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Knowledge Translation & Medical Education Research

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Ophthalmology residents require proficiency in basic strabismus surgery, spending 4–6 months in PGY-3 to achieve competency. Training programs in strabismus surgery traditionally depend on teaching surgical skills in the operating room on live patients, with graduated responsibility, under direct supervision by an experienced mentor. However, compared to higher case volume cataract surgery, ophthalmology residents perform relatively fewer strabismus surgeries, resulting in fewer opportunities in which to improve their skills

This is why simulation surgery is a necessary part of surgical training, providing risk-free training in technical skills. Deliberate practice in a simulation setting allows skill acquisition, develops efficiency and expertise, resulting in accelerated learning in the operating room with improved patient outcomes.

However, there is a paucity of literature pertaining to assessment tools and curriculum design in strabismus surgery, variable simulation surgery use between training programs and lack of an effective simulation model. In the era of Competency Based Medical Education (CBME) there is a need to develop and validate a high-quality strabismus surgery simulation model, assessment tools, and curriculum to provide our residents with the framework to become competent in strabismus surgery prior to patient exposure in the operating room.

This project will address this issue by developing and validating a novel, high-fidelity 3D printed model eye for strabismus surgery. Using this model, a validated strabismus surgery curriculum will be developed for ophthalmology residents, using surgical video learning, pre- and post-video questionnaires and validated assessment tools.

3D eye model

The intended outcome of the project is to validate both a novel strabismus surgery model and curriculum design for ophthalmology resident training in the simulation lab.

This will be the first structured simulation lab curriculum in strabismus surgery using a validated eye model with validated assessment tools and defined competency targets. Once developed, this curriculum can be adopted nationally and internationally.

In collaboration with the Agnes Etherington Art Centre and the Office of Professional Development and Educational Scholarship, Drs. Christine Law and Rachel Curtis launched a study this spring that compared different approaches to art observation training and their impact on clinical observation skills in first year Queen’s medical students. As part of the pilot project, participants were invited to attend four different art-based observation sessions using visual thinking strategies (VTS) and artful thinking frameworks, designed and delivered by expert staff from the Agnes Etherington Art Centre.

At the beginning and end of each two-hour session, participants were asked to describe both art and clinical images to the best of their ability. Although unified in a general theme, each session was distinct, delving into visual skills development through nude model drawing, visual understanding through clay sculpting, environmental and self-awareness with guided meditation, and directed sculpture and painting observation to develop artful thinking routines and visual thinking strategies.

Medical Student sketching

This project builds on previous studies in the literature investigating the relationship between art observation and improved clinical observation skills, but we have endeavored to define what type of sessions are the most effective by offering four unique but related art-observation experiences. The content delivery and final surveys for this study are now complete, and we look forward to formally analyzing our results and publishing our findings. We will also be conducting focused interviews with the study participants for a critique of the course, and to gain insight into how the pilot curriculum was received.

Driven by the enthusiasm shown by participants, as well as the encouraging initial survey results, our research team has made plans to continue this project under a larger art-based curriculum. We hope to branch into further studies that will expand on the pilot work completed with medical students across other years of medical school, as well as exploring the clinical implications of art-based observation by evaluating skills during an Objective Structured Clinical Examination (OSCE). We have also discussed investigating surgical skill development in resident physicians through sculpting classes.

Beyond contributing to an innovative and expanding field of research, this project has fostered collaboration between groups of Queen’s University professionals that seldom intersect. We look forward to continuing our partnership with not only the Agnes Etherington Art Centre, but also Dr. Morehead from the Department of Art History and Art Conservation, and the rest of the research team including one of our incoming ophthalmology residents, Dr. Hassan Hazari, who shares Dr. Curtis’s underlying interest in painting and art appreciation.

Diabetic retinopathy is a leading cause of visual loss. This condition affects central vision and, if untreated, can lead to blindness. It has been estimated to affect 3.7% of the Canadian population; nearly 25% of Aboriginal Canadians have some form of diabetic retinopathy.

In many medical schools, ophthalmology is frequently not covered in the curriculum. Given the high prevalence of diabetes in the Canadian population, and the critical role that primary care physicians have in initiating screening, this has led to a significant percentage of the diabetic population being under-screened. A cohort study of five Canadian provinces has shown that 38% of patients did not receive a screening examination, and another 30% had not had a screening examination within the previous two years. The intent of this grant is to develop an educational module, Screening for Diabetic Eye Disease, to ensure that Canadian medical students and healthcare practitioners are more likely to recommend appropriate screening to their diabetic patients.

Age-related macular degeneration (AMD) is the leading cause of visual loss and blindness in those over the age of 50 years. New onset distortion is a common symptom that may signify the development of wet AMD and urgent treatment can prevent blindness. 

Meanwhile, in many medical schools, ophthalmology is frequently not covered in the curriculum. Given the high prevalence of AMD in the Canadian population, the intent of this grant is to develop an educational module on new distortion, a presentation that is very sensitive to wet AMD.

This grant will allow us to teach medical students from most Canadian medical schools how to diagnose and treat AMD in a timely fashion through, a free open-access medical education platform used by students from over 70 medical schools in North America.