Abolfathzadeh, N.

Nilforushan, N.

eprints Iran University of Medical Sciences

Letter to EditorThe Impact of the COVID-19 Pandemic onOphthalmology Residency TrainingNaveed Nilforushan1,2 MD, Navid Abolfathzadeh2 MD, MPH1Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran2Department of Ophthalmology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, IranORCID:Naveed Nilforushan: http://orcid.org/0000-0001-7720-1757J Ophthalmic Vis Res 2021; 16 (2): 312–313Dear Editor,The outbreak of Coronavirus Disease-2019(COVID-19) has impacted different aspects of lifefor people all around the world. Students atdifferent levels of education are among those whohave been significantly affected by this pandemic.As a higher level of education, ophthalmologyresidency is a top specialty in different parts ofthe world including Iran. Ophthalmology residentsare expected to learn highly technical surgeriesand acquire knowledge throughout their trainingperiod. However, during the past year, residencyprograms have been negatively impacted by thiscrisis worldwide.[1–4]Major reasons for this detrimental effectare restriction and suspension of clinicalactivities and elective surgeries, cancellationof conventional lecturing sessions and educationalcourses, periodic lockdown of cities, persistentpsychological and emotional stress on bothtrainers and trainees as a consequence of closecontact with patients, in addition to loss ofcolleagues, family members or friends. Moreover,in order to reducing the chance of exposureCorrespondence to:Naveed Nilforushan, MD. Ophthalmology Department,Faculty of Medicine, Iran University of Medical Sciences,Tehran 1445613131, Iran.Email: naveednil@yahoo.comReceived: 21-11-2020 Accepted: 21-02-2021Access this article onlineWebsite: https://knepublishing.com/index.php/JOVRDOI: 10.18502/jovr.v16i2.9102to infection, the patients themselves prefer tostay at home instead of seeking ophthalmicexaminations at university-based centers andespecially general hospitals, unless some urgent oremergent situations happen.Overall, ophthalmology residents have hadsignificant reduction in their clinical and surgicalopportunities and are less motivated in theirdaily routine schedules.[1] Cataract, strabismus,pterygium, lid, and nasolacrimal duct surgeries areamong the mandatory group of surgeries in thetraining curriculum for ophthalmology which aremostly categorized as elective surgeries. On theother hand, urgent cases scheduled for surgeryduring the pandemic are usually sophisticatedones including vitreoretinal and glaucoma casesthat need to be handled by experienced surgeonsincluding fellows and/or attending physicians. Evenin the pre-COVID-19 era, direct involvement in suchcases was mostly limited and far from the generalscope of the residency curriculum. Therefore,the decision to involve residents in such difficultsurgical cases in current practice raises multipleethical dilemmas in the operating room. To involveresidents in such cases, we usually prefer generalanesthesia instead of routine topical and/or localanesthesia. This leads to prolongation of patientThis is an open access journal, and articles are distributed under the terms ofthe Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, whichallows others to remix, tweak, and build upon the work non-commercially, aslong as appropriate credit is given and the new creations are licensed under theidentical terms.How to cite this article: Nilforushan N, Abolfathzadeh N. The Impact of theCOVID-19 Pandemic on Ophthalmology Residency Training. J OphthalmicVis Res 2021;16:312–313.312 © 2021 JOURNAL OF OPHTHALMIC AND VISION RESEARCH | PUBLISHED BY PUBLISHED BY KNOWLEDGE ELetter to Editor; Nilforushan et alstay at the hospital and also higher workloadfor the anesthesiology team which canincrease the risk of COVID-19 infection forthe patient and the medical staff. On theother hand, not including residents in theprocedures can result in graduation of lessexperienced surgeons in future. Therefore,each decision would be a great challenge forthe mentors and the heads of ophthalmologydepartments.It is expected that the social and economicimpacts of this crisis will persist for the nextfew years and that health systems may faceother similar unpredictable crises in the future.Therefore, health authorities should facilitatethe incorporation of innovative ways of surgicaltraining such as simulation-based or wet lab-based training to fill this educational gap. Weunderstand that it will take time and needmore efforts to reprogram the educationalcurriculum for ophthalmology residency in theCOVID-19 pandemic. In addition, we know thatmoving toward such innovative ways will imposea significant economic burden on the healthsystem especially in developing countries whichare already under stress for funding sourcesrelated to the COVID-19 pandemic; therefore, thisapproachmay not be among the priorities of healthpolicymakers.It is good to say that, besides the negative andtragic impacts of this pandemic, new opportunitieshave emerged in the field of education whichwill definitely change our practice in future.There are plenty of affordable e-learning facilitiesfor improving residency education includingoffline surgical movie clips, online virtual grand-rounds like web-based case presentations andjournal clubs, webcasts and online nationaland international webinars. These positivechanges have happened mostly after theCOVID-19 pandemic, in which online webinarsare the most widespread ones. They let largenumbers of ophthalmologists from all overthe world to be involved, discuss, and learnsimultaneously. Such online gatherings willundoubtedly remain and continue even afterthe pandemic ceases. However, one shouldkeep in mind that developing countries faceobstacles in accessing online programs includinginternet connectivity and speed, in addition to thecost.These new circumstances have also changedour communication with patients and madetelemedicine-basedmanagementmore prominent.Nowadays, patients can easily contact theirphysicians and send them information, images,and tests using smartphones. All of these maylead to safer and more cost-effective patient visits.Telemedicine and its applications can be a part ofthe education during these hard times.Last but not the least, it is important toperform and validate residency examinationand evaluations in a standardized and uniformelectronic format. Attention should also be paid tonecessary changes in the national curriculum ofophthalmology residency education, to prepareresidents with non-surgical but fundamental skillssuch as crisis management and teamwork.[5]Additionally, as a priority, we must ensure that ourtrainees are and will be safe and healthy duringtheir education period, therefore all necessaryprotective equipment and measures should beprovided to fulfill this goal.Financial Support and SponsorshipNil.Conflicts of interestThere are no conflicts of interest.REFERENCES1. Ferrara M, Romano V, Steel DH, Gupta R, Iovino C,et al. Reshaping ophthalmology training after COVID-19pandemic. Eye 2020;34: 2089–2097.2. Bakshi SK, Ho AC, Chodosh J, Fung AT, Chan RVP, et al.Training in the year of the eye: the impact of the COVID-19 pandemic on ophthalmic education. Br J Ophthalmol2020;104:1181–1183.3. Alahmadi AS, Alhatlan HM, Bin Helayel H, Khandekar R, AlHabash A, Al-Shahwan S. Residents’ perceived impact ofCOVID-19 on Saudi Ophthalmology Training Programs - asurvey. Clin Ophthalmol 2020;14:3755–3761.4. Mishra D, Nair AG, Gandhi RA, Gogate PJ, MathurS, Bhushan P, et al. The impact of COVID-19 relatedlockdown on ophthalmology training programs in India –outcomes of a survey. Indian J Ophthalmol 2020;68:999–1004.5. Kumar A, Agarwal D. Commentary: restructuringresidency training in ophthalmology during COVID-19 era: challenges and opportunities. Indian J Ophthalmol2020;68:1005–1006.JOURNAL OF OPHTHALMIC AND VISION RESEARCH VOLUME 16, ISSUE 2, APRIL-JUNE 2021 313

The Impact of the COVID-19 Pandemic on Ophthalmology Residency Training

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The Impact of the COVID-19 Pandemic on Ophthalmology Residency Training

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