Keywords
fellowship - Web site - Web site content - ophthalmology fellowships
As a result of the COVID-19 pandemic, residency and fellowship programs were adapted
by using virtual interviews and information sessions. A virtual format places increased
emphasis on the availability and quality of online resources for applicants to prepare
before an interview.[1] As a vehicle for that information, program Web sites play an important role in guiding
residency and fellowship applicants' decision-making. Several studies across medical
specialties have identified online presence both in Web site and social media as a
determining factor in fellowship selection among new physicians.[2]
[3]
[4]
[5]
[6]
[7]
[8]
[9]
[10]
[11]
[12]
[13]
Fellowship program Web sites (FPWs) have been assessed across medical specialties
for content relevant to applicants.[14]
[15] As part of this assessment, authors established criteria to describe FPW content
that may be utilized as a comparative scoring method. For example, Wei et al utilized
20 distinct criteria to evaluate 147 dermatopathology, micrographic surgery and dermatologic
oncology, and pediatric dermatology FPWs.[13] Ruddell et al assessed thoracic surgery program Web sites based on 25 distinct criteria.[14] Previous studies of ophthalmology trainees have identified factors that are particularly
influential when applying to programs and deciding whether to subspecialize.[2]
[3]
[4]
[5]
[6]
[7]
[8]
[9]
[10]
[11]
[16]
[17] Many of the factors identified are ones included in previous Web site assessments,
such as surgical volume and research opportunities.
Ophthalmologic FPW content has been assessed only for ophthalmic plastic and reconstructive
surgery.[15] Reviewing program Web sites of the remaining ophthalmology subspecialty fellowships
may provide insight into any discrepancies in the information available among subspecialties.
Notably, a difference in program Web site content availability and quality between
subspecialties may have an unintended effect on applicants' decisions when applying
to fellowship programs. This study assesses the availability and breadth of 26 predefined
content items on the Web sites of Association of University Professors of Ophthalmology
(AUPO)-compliant surgical retina and vitreous; cornea, external disease, and refractive
surgery; glaucoma; neuro-ophthalmology; and pediatric ophthalmology fellowship programs.
Methods
Study Design
Web sites of programs from the following subspecialty fellowships were analyzed for
completeness of content: surgical retina and vitreous; cornea, external disease, and
refractive surgery; glaucoma; neuro-ophthalmology; and pediatric ophthalmology. A
list of AUPO-compliant ophthalmology fellowship programs within these five subspecialties
was extracted from the AUPO “Programs in Compliance” Web site.[18] These subspecialties were chosen for analysis since they offer the greatest number
of accredited fellowship positions annually. Ophthalmic reconstructive and plastic
surgery fellowship programs were not assessed as they have been examined previously
and are not supported by the AUPO Fellowship Compliance Committee.[15] Programs were assessed for the presence of a dedicated Web site or Web site section.
Afterward, each Web site was scored on the presence or absence of 26 key content criteria
derived from previous studies assessing Web site content of ophthalmic plastic and
reconstructive surgery, dermatology, and cardiothoracic surgery fellowship Web sites.[15]
[16]
[17] Based on Weibull distribution modeling indicating dwell times of 10 to 20 seconds,
content was considered “accessible” if it could be found within two clicks from the
FPW web page.[19] Videos or documents found within two clicks from the web page were also reviewed
for content criteria.
Among the 26 content criteria chosen, 13 were categorized as “program demographics,”
including: description of the fellowship program, phone number of the fellowship or
ophthalmology department, e-mail of the fellowship or ophthalmology department, mailing
address of the fellowship or ophthalmology department, name of the fellowship director,
affiliated hospital, number of positions available, names of current fellows, names
of past fellows, current employers of past fellows, link to or location of application
form, requirements for application, and application deadline. Ten criteria were categorized
as “program features,” including: salary, employment benefits, didactic information
(mention of grand rounds, lectures, bedside learning), journal club, rotation schedule
(either day-to-day or semester schedule), clinic or call responsibilities, research
opportunities and requirements, availability of time off/funding for conferences,
case diversity, and surgical statistics. Three criteria were categorized as “social
life,” including: community information/activities to do in the area, health and wellness
programs, and link to a fellowship program or ophthalmology department/hospital social
media page.
Statistical Analysis
Fellowship Web site presence was compared between ophthalmology subspecialties using
a chi-square test. The average percentage of FPW criteria (total and by criterion
cluster) present was compared across subspecialties and analyzed using the chi-square
test. Chi-square tests were also used to test for nonequivalence between observed
and expected values of the 26 Web site criteria between different subspecialties.
Fisher's exact test was used when the assumptions for a chi-square test were not met.
Analyses were performed in Microsoft Excel (Redmond, WA).
Results
Two hundred forty of 266 (90.2%) distinct fellowship programs had Web sites. There
was no statistically significant difference among subspecialties in Web site presence
(p = 0.255) ([Table 1]). Across all the disciplines, FPWs contained an average of 57.2% of the total criteria,
63.8% of program demographic criteria, 58.4% of program feature criteria, and 23.5%
of social life criteria ([Table 2]). Between disciplines, there were significant differences in the presence of total
criteria (p < 0.001), program features criteria (p < 0.001), and social life criteria (p = 0.031). Neuro-ophthalmology FPWs contained the lowest percentage of total criteria
(50.8%) and program features criteria (49.2%), while glaucoma programs contained the
lowest percentage of social life factors (17.2%).
Table 1
Fellowship Web site presence
|
Fellowship programs with Web site, N (%)
|
|
Surgical retina and vitreous (n = 77)
|
70 (90.9)
|
|
Cornea, external disease, and refractive surgery (n = 50)
|
42 (84.0)
|
|
Glaucoma (n = 66)
|
58 (87.8)
|
|
Neuro-ophthalmology (n = 29)
|
28 (96.6)
|
|
Pediatric ophthalmology (n = 44)
|
42 (95.5)
|
|
p = 0.255[
a
]
|
a The p-value was calculated using chi-square test.
Table 2
Average percentage of Web site criteria by fellowship subspecialty
|
Web site criteria group
|
Total (%)
|
Surgical retina and vitreous (%)
|
Cornea, external disease, and refractive surgery (%)
|
Glaucoma (%)
|
Neuro-ophthalmology (%)
|
Pediatric ophthalmology (%)
|
p-Value[a]
|
|
All factors (n = 26)
|
57.2
|
61.0
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58.3
|
53.5
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50.8
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59.3
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< 0.001
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|
Program demographics (n = 13)
|
63.8
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66.2
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63.7
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60.1
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62.6
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65.8
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0.099
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|
Program features (n = 10)
|
58.4
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64.0
|
58.1
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55.5
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49.2
|
63.1
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< 0.001
|
|
Social life (n = 3)
|
23.5
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27.1
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31.0
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17.2
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22.6
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19.0
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0.031
|
a The p-values were calculated using chi-square tests. Bold text indicates a p-value significant at 5% level of significance.
The presence of each individual content factor by fellowship subspecialty Web site
is summarized in [Table 3]. In the program demographics cluster, significant differences between specialties
were observed in program description (with neuro-ophthalmology programs most often
lacking this criterion [92.9%, p = 0.046], average = 98.3%), presence of a mailing address (with glaucoma programs
most often lacking this criterion [48.3%, p = 0.014], average = 61.6%), hospital affiliation (with neuro-ophthalmology programs
most often lacking this criterion [85.7%, p < 0.001], average = 97.9%), name of current fellows (with pediatric ophthalmology
programs most often lacking this criterion [28.6%, p = 0.004], average = 46.3%), and application requirements (with both surgical retina
and vitreous, and cornea programs most often lacking this criterion [42.9%, p = 0.022], average = 50.0%). In the program features cluster, significant differences
were noted for the presence of a journal club (with neuro-ophthalmology programs most
often lacking this criterion [17.9%, p = 0.016], average = 42.9%), case diversity (with neuro-ophthalmology programs most
often lacking this criterion [50.0%, p = 0.001], average: 79.6%), and surgical statistics (with neuro-ophthalmology programs
most often lacking this criterion [10.7%, p = 0.015], average: 30.8%). No statistically significant differences were observed
in the social life category ([Table 3]).
Table 3
Fellowship Web site criteria by fellowship subspecialty
|
Factor
|
Surgical retina and vitreous (n = 70), n (%)
|
Cornea, external disease, and refractive surgery (n = 42), n (%)
|
Glaucoma (n = 58), n (%)
|
Neuro-ophthalmology (n = 28), n (%)
|
Pediatric ophthalmology (n = 42), n (%)
|
p-Value[a]
|
|
Program demographics
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|
Program description
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70 (100)
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41 (97.6)
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58 (100)
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26 (92.9)
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41 (97.6)
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0.046
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|
Telephone number
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53 (75.7)
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32 (76.2)
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39 (67.2)
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22 (78.6)
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36 (85.7)
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0.320
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|
E-mail address
|
59 (84.3)
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35 (83.3)
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43 (74.1)
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25 (85.7)
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38 (90.4)
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0.211
|
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Mailing address
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41 (58.6)
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25 (59.5)
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28 (48.3)
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20 (71.4)
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34 (81.0)
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0.014
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Director name
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65 (92.9)
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37 (88.1)
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49 (84.5)
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24 (85.7)
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37 (88.0)
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0.660
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Hospital affiliation
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70 (100)
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42 (100)
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58 (100)
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24 (85.7)
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41 (97.6)
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< 0.001
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No. of positions
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42 (60.0)
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25 (59.5)
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36 (62.1)
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17 (60.7)
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24 (57.1)
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0.992
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Names of current fellows
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45 (64.3)
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18 (42.9)
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25 (43.1)
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11 (39.3)
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12 (28.6)
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0.004
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Names of past fellows
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26 (37.1)
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12 (28.6)
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15 (25.9)
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6 (21.4)
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12 (28.6)
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0.518
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Past fellow's current employer
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11 (15.7)
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4 (9.5)
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7 (12.1)
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3 (10.7)
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12 (28.6)
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0.104
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Application form
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61 (87.1)
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38 (90.5)
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47 (81.0)
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20 (71.4)
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35 (83.3)
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0.246
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Application requirements
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30 (42.9)
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18 (42.9)
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26 (44.8)
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21 (75.0)
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25 (59.5)
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0.022
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Application deadline
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29 (41.4)
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21 (50.0)
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22 (37.9)
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10 (35.7)
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22 (52.4)
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0.461
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Program features
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|
Salary
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31 (44.3)
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13 (31.0)
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21 (36.2)
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6 (21.4)
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20 (47.6)
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0.133
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|
Benefits
|
35 (50.0)
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16 (38.1)
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16 (27.6)
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8 (28.6)
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17 (40.5)
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0.089
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Didactic information
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58 (82.9)
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36 (85.7)
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49 (84.5)
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22 (78.6)
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33 (78.6)
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0.876
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Journal club
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34 (48.6)
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18 (42.9)
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22 (37.9)
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5 (17.9)
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24 (57.1)
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0.016
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Rotation schedule
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39 (55.7)
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17 (40.5)
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24 (41.4)
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10 (35.7)
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17 (40.5)
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0.266
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Clinic/call responsibilities
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57 (81.4)
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34 (81.0)
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49 (84.5)
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21 (75.0)
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40 (95.2)
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0.185
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Research requirements
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64 (91.4)
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37 (88.1)
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53 (91.4)
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21 (75.0)
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36 (85.7)
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0.195
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Conferences/travel funding
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45 (64.3)
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21 (50.0)
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29 (50.0)
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13 (46.4)
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26 (61.9)
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0.283
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Case diversity
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57 (81.4)
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36 (85.7)
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47 (81.0)
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14 (50.0)
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37 (88.1)
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0.001
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Surgical statistics
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28 (40.0)
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16 (38.1)
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12 (20.7)
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3 (10.7)
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15 (35.7)
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0.015
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|
Social life
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Community information
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26 (37.1)
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17 (40.5)
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12 (20.6)
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6 (21.4)
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9 (19.0)
|
0.066
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|
Wellness programs
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9 (12.9)
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5 (11.9)
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4 (6.9)
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5 (17.9)
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4 (9.5)
|
0.618
|
|
Social media link
|
22 (31.4)
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17 (40.5)
|
14 (24.1)
|
8 (28.6)
|
11 (26.2)
|
0.473
|
a The p-values were calculated using chi-square tests. For program description and hospital
affiliations, Fisher exact tests were used. Bold text indicates a p-value significant
at 5% level of significance.
Discussion
Although 90.2% of AUPO-compliant ophthalmology fellowship programs have Web sites,
this study identified high heterogeneity among criteria completeness. On average,
the program Web sites contained only 57.2% of the 26 criteria examined; among which
only 23.5% were social life criteria, compared with 63.8 and 58.4% of program demographic
and program feature criteria, respectively. This suggests that some information desired
by applicants might not be readily accessible, and the completeness of these Web sites
may potentially be improved.
Among the criteria clusters analyzed, social life was the one that lacked information
most often. Mari et al have demonstrated that wellness interventions (e.g., art therapy,
exercise classes) have the ability to reduce burnout among residents.[20] Therefore, by increasing FPW content available regarding community information and
wellness programs, programs demonstrate concern regarding mental health. Additionally,
medical graduates often utilize the internet to seek information regarding programs.[2]
[3]
[4]
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[6]
[7]
[8]
[9]
[10]
[11]
[21]
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[23]
[24]
[25]
[26]
[27]
[28] By increasing their social media presence, programs can display information efficiently
and better attract prospective applicants.
Although program demographics (63.8%) and program features (58.4%) were much more
complete than social life (23.5%), they still present an opportunity for fellowship
Web sites to improve. Surgical volume and case diversity are important factors affecting
resident applicants' choice of program.[17] Additionally, the desire to acquire special skills was the most important factor
affecting career choice for graduating ophthalmology residents.[16] Although 79.6% of Web sites had information on case diversity, only 30.8% of Web
sites contained surgical statistics that may influence program choice. Increasing
information available regarding total surgical volume and surgical diversity may attract
prospective applicants into applying to specific programs.
Significant heterogeneity was observed among FPWs by subspecialty. Notably, neuro-ophthalmology
program Web sites tended to have significantly fewer total (50.8%) and program feature
(49.2%) criteria than other subspecialties. This might derive from the underrepresentation
of certain factors on neuro-ophthalmology FPWs that are inherent to that subspecialty.
For example, case diversity and surgical statistics were significantly lower among
neuro-ophthalmology FPWs, which may be because neuro-ophthalmology is largely nonsurgical.
However, while assessing Web site criteria, it has been noted that most neuro-ophthalmology
FPWs were listed online under “neurology” fellowships rather than “ophthalmology”
fellowship pages, indicating that both neurology and ophthalmology residents can apply
for this fellowship. Since ophthalmology is regarded as one of the most competitive
specialties by medical students, this may explain the relative thoroughness of FPWs
for strictly ophthalmology fellowships.[29] However, neuro-ophthalmology FPWs more often listed application requirements. As
there are different residency routes for individuals considering a career in neuro-ophthalmology,
programs may need to display application requirements more clearly to avoid any confusion
for ophthalmology and neurology residents.
Another criterion whose presence varied between FPWs for different subspecialties
was names of current fellows, with surgical retina and vitreous FPWs showcasing trainees
more often. This may be explained by differences in the number of positions available
within each subspecialty. Surgical retina fellowships have 142 positions available
among all AUPO-compliant programs, which is noticeably more than other subspecialties
(e.g., 42 for neuro-ophthalmology and 106 for glaucoma). With an increased number
of positions and the competitiveness of surgical retina fellowships, programs may
be more likely to showcase their fellows for potential applicants to reach out and
appear more attractive.
This study is not without limitations. First, it did not assess content on all the
ophthalmology fellowships. AUPO does not set standards for ophthalmic plastic and
reconstructive surgery, and other fellowship programs, such as ocular oncology, have
a limited number of AUPO-compliant programs (<5). Additionally, information found
on the fellowship Web sites may not be completely accurate. Web sites may have been
scored as containing/not containing the information when the Web site content was
outdated, or simply the feature was not listed. There was no secondary source of information
to validate the accuracy of the Web sites assessed in this study. Finally, this study
was not able to offer commentary on the link between content and recruitment outcomes.
Studies in other fellowship matches and residency matches in other disciplines have
established this link, leaving the possibility the same is true for ophthalmology.[25]
[26]
[27]
[28] Further work may establish this to be true for ophthalmology fellowship Web sites.
Conclusion
Although most fellowship programs had a Web site, areas of content improvement in
the different ophthalmology fellowship programs were identified. Within these five
ophthalmology subspecialties, significant variability in program Web site content
was noted, with neuro-ophthalmology programs presenting the lowest percentage of criteria.
Heterogeneity was seen in different Web site elements including names of current fellows
and surgical statistics. Areas of FPW content deficiencies were explored among the
subspecialties, with social life criteria being the most lacking across all five of
them. Addressing missing information on ophthalmology FPWs may better assist applicants
in identifying programs to apply to, help optimize program-applicant fit, and reduce
any unintended effect on applicants' choice of subspecialty.
