Do U.S. ophthalmology departments help residents succeed in 'real world'?

Recently, a ranking of U.S. business schools was published by Forbes magazine. The top school, according to this ranking, was the Tuck School of Business at Dartmouth College, Hanover, NH. The criterion used to determine the "best" school was a remarkable one: starting salary of recent graduates. This struck me as an interesting measure of the quality of an education.

How do we measure the quality of education in U.S. ophthalmology residency programs? Not, to my knowledge, by the starting salaries of our graduates.

One survey, conducted by Ophthalmology Times, has queried department chairmen and residency program directors for the past decade. The Residency Review Committee of the Accreditation Council for Graduate Medical Education (ACGME) uses a number of quantitative criteria to assess educational quality: surgical volume, number of supervised and non-supervised patient interactions, regular performance appraisals in the residents' files, etc.

In my experience, a lot of academic types are willing to forego the higher incomes associated with private practice in return for the satisfaction that comes from training the bright, energetic residents that are the future of our specialty. With all these people focused on training and the (increasing) requirements to maintain residency accreditation, we must be doing a great job, right?

Maybe not. One way to assess the quality of our residency training programs is to ask our graduates about their education. How do they evaluate us? In August the Ophthalmology Times E-Newsletter posed the following statement:

"U.S. ophthalmology residency programs do a good job of teaching residents how to succeed in the 'real world' of clinical practice after they finish training. True or False?"

Of 73 respondents, 72% said "false."

What is this all about? I am not prepared to assert that the unscientific survey of a non-random sampling of American ophthalmologists proves we are not doing a great (or even good) job in our residency training programs.

Nonetheless, when almost three-fourths of our grads say we are not doing at least a "good" job, I think this deserves our scrutiny. Are we preparing our grads well to succeed after leaving the ivory tower?

One survey respondent writes that many faculty are unable to set any example for how to run a practice in a business-like manner and actually set a bad example for how to treat patients in a respectful manner (such as by showing up late to their clinics). It is true that many academicians are trying to juggle research, teaching, and patient care, and the provision of outstanding customer service sometimes (not always) suffers.

Most department faculty have never worked out in the "real world" of private practice, worried about making payroll, or lost sleep over the things that keep those of you in practice awake at night. Half of ophthalmologists in practice employ optometrists and oversee a team (technicians, optometrists, ophthalmologist) to care for patients in an efficient, cost-effective manner. Few departments expose their residents to such an experience, let alone teach them how to do it in an ethical and optimal manner.

Conduct a larger survey

My modest proposal is as follows: A large, scientific sampling of American Academy of Ophthalmology members should be performed to gauge better how our residency programs are doing.

If we are failing to meet the needs of our graduates, let's take a fresh look at how we teach and how we run our teaching clinics. If we academic types don't have the business experience required to prepare our residents to run private practices, let's enlist the help of those who do.

Let's get a blue-ribbon panel of academicians and private practitioners committed to excellent resident education to take a fresh look at how we train the people who are the future of our field.

Peter J. McDonnell, MD is director of The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of Ophthalmology Times. He can be reached at 727 Maumenee Building, 600 North Wolfe St., Baltimore, MD 21287-9278 Phone: 443/287-1511 Fax: 443/287-1514 E-mail: pmcdonn1@jhmi.edu