Quality of life and depression among patients with high myopia in Nigeria: a cross sectional study

AIM: To evaluate the quality of life (QOL) and level of depression among participants with high myopia in Nigeria and the demographic factors associated with these outcomes. METHODS: This cross-sectional study was conducted on 100 adult participants with high myopia (defined as refractive error ≤-5.00 D or worse, and uncorrected visual acuity worse than 6/18 in the better seeing eye) attending ophthalmology centres in Nigeria from 2 October 2021 to 30 August 2022. The means and standard deviations were calculated for each of the four domains of World Health Organization Quality of life scale (WHOQOL-BREF) using the transformed scores. The Beck Depression Inventory (BDI) scale was used to assess the level of depression. RESULTS: The highest and the lowest mean scores of WHOQOL-BREF domains were found for the psychological and physical health domains (mean percentage scores were 67.0 [95% confidence intervals (CI) 64.1-68.9] and 55.3 (95%CI 51.8-58.8, P<0.001), respectively. One-way analysis of variance (ANOVA) revealed significant differences in physical health with educational status (higher among those with tertiary education: mean difference 0.9, 95%CI -0.2-2.1; P=0.049), differences in psychological health with working status (higher among those who were working 1.2, 95%CI 0.3-2.1; P=0.012). Also, the result showed a statistically significant association between environmental health and marital status (higher among non-married: 1.7, 95%CI -0.9-2.3; P=0.012) while overall health was associated with place of residence (higher in urban areas: 2.3, 95%CI 1.2-3.5; P=0.024). For depression, one in every nine participants reported major depressive symptom, mostly younger people (aged 16-29 vs 30-49y: 17.0% vs 0, P=0.019), and slightly more women than men (14.3% vs 0, P=0.064). There were significant negative correlations between the depression scores and psychological health (r=-0.48, P<0.001), physical health (r=-0.29, P=0.002), social and relationship (r=-0.49, P<0.001), environmental (r=-0.48, P<0.001) and overall health (r=-0.49, P<0.001) CONCLUSION: People with high myopia have a relatively moderate QOL, but poor physical health, particularly the younger age group, and women who are more likely to experience clinically relevant depression. Eye care professionals should consider possible referrals for counselling for people with high myopia

How Do Clinical Competency Committees Assess Resident Performance on the Internal Medicine Milestones

Clinical competency committees (CCCs) play a critical role in determining the developmental progress of residents. This study examines how CCCs synthesize assessment data to make judgments about residents’ clinical performance. Beginning in 2014, CCC faculty completed questionnaires about the CCC process after each six -month reporting period to the Accreditation Council of Graduate Medical Education (ACGME). Subsequently, a focus group interview was conducted. Qualitative data was analyzed using the constant comparative method, consistent with a grounded theory approach. Milestones ratings were analyzed for two ACGME reporting cycles (n=102 categorical residents). Seven CCC members provided qualitative data for four ACGME reporting cycles. Three major themes were identified: 1) “data-input issues” (i.e., problems with the data or lack thereof); 2) “CCC data processing issues” (i.e., factors influencing ratings and decision-making processes) and 3) “data output issues” (i.e., how CCC generated milestones ratings are used). CCC members weighted rotation evaluation scores highest (weight=37%), followed by comments (weight=27%), and personal experience with residents (weight=14%) to make judgments about learner milestone levels. Generally, milestone levels improved significantly over time for second- and third-year residents; however, for first-year residents, milestone levels during the second reporting cycle were significantly lower. Milestones that received the most “not able to assess ratings” were PC4, PC5, SBP2, PBLI2 and PROF3. Identifying factors that affect assessment data at all stages of the CCC process can assist in improving assessment systems and in supporting faculty development for CCCs. In addition, recognizing challenges in synthesizing first- and second-hand assessment data is an important step toward understanding the CCC decision-making process

How do clinical competency committees use different sources of data to assess residents’ performance on the internal medicine milestones?A mixed methods pilot study

<p><b>Purpose:</b> This study examines how Clinical Competency Committees (CCCs) synthesize assessment data to make judgments about residents’ clinical performances.</p> <p><b>Methods:</b> Between 2014 and 2015, after four six-month reporting periods to the Accreditation Council for Graduate Medical Education (ACGME), 7 of 16 CCC faculty at Rush University Medical Center completed questionnaires focused on their perspectives about rating residents on their achievement of the milestones and participated in a focus group. Qualitative data were analyzed using grounded theory. Milestones ratings for two six-month ACGME reporting cycles (<i>n</i> = 100 categorical residents) were also analyzed.</p> <p><b>Results:</b> CCC members weighted resident rotation ratings highest (weight = 37%), followed by faculty rotation comments (weight = 27%) and personal experience with residents (weight = 14%) for making judgments about learner’s milestone levels. Three assessment issues were identified from qualitative analyses: (1) “design issues” (e.g. problems with available data or lack thereof); (2) “synthesis issues” (e.g. factors influencing ratings and decision-making processes) and (3) “impact issues” (e.g. how CCC generated milestones ratings are used).</p> <p><b>Conclusions:</b> Identifying factors that affect assessment at all stages of the CCC process can contribute to improving assessment systems, including support for faculty development for CCCs. Recognizing challenges in synthesizing first and second-hand assessment data is an important step in understanding the CCC decision-making process.</p

Stages of Milestones Implementation: A Template Analysis of 16 Programs Across 4 Specialties.

BackgroundSince 2013, US residency programs have used the competency-based framework of the Milestones to report resident progress and to provide feedback to residents. The implementation of Milestones-based assessments, clinical competency committee (CCC) meetings, and processes for providing feedback varies among programs and warrants systematic examination across specialties.ObjectiveWe sought to determine how varying assessment, CCC, and feedback implementation strategies result in different outcomes in resource expenditure and stakeholder engagement, and to explore the contextual forces that moderate these outcomes.MethodsFrom 2017 to 2018, interviews were conducted of program directors, CCC chairs, and residents in emergency medicine (EM), internal medicine (IM), pediatrics, and family medicine (FM), querying their experiences with Milestone processes in their respective programs. Interview transcripts were coded using template analysis, with the initial template derived from previous research. The research team conducted iterative consensus meetings to ensure that the evolving template accurately represented phenomena described by interviewees.ResultsForty-four individuals were interviewed across 16 programs (5 EM, 4 IM, 5 pediatrics, 3 FM). We identified 3 stages of Milestone-process implementation, including a resource-intensive early stage, an increasingly efficient transition stage, and a final stage for fine-tuning.ConclusionsResidency program leaders can use these findings to place their programs along an implementation continuum and gain an understanding of the strategies that have enabled their peers to progress to improved efficiency and increased resident and faculty engagement

Stages of Milestones Implementation: A Template Analysis of 16 Programs Across 4 Specialties

BACKGROUND: Since 2013, US residency programs have used the competency-based framework of the Milestones to report resident progress and to provide feedback to residents. The implementation of Milestones-based assessments, clinical competency committee (CCC) meetings, and processes for providing feedback varies among programs and warrants systematic examination across specialties. OBJECTIVE: We sought to determine how varying assessment, CCC, and feedback implementation strategies result in different outcomes in resource expenditure and stakeholder engagement, and to explore the contextual forces that moderate these outcomes. METHODS: From 2017 to 2018, interviews were conducted of program directors, CCC chairs, and residents in emergency medicine (EM), internal medicine (IM), pediatrics, and family medicine (FM), querying their experiences with Milestone processes in their respective programs. Interview transcripts were coded using template analysis, with the initial template derived from previous research. The research team conducted iterative consensus meetings to ensure that the evolving template accurately represented phenomena described by interviewees. RESULTS: Forty-four individuals were interviewed across 16 programs (5 EM, 4 IM, 5 pediatrics, 3 FM). We identified 3 stages of Milestone-process implementation, including a resource-intensive early stage, an increasingly efficient transition stage, and a final stage for fine-tuning. CONCLUSIONS: Residency program leaders can use these findings to place their programs along an implementation continuum and gain an understanding of the strategies that have enabled their peers to progress to improved efficiency and increased resident and faculty engagement