of Ophthalmologists of Hong Kong. 2000.
    1. Guidelines of ophthalmology resident training. . Last accessed November 16, 2013. [in Chinese].
    1. Accreditation Council for Graduate Medical Education. Required Minimum Number of Procedures for Graduating Residents in Ophthalmology. Review Committee for Ophthalmology. . Last accessed October 3, 2013.
    1. Singapore Country Addendum to the ACGME-I Advanced Specialty Requirements. . Last accessed November 16, 2013.
    1. Chan WH, Saedon H, Falcon MG. Postgraduate ophthalmic training: how do we compare? Eye (Lond) 2011;25(8):965–7. doi: 10.1038/eye.2011.120.
    1. Yeu E, Reeves SW, Wang L, Randleman JB. ASCRS Young Physicians and Residents Clinical Committee. Resident surgical experience with lens and corneal refractive surgery: survey of the ASCRS Young Physicians and Residents Membership. J Cataract Refractive Surg. 2013;39(2):279–84. doi: 10.1016/j.jcrs.2012.09.029.
    1. Wiggins MN, Warner DB. Resident physician operative times during cataract surgery. Ophthalmic Surg Lasers Imaging. 2010;41(5):518–22. doi: 10.3928/15428877-20100726-07.
    1. Tsai JC, Lee PP, Chasteen S, Taylor RJ, Brennan MW, Schmidt GE. Resident physician mentoring program in ophthalmology: the Tennessee experience. Arch Ophthalmol. 2006;124(2):264–7. doi: 10.1001/archopht.124.2.264.
    1. Sambunjak D, Straus SE, Marusic A. Mentoring in academic medicine: a systematic review. JAMA. 2006;296(9):1103–15. doi: 10.1001/jama.296.9.1103.
    1. Thomas R, Dogra M. An evaluation of medical college departments of ophthalmology in India and change following provision of modern instrumentation and training. Indian J Ophthalmol. 2008;56(1):9–16. doi: 10.4103/0301-4738.37589.
    1. Congdon NG, Aung T. A tale of two systems: health reform in China and the United States. Ophthalmology. 2010;117(3):407–8. doi: 10.1016/j.ophtha.2010.01.025.
    1. Yuan HF, Xu WD, Hu HY. Young Chinese doctors and the pressure of publication. Lancet. 2013;381(9864) doi: 10.1016/S0140-6736(13)60174-9.
    1. Lessin MS, Klein MD. Does research during general surgery residency correlate with academic pursuits after pediatric surgery residency? J Pediatric Surg. 1995;30(9):1310–3. doi: 10.1016/0022-3468(95)90492-1.
    1. Macknin JB, Brown A, Marcus RE. Does research participation make a difference in residency training? Clin Orthop Relate Res. 2014;472(1):370–6. doi: 10.1007/s11999-013-3233-y.
    1. Legislative Council Questions (LCQ 12): Cataract Surgery Services. . Last accessed November 16, 2013.
    1. National Plan of Blindness Prevetion and Treatment (2012-2015). . Last accessed November 16, 2013 [in Chinese].
    1. Liang YB, Friedman DS, Wong TY, Zhan SY, Sun LP, Wang JJ, et al. Prevalence and causes of low vision and blindness in a rural chinese adult population: the Handan Eye Study. Ophthalmology. 2008;115(11):1965–72.
    1. ACGME Institutional Requirements. . Last accessed October 3, 2013.
    1. Golnik K, Mayorga E, Spivey B, Ritch R, Gauthier T-M. International Council of Ophthalmology: refocusing ophthalmic education in the Asia-Pacific Region and Beyond. Asia Pac J of Ophthalmol. 2012;1(5):255–258. doi: 10.1097/APO.0b013e31826cd918.
    1. Lam DSC, Martin FJ, Tham CCY. APAO’s Commitment to Ophthalmic Education. Asia Pac J of Ophthalmol. 2012;1(4):190–192. doi: 10.1097/APO.0b013e318260069e.

Source: PubMed

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