Keywords
virtual externship - ophthalmology - confidence - mentorship
Traditionally, across diverse medical disciplines, clinical opportunities have manifested
in the form of externships, offering medical students a potential avenue for discovering
their desired specialties and enhancing their medical knowledge.[1]
[2]
[3]
[4] The onset of the coronavirus disease 2019 (COVID-19) pandemic in 2020 introduced
an array of challenges to the United States' medical education system, prompting a
shift in information dissemination to students. In response, medical educators swiftly
embraced contemporary teaching methodologies encompassing self-directed learning and
virtual instruction. For instance, Yale Medical School introduced a “Quarantine Curriculum,”
employing interactive online lectures for foundational topics in psychiatric neuroscience,
complemented by self-study resources.[5] Similarly, Imperial College of London integrated a “digital clinical placement,”
simulating bedside teaching through weekly interactive online cases, supplemented
by webinar feedback.[6] At the University of Washington School of Medicine, a virtual internal medicine
subinternship emerged, led by near-peer educators facilitating online case discussions
and personalized independent learning plans for senior medical students.[7] In this swiftly evolving landscape, virtual learning has expeditiously evolved into
the paradigm for contemporary medical education.
It is incumbent upon specialty leaders and educators to attract aspiring medical students
to their respective domains.[8]
[9] Despite ophthalmology being a competitive field, many medical institutions are reducing
the extent of ophthalmology exposure within their foundational science curricula.[10]
[11]
[12] A 2018 survey revealed that only 16% of medical schools mandated a clinical rotation
in ophthalmology.[8] Enhancing students' engagement with ophthalmology, particularly amidst the challenges
of the COVID-19 pandemic, poses an ongoing educational quandary. This has led to fewer
than 50% of incoming residents meeting the ophthalmology competency standards as outlined
by the Association of University Professors in Ophthalmology (AUPO).[13]
[14]
[15] In response, the Kresge Eye Institute at Wayne State University School of Medicine
established the Ophthalmology Virtual Externship (OVE), designed to offer medical
students enhanced learning prospects and greater familiarity with ophthalmology. This
pilot study was primarily conducted to assess the impact of the OVE, indicating a
noteworthy elevation in medical students' knowledge, confidence, and propensity to
seek mentorship within ophthalmology. Additionally, as a secondary outcome the study
explored the perspective of 4th year medical students serving as junior professors
in the program, revealing an enjoyable experience coupled with an augmentation of
teaching skills and ophthalmology expertise.
Materials and Methods
Virtual Externship Program and Student Enrollment
Our study received Institutional Review Board (IRB) exemption from the IRB at Wayne
State University, rendering individual consent unnecessary. The OVE program was executed
in May 2020 through the Zoom platform and was extended to 2nd, 3rd, and 4th year medical
students enrolled at Wayne State University School of Medicine. A total of 76 students
voluntarily engaged in the program.
The OVE initiative comprised four 2-hour interactive sessions, comprehensively addressing
various fundamental ophthalmology subjects, including but not limited to anatomy,
glaucoma, neuro-ophthalmology, oculoplastics, cornea, uveitis, pediatrics, and trauma.
These sessions were led by a faculty preceptor, with 4th year medical students serving
as near-peer “junior professors” delivering the lectures. The selection of junior
professors was derived from the pool of medical students applying for ophthalmology
in that particular year. The faculty preceptor was present throughout the teaching
session, offering support to junior professors in elucidating intricate topics and
supplementing each lecture with additional instructional insights. Optionally, weekly
American Academy of Ophthalmology (AAO) case assignments were administered by faculty
members.
Survey and Test Design
The participants in the OVE were required to complete confidential surveys ([Table 1]) and take pre- and postprogram tests. The presurvey encompassed inquiries concerning
students' rankings of their interests and perceived confidence in ophthalmology. Additionally,
participants were queried about their previous experiences in ophthalmology and their
comfort levels in pursuing mentorship opportunities. The postsurvey paralleled the
presurvey, augmented by supplementary questions gauging their contentment with the
externship. Optional self-study AAO case assignments were also included. Furthermore,
the 4th year medical students who served as junior professors were surveyed about
their teaching experiences and general satisfaction with their instructional role
in the OVE.
Table 1
Survey questions and knowledge-based questions[a]
|
Demographic questions
|
|
1. What year of medical school will you be in September 2020?
|
|
2. Have you previously shadowed an Ophthalmologist?
|
|
3. Have you ever participated in ophthalmology research?
|
|
4. Have you previously participated in outreach or volunteer eye care events related
to ophthalmology?
|
|
5. How many ophthalmology electives have you taken? (If you are currently in an elective,
please count as yes)
|
|
6. Please list any other experience in Ophthalmology prior to this Virtual Ophthalmology
Externship
|
|
Confidence questions
|
|
7. I am comfortable with my understanding of basic ophthalmology[a]
|
|
8. I am comfortable with my understanding of clinical ophthalmology[a]
|
|
9. I feel knowledgeable enough to discuss eye health with patients[a]
|
|
Interest question
|
|
10. I am interested in Ophthalmology as a potential career specialty[a]
|
|
Mentor questions
|
|
11. I feel comfortable reaching out to senior students for advice regarding research
in Ophthalmology[a]
|
|
12. I feel comfortable reaching out to senior students for advice if I consider applying
to Ophthalmology residency[a]
|
|
Miscellaneous questions
|
|
13. What are your goals for participating in this Ophthalmology Externship?
|
|
14. As a student in this virtual externship class, I will adhere to professionalism
and the honor system regarding attendance and survey completion. I will not look up
or discuss the quiz answers prior to taking this 12 question quiz. I understand the
results are anonymous, and this quiz is to help in my learning through the externship.
I will not copy or share the quiz or externship materials
|
|
Knowledge-based questions
|
|
15. A 25-year-old female presents with sudden onset of left eye vision loss that is
accompanied by pain with eye movement and reduced color vision. She reports a similar
episode that occurred two years ago, along with an incidence of urinary incontinence
6 months ago. What is the patient's most likely diagnosis?
|
|
16. A 35-year-old male who has worn glasses since youth presents with new onset of
multiple floaters, flashes, and a dark curtain obscuring his vision. He noticed the
symptoms shortly after hitting his head four hours ago. The patient denies any loss
of consciousness, confusion, nausea, or vomiting. What is the next step in management?
|
|
17. A 30-year-old female with a recent upper respiratory tract infection presents
with bilateral eye redness and watery discharge. She reports that her ocular symptoms
began with burning, redness, and tearing affecting her right eye two days ago, and
are now affecting her left eye as of this morning. In addition to diffuse conjunctival
injection, physical exam is also significant for a palpable pre-auricular node on
the right. What is the most likely diagnosis?
|
|
18. A 35-year-old male with a long-standing history of asthma since childhood presents
with bilateral decreased vision over several months, especially apparent while reading.
The patient uses a steroid inhaler daily and has required intermittent steroid use
over the past several years. What is the next best step in management for this patient?
|
|
19. The patient is a 65-year-old female on chronic immunosuppressant therapy who presents
with a several-day history of right eye redness, mild pain, tearing, and blurred vision.
Slit lamp examination reveals corneal dendritic ulcers. Which of the following is
the most likely diagnosis?
|
|
20. Which of the following does NOT typically cause a relative afferent pupillary
defect (RAPD)?
|
|
21. A 4-year-old child who wears glasses presents for his annual visit to his pediatrician.
His physical exam is normal except that the red reflex cannot be observed in his left
eye. As you examine the affected eye more closely, you notice a whitish appearance
near the pupil. Which would most likely NOT be included in a differential diagnosis
for this child?
|
|
22. What can prevent the progression of dry age-related macular degeneration (ARMD)?
|
|
23. Which of the following is/are risk factor(s) for developing primary open-angle
glaucoma?
|
|
24. A 60-year-old African American female with a history of seizures, diabetes mellitus,
and hypertension presents with significant abdominal pain that is associated with
nausea. She also reports seeing halos around lights. On exam, her right eye is red
with a fixed mid-dilated pupil. When you cover her left eye, she notes decreased vision.
Which of the following is a risk factor(s) for this patient's most likely diagnosis?
|
|
25. What anatomical structures make up the angle that aqueous fluid drains through?
|
|
26. A 28-year-old patient with no past medical history presents to your clinic with
eye irritation. He has a swelling as pictured below. Which of the following is the
most appropriate treatment?
|
Note: Survey questions and knowledge based test (questions derived from Association
of University Professors in Ophthalmology [AUPO]) completed by medical student participants.
a Measured on a 7-point Likert scale (1 = strongly disagree, 2 = disagree, 3 = somewhat
disagree, 4 = neither agree nor disagree, 5 = somewhat agree, 6 = agree, 7 = strongly
agree).
A 7-point Likert scale, ranging from 1 (strongly disagree) to 7 (strongly agree),
was employed in the surveys. The tests comprised 12 questions selected from the AUPO
Web site. Pre- and postexternship student performance was juxtaposed, forming the
quantitative assessment of the virtual externship's impact on students' learning.
Data Collection and Analysis
The data were presented as mean values ± standard deviation. Statistical analyses
were conducted using IBM SPSS Statistics (Version 25.0, IBM Corp., Armonk, NY). The
unpaired Student's t-test was employed for the juxtaposition of continuous variables within two groups.
Statistical significance was achieved at a threshold of p < 0.05. The chi-square test of independence was applied to evaluate differences in
categorical variables, and Spearman's rank correlation was utilized to quantify the
strength of association among ranked variables.
Results
Demographic Information
A total of 76 medical students actively engaged in the OVE, ultimately completing
both a presurvey and a pretest, while 70 successfully concluded the postsurvey, and
64 accomplished the posttest. The surveys encapsulated information about the participants'
academic year within medical school and any pertinent prior exposure to ophthalmology
before their participation in the OVE. Out of the initial cohort of 76 surveyed students,
the distribution included 1 first-year student, 25 second-year students, 38 third-year
students, and 12 fourth-year students. A notable 33 (43%) students had previously
shadowed an ophthalmologist, while 26 (34%) had participated in ophthalmology research
endeavors. Furthermore, 45 (59.21%) participants had actively engaged in volunteer
or outreach activities connected to ophthalmology, and 9 (12%) had prior exposure
to ophthalmology electives. Additionally, students reported other experiences including
involvement in interest groups, scribing, journal clubs, workshops, and resident buddy
programs.
The Impact of the OVE on Interest, Confidence, and Seeking Mentorship in Ophthalmology
The participants of the OVE were administered pre- and postexternship surveys, aimed
at gauging their self-assessed confidence in ophthalmological knowledge, their level
of interest in the field, and their comfort in seeking mentorship for guidance. To
comprehensively evaluate the impact of the OVE on students' overall confidence, interest,
and comfort, an independent samples t-test was employed to contrast the pre- and postsurvey outcomes. The analysis revealed
a noteworthy increase in confidence regarding ophthalmological knowledge (3.842 ± 1.510
vs. 5.619 ± 0.852, p < 0.001). However, this change was not mirrored in students' interest in the field
of ophthalmology (p = 0.480) or in seeking mentorship (p = 0.085) ([Table 2]).
Table 2
Independent samples comparison of confidence, interest, and mentorship in all students
pre- versus postsurvey
|
Presurvey (n = 76)
Mean ± SD
|
Postsurvey (n = 70)
Mean ± SD
|
p-Value[a]
|
|
Confidence
|
3.842 ± 1.510
|
5.619 ± 0.852
|
< 0.001
|
|
Interest
|
6.066 ± 0.998
|
5.943 ± 1.102
|
0.480
|
|
Mentorship
|
5.579 ± 1.329
|
6.000 ± 0.921
|
0.085
|
Abbreviation: SD, standard deviation.
a
p-Value based on Brunner–Munzel test.
An additional analysis, utilizing an independent samples t-test, was undertaken to investigate potential associations between prior ophthalmology
experiences and discrepancies in students' pre- and postsurvey outcomes. Prior shadowing
emerged as significantly linked with a notable elevation in confidence (4.110 ± 1.440
vs. 5.440 ± 1.286, p < 0.001), interest (5.630 ± 1.040 vs. 6.480 ± 0.854, p < 0.001), and comfort seeking mentorship (5.530 ± 1.180 vs. 6.100 ± 1.070, p = 0.003).
Likewise, research experience was significantly linked with heightened confidence
(4.320 ± 1.500 vs. 5.350 ± 1.347, p < 0.001) and interest (5.720 ± 1.070 vs. 6.510 ± 0.800, p < 0.001). However, there was no significant association with comfort seeking mentorship
(p = 0.081).
Furthermore, outreach experience demonstrated a significant connection with an elevation
in confidence (4.230 ± 1.570 vs. 5.010 ± 1.412, p = 0.002) and interest (5.470 ± 1.120 vs. 6.370 ± 0.823, p < 0.001), though not with a surge in comfort related to seeking mentor relationships
(p = 0.276) ([Table 3]).
Table 3
Independent samples comparison of prior ophthalmology experience and change in presurvey
versus postsurvey results
|
Prior ophthalmology experience
|
|
Presurvey
(n = 76)
Mean ± SD
|
Postsurvey
(n = 70)
Mean ± SD
|
p-Value[a]
|
Effect size
(Cohen's d)
|
|
Shadowing
|
Confidence
|
4.110 ± 1.440
|
5.440 ± 1.286
|
< 0.001
|
0.961
|
|
Interest
|
5.630 ± 1.040
|
6.480 ± 0.854
|
< 0.001
|
0.885
|
|
Mentorship
|
5.530 ± 1.180
|
6.100 ± 1.070
|
0.003
|
0.503
|
|
Research
|
Confidence
|
4.320 ± 1.500
|
5.350 ± 1.347
|
< 0.001
|
0.716
|
|
Interest
|
5.720 ± 1.070
|
6.510 ± 0.800
|
< 0.001
|
0.806
|
|
Mentorship
|
5.630 ± 1.270
|
6.040 ± 0.919
|
0.081
|
0.349
|
|
Outreach
|
Confidence
|
4.230 ± 1.570
|
5.010 ± 1.412
|
0.002
|
0.937
|
|
Interest
|
5.470 ± 1.120
|
6.370 ± 0.823
|
< 0.001
|
0.525
|
|
Mentorship
|
5.650 ± 1.250
|
5.870 ± 1.104
|
0.276
|
0.185
|
Abbreviation: SD, standard deviation.
a
p-Value based on Brunner–Munzel test.
Furthermore, a comparative analysis of pre- and postsurvey outcomes was executed,
stratified by the year of medical school, employing independent samples t-tests. Regarding the augmentation of confidence in ophthalmology knowledge, 2nd year
students (3.120 ± 1.298 vs. 5.095 ± 0.838, p < 0.001), 3rd year students (3.772 ± 1.425 vs. 5.685 ± 0.745, p < 0.001), and 4th year students (5.500 ± 0.882 vs. 6.333 ± 0.603, p = 0.013) all exhibited significant associations with an increase in confidence. However,
none of the academic years displayed a significant association with heightened interest.
Notably, 2nd year students (5.060 ± 1.372 vs. 5.762 ± 0.562, p = 0.034) and 3rd year students (5.513 ± 1.271 vs. 6.135 ± 0.948, p = 0.019) demonstrated a substantial increase in comfort related to seeking mentorship
([Fig. 1]).
Fig. 1 Comparison of pre- and postexternship interest, confidence, and seeking mentorship
in ophthalmology in 2nd, 3rd, and 4th year medical students. ns, not significant.
*p < 0.05, **p < 0.01, ***p < 0.001.
The Impact of the OVE on Students' Knowledge in Ophthalmology
Students underwent a comprehensive assessment of their ophthalmology knowledge through
a 12-question pre- and posttest evaluation. Out of the initial cohort of 76 students
who participated in the test, 64 completed both the pre- and posttests following their
engagement in the OVE. To explore potential associations between prior ophthalmology
exposure—encompassing research, shadowing, and outreach/volunteering—and attaining
a score above 70%, a chi-square test of independence was executed on the pretest outcomes.
Specifically, prior shadowing (chi-square [1, N = 76] = 6.720, p = 0.010) and research experience (chi-square [1, N = 76] = 9.520, p = 0.002) exhibited a statistically significant correlation with scores surpassing
70%. However, no substantial association was found between prior outreach experience
and achieving scores above 70% (p = 0.407) ([Table 4]).
Table 4
Association of prior ophthalmology exposures with scoring above 70% on for OVE participants
|
Experience
|
Exposure (n = 76)
|
p-Value[a]
|
|
Yes
|
No
|
|
|
Shadowing
|
33
|
43
|
0.010
|
|
Research
|
26
|
50
|
0.002
|
|
Outreach
|
45
|
31
|
0.407
|
Abbreviation: OVE, Ophthalmology Virtual Externship.
a Chi-square continuity corrected p-values.
A Spearman's rank correlation analysis was undertaken to elucidate the relationship
between a student's current academic year and their pretest performance. Evidently,
a moderately positive correlation emerged (ρ [74] = 0.488, p < 0.001).
An independent samples t-test was undertaken to analyze the disparity in ophthalmic knowledge before and after
the OVE. The outcomes distinctly revealed a substantial enhancement in ophthalmic
knowledge subsequent to OVE participation (6.800 ± 2.040 vs. 9.450 ± 2.130, p < 0.001) among the entirety of the medical student cohort ([Table 5]).
Table 5
Independent samples comparison of ophthalmic knowledge (KBQ) in all students pre-
versus posttest
|
Pretest (n = 76)
Mean ± SD
|
Posttest (n = 64)
Mean ± SD
|
p-Value[a]
|
|
KBQ (15–26)
|
6.800 ± 2.040
|
9.450 ± 2.130
|
< 0.001
|
Abbreviations: KBQ, Knowledge-Based Questions; SD, standard deviation.
Note: Means represent number correct out of 12.
a
p-Value based on Brunner–Munzel test.
To elucidate potential disparities in the performance of medical students across different
years of study on the Knowledge-Based Questionnaire, independent samples t-tests were conducted to contrast their scores before and after the OVE program. The
2nd year students exhibited a substantial score augmentation (5.680 ± 2.056 vs. 8.750 ± 2.403,
p < 0.001), as did the 3rd year students (6.947 ± 1.676 vs. 9.559 ± 1.972, p < 0.001), and 4th year students (8.750 ± 1.603 vs. 10.500 ± 1.716, p = 0.022). This collective evidence underscores a notable increase in scores across
all academic levels subsequent to their participation in the OVE program ([Fig. 2]).
Fig. 2 Comparison of test scores pre- and postexternship in 2nd, 3rd, and 4th year medical
students. ns, not significant. *p < 0.05, **p < 0.01, ***p < 0.0001.
A chi-square test of independence was conducted to assess the association between
pretest and posttest outcomes for individual questions. Globally, students exhibited
statistically significant improvements in their performance on 9 out of the 12 knowledge-based
questions. Questions 1, 10, and 11 did not yield statistically significant differences
(p > 0.050). These questions encompassed topics in neuro-ophthalmology, glaucoma, and
general ophthalmology, respectively. The questions manifesting the most substantial
shifts were Q8 and Q9 (p < 0.001), which exhibited the most pronounced deficits in the pretest. These two
questions pertained to different domains, specifically retina and glaucoma. The remaining
questions, Q1 to 7 and Q12, all demonstrated statistically significant enhancement
(p < 0.050) ([Table 6]).
Table 6
Pre- and postsurvey knowledge-based questions (Q1–12): results for OVE participants
|
Question
|
Pre, n = 76, Post, n = 64
|
p-Value[a]
|
|
Correct responses (%)
|
|
|
1
|
87
|
89
|
0.950
|
|
2
|
86
|
98
|
0.016
|
|
3
|
66
|
86
|
0.011
|
|
4
|
68
|
84
|
0.046
|
|
5
|
66
|
89
|
0.002
|
|
6
|
45
|
66
|
0.021
|
|
7
|
37
|
63
|
0.004
|
|
8
|
30
|
75
|
< 0.0001
|
|
9
|
11
|
67
|
< 0.0001
|
|
10
|
54
|
64
|
0.130
|
|
11
|
53
|
67
|
0.150
|
|
12
|
79
|
97
|
0.004
|
Abbreviation: OVE, Ophthalmology Virtual Externship.
a Chi-square continuity corrected p-value.
Satisfaction of the OVE
Medical students indicated a robust level of satisfaction with the OVE, recording
an average Likert score of 6.35 out of 7 ([Table 7]). Notably, the spectrum of satisfaction scores exhibited variability across different
academic years, with 2nd year students reporting the lowest score (6.21) and 4th year
students attaining the highest (6.56). When stratified by ophthalmology exposure,
students who had undergone all three ophthalmology experiences reported an aggregated
satisfaction rating of 6.44, while those without any prior experience registered a
score of 6.24.
Table 7
Satisfaction ratings among student participants
|
Category
|
Satisfaction rating
Mean ± SD
|
|
Overall satisfaction (all classes)
|
6.35 ± 0.326
|
|
2nd year satisfaction
|
6.21 ± 0.372
|
|
3rd year satisfaction
|
6.36 ± 0.373
|
|
4th year satisfaction
|
6.56 ± 0.291
|
|
Students with all 3 experiences
|
6.44 ± 0.304
|
|
Students with no experiences
|
6.29 ± 0.547
|
|
Quality of lectures
|
6.37 ± 0.383
|
Abbreviation: SD, standard deviation.
Note: Measured on a 7-point Likert scale (1 = strongly disagree, 2 = disagree, 3 = somewhat
disagree, 4 = neither agree nor disagree, 5 = somewhat agree, 6 = agree, 7 = strongly
agree).
A noteworthy 87% of participants expressed appreciation for the virtual format employed
in the externship, attributing to it an augmentation of their comprehension of ophthalmic
disease processes. Pertaining to the quality of lectures, students bestowed an average
rating of 6.37 out of 7, signaling a high level of approval for the educational content
delivered.
The Experience and Satisfaction of the OVE in Junior Professors
All 12 fourth year students selected as junior professors successfully completed the
Junior Professor Survey ([Supplementary Table S1] [available in the online version]). Among them, 50% of junior professors acknowledged
that this engagement marked their inaugural experience in delivering lectures to 2nd
and 3rd year medical students. The junior professors were queried on aspects encompassing
the impact of the externship on their instructional acumen, comfort level in virtual
presentation, and perceived program advantages. Following their participation in the
OVE, their confidence in conducting subsequent virtual lectures exhibited a statistically
significant enhancement, rising from a mean of 5.0 to 6.33 out of 7 (p < 0.001). Moreover, a substantial 70% of participants expressed strong agreement
in the notion that their teaching skills improved through their involvement in the
externship.
Students' perspectives were also solicited concerning their overall contentment with
the OVE and their roles as junior professors. Impressively, 83% of respondents strongly
concurred that the process of preparing lectures contributed to their comprehension
of ophthalmic diseases and their underlying pathophysiology. An overwhelming majority
(83%) expressed strong agreement with the proposition that the OVE could serve as
a valuable supplement to the medical school curriculum. Notably, all participants
were unanimous in their view that the conception of analogous programs for other medical
specialties would yield positive outcomes.
Discussion
Externships provide students with a valuable avenue to broaden their knowledge base,
explore their interests, and initiate the development of the necessary confidence
for pursuing a specialized medical career[1]
[2]
[3]
[4] The advent of the COVID-19 pandemic necessitated the adoption of virtual platforms
for sustaining clinical medical education. In response, the Kresge Eye Institute at
Wayne State University School of Medicine introduced the OVE program, aiming to facilitate
medical students' engagement with ophthalmology. To the best of the authors' knowledge,
this study represents the pioneering effort in investigating the impact of a virtual
externship within the field of ophthalmology. The present study demonstrates that
participation in the OVE program significantly enhances students' knowledge, confidence,
and propensity to seek mentorship in ophthalmology.
Overall, students exhibited a high level of satisfaction with the virtual externship,
with an average score of 6.35 out of 7. This satisfaction was substantiated by their
sustained engagement in ophthalmology activities over an extended period. Six weeks
post the virtual externship, students reported active involvement in ophthalmology
research, mentorship seeking, and enrollment in webinars and elective courses. Remarkably,
this heightened satisfaction was attained without impinging upon the demands of their
medical school curriculum, a notable achievement given the compressed timelines of
preclinical years and rigorous clerkship schedules for medical students.[16]
[17] In this context, the virtual externship presents an efficient and gratifying avenue
to introduce students to ophthalmology, especially considering the constraints posed
by abbreviated summers and intensive academic calendars.
Students expressed a preference for the interactive format of the virtual externship
over traditional in-person lectures and prerecorded online sessions. Such insights
hold significance as medical education progressively integrates technological advancements.[18]
[19] The merits of the virtual platform encompass the flexibility it offers in terms
of students' preferred learning environments, streamlined interactions through features
like group chats for real-time anonymous questioning, and the stimulation of interactive
digital resources to facilitate effective learning.[20]
[21] These attributes align with the evolving landscape of medical education and its
growing reliance on technology.
Of note, there was no significant change between pre- and postexternship interest
ratings. This is likely due to the self-selective nature of the externship. Participation
was optional and likely fueled by prior interest in the field. Additionally, high
interest levels preexternship was expected for the 4th year students as they were
applying to ophthalmology residency that year.
Within the current framework of medical school curricula, the exposure of students
to ophthalmology remains notably restricted.[8] This constraint likely contributes to the discernibly modest confidence scores evident
in the preliminary survey. The OVE initiative systematically addresses a multitude
of ophthalmology competencies as delineated by the guidelines set forth by the AUPO[13]
[14]
[15]; these competencies are deemed imperative for prospective physicians' comprehension
and adept management. Through our investigation, we have substantiated that active
engagement in the OVE engenders a marked enhancement in confidence levels pertaining
to ophthalmological knowledge. Furthermore, a statistically significant increase in
examination scores spanning all academic years was observed post-OVE participation.
This evidence collectively attests to both an objective augmentation in familiarity
with ophthalmology and a subjective elevation in students' proficiencies.
Furthermore, to the best of our knowledge, this study represents the inaugural effort
to elucidate the diverse effects of preceding student experiences on their holistic
ophthalmic knowledge, along with their subjective sense of comfort and confidence
in their capabilities. As anticipated, students with previous involvement in shadowing,
research, and/or outreach exhibited elevated presurvey and test scores. Nonetheless,
a notable discovery emerged: all students, irrespective of prior experience, exhibited
comparable enhancements in both ophthalmic knowledge and their subjective confidence
in the field subsequent to their participation in the OVE. The outcomes of our study
substantiate the efficacy of a condensed, 1-month virtual program such as the OVE,
which operates beyond the confines of the conventional medical school curriculum,
in fortifying students' grasp of ophthalmological principles and bolstering their
self-assurance within a compressed timeframe.
Given that each interactive lecture within the virtual externship was delivered by
a 4th year medical student, an avenue emerged for 2nd and 3rd year medical students
to establish a near-peer mentorship dynamic with their 4th year counterparts who shared
an interest in ophthalmology. Near-peer tutoring initiatives have demonstrated their
efficacy in enhancing knowledge and skills for both mentors and mentees, offering
a low-stress educational milieu.[22]
[23]
[24] Subsequent to the externship, students conveyed increased ease in seeking mentorship
and guidance from senior medical students, as indicated by notably elevated scores
on questions related to mentorship-seeking subsequent to OVE participation. The establishment
of mentor–mentee relationships between students and their seasoned peers assumes significance
in nurturing interest and commitment to specific medical disciplines.[25]
[26]
[27] Notably, there was a noteworthy decline in mentorship-seeking ratings among 4th
year students following their participation in the OVE. This occurrence may be attributed
to the fact that 4th year students were in the process of applying for ophthalmology
residencies shortly after the OVE experience.
In aggregate, the junior professors expressed high levels of satisfaction with the
program. They conveyed a positive experience as junior professors, expressed a willingness
to participate again, and showed enthusiasm for recommending the program to those
with an interest in ophthalmology. This elevated satisfaction is particularly noteworthy
as the efficacy of the virtual externship hinged upon the active involvement of these
junior professors. Positioned as intermediaries between learners and faculty, junior
professors assume a pivotal role by bridging the gap between the student perspective
and established faculty, thus fostering a more open and approachable academic discourse.[28] Furthermore, the act of preparing lectures emerged as a significant learning experience
for junior professors. This process not only deepened their understanding of ophthalmic
diseases but also bolstered their readiness for forthcoming ophthalmology rotations,
thereby enhancing their ability to teach ophthalmic diseases to future patients.
The impact of the virtual format on junior professors was minimal, as indicated by
their unaffected response. Moreover, their confidence in delivering virtual lectures
witnessed an improvement following their participation in the virtual externship.
This increased comfort with the virtual platform bears relevance in both the immediate
and long-term contexts of medical education. In the short term, such proficiency becomes
pertinent as students engage in virtual residency interviews, a trend accentuated
during the pandemic.[29] Looking ahead, as medical education continues to embrace technologically advanced
pedagogical methods,[18]
[21]
[30] the aptitude to navigate virtual platforms will undoubtedly prove advantageous.
Limitations
The study exhibits several limitations. First, the OVE program was an elective course,
resulting in a potential selection bias toward medical students with a preexisting
interest in ophthalmology, as evident from our presurvey findings. Such students are
likely to possess a higher degree of familiarity with the field, enhanced subject
knowledge, greater confidence, and a heightened inclination to seek mentorship even
before engaging in the OVE, thereby introducing a skew into our data. Second, the
duration of follow-up in this study is short. A more extensive longitudinal investigation
would be advantageous to ascertain the enduring impact of the virtual externship.
It would be insightful to ascertain the extent to which participating students opt
to pursue ophthalmology as a career, and whether the virtual externship plays a role
in shaping this decision.
Third, the study incorporated 2nd, 3rd, and 4th year medical students within a singular
instructional context. The distinct levels of medical knowledge among students across
various stages of their medical education present potential confounds. Subsequent
research endeavors should consider segregating students by their academic years to
tailor the intervention to their specific educational requirements, accounting for
potential disparities in baseline knowledge. Fourth, the scope of our study is confined
to ophthalmology. Exploring the impact of virtual externships on other specialties,
especially those with limited coverage in medical school curricula like otolaryngology,
radiology, orthopaedics, and others, would provide valuable insights into broader
educational contexts.
Lastly, the study is limited by its modest sample size. Expanding the sample size
would facilitate a more comprehensive assessment of the effectiveness and adaptability
of an interactive virtual externship in enhancing medical student education.
Conclusion
The virtual externship has demonstrated its efficacy through students' contentment,
heightened confidence in ophthalmology, and the cultivation of mentorship relationships.
Initiatives of this nature hold the potential to furnish early career exposure, a
resource of immense worth for aspiring ophthalmologists. The junior professors, pivotal
contributors to the virtual externship, also registered high satisfaction levels,
expanding their knowledge and acquiring skills that bear prospective advantages. This
hybrid format of virtual, interactive instruction has effectively fulfilled its intended
purpose, offering an engaging educational experience to students amid the challenges
posed by the COVID-19 pandemic. It is recommended that further examination of the
OVE be undertaken to augment student learning, aligning with the progressive trajectory
of technological advancements. Furthermore, our study has laid the groundwork for
addressing ophthalmic knowledge disparities among all medical students, outside of
the formal medical school curricula. Future research endeavors should consider investigating
the feasibility of broadening the scope of ophthalmic knowledge assessment and clinical
examination skills evaluation. This expansion would enable a comprehensive analysis
of its impact on all medical students, thereby effectively addressing the deficiencies
delineated by the AUPO guidelines.[13]
[14]
[15]
