Wills Clinical Vision Research Training and Mentoring Program:

Implementation and EvaluationJulia A. Haller MD, Ann P. Murchison MD, Lisa Hark PhD

January 29, 2016

Clinician Investigators as an Endangered Species

Over the past 50 years, there has been a decline in the number of physicians pursuing careers in clinical research.Causes:Focus on basic science over patient-oriented researchLack of clinical research introduction early in medical education

Lack of Clinician Investigators

in OphthalmologyOnly 2% of ophthalmologists are actively involved in research activities.

Yet the need for clinician investigators continues to grow with the increasing eye care demands of

the aging population.

The Bridgetender:Francis D. Moore, MD 1958

The surgical investigator must be a bridgetender, channeling knowledge from basic science to the patient’s bedside and back again. He traces his origin from both sides of the bridge. He is thus a bastard, and is called this by everybody. Those at one end of the bridge say that he is not a very good scientist, and those at the other say that he does not perform enough operations. It is much harder to stay in the middle of the bridge than it is to retreat to one end or the other. But all of the fundamental advances in surgery from Vesalius to Halsted to Cushing have been made by those willing to maintain this uncomfortable posture - the bridgetender.

Potential SolutionExpert panels have recommended exposing students early in their training to structured, didactic curricula with clinical research experience and mentoring opportunities.

Wills Vision Research Program Purpose

To develop, implement, and evaluate a full-time, 8-week Clinical Vision Research Training and Mentoring Program for undergraduate and medical students.

The program provides a structured, didactic vision research curriculum to enhance students’ understanding of vision research methods.

Wills Vision Research Program Activities

Participate in a vision research projectConduct vision-related literature reviewsRecruit patients for research studiesPerform electronic medical records reviewWrite and submit a paper for a peer-reviewed journalReceive mentoring from faculty and research staff

Summer 2014 and 2015 EnrollmentType of Student Number Universities Represented

Undergraduate (pre-medicine)

4 Columbia UniversityUniversity of PennsylvaniaEmory UniversityLaSalle College

Undergraduate (public health)

1 Temple University

Medical school 29 Sidney Kimmel Medical College at Thomas Jefferson UniversityDrexel University College of MedicineTemple University School of MedicinePhiladelphia College of Osteopathic MedicineRobert Wood Johnson School of Medicine George Washington School of MedicineNortheast Ohio Medical University

Eye Research-Related Lectures

Lecture

Topic (11-hours)

1 Introduction to ophthalmology2 Introduction to glaucoma3 Introduction to neuro-ophthalmology and optic neuropathy4 Introduction to diabetes and diabetic retinopathy5 Introduction to age-related macular degeneration6 Introduction to cataract and refractive surgery7 Introduction to smoking and eye disease8 Glaucoma community outreach demonstration project9 Quality-of-life study for glaucoma

10Transcorneal electrical stimulation study for optic neuropathy

11 Institutional Review Board (IRB) policies and procedures

Manuscript-Writing Workshops

Workshop Topic (10-hours)1 Electronic medical record (EMR) training 2 Patient recruitment and data collection training3 Conducting a literature review and EndNote® training 4 Writing the introduction 5 Writing the research methods 6 Writing the data analysis 7 Writing the results 8 Writing the discussion 9 Developing an abstract and poster presentation

Evaluation MethodsStudents complete a 40-question pre- and post-test assessing knowledge of ophthalmology and vision research methods.

Pre- and post-test scores were analyzed using a paired-samples t-test.

Students completed a program evaluation.

Data are reported for 2014 and 2015.

Evaluation ResultsStudents scored significantly higher on the knowledge post-test (M=79.78%, SD=6.25) than on the pre-test (M=71.43%, SD=8.43); P<0.001.

Results of the pre- and post-test analysis indicate that lecture material supplemented with hands-on experience can lead to better understanding of ophthalmology and research.

Evaluation Results

The program evaluations indicate that students were very satisfied with the program and that the lecture series and manuscript-writing workshops enhanced their learning.

All mean scores >4 (Scale 0-5).

Evaluation Results: Scale 0-5Evaluation Questions M (SD)I was satisfied with the program. 4.6 (0.51)Program goals and objectives were clear. 4.3 (0.63)Program was organized in a manner consistent with its stated goals. 4.3 (0.68)Pre- and post-test questions were fair. 4.2 (0.82)Adequate review mechanisms were provided for manuscript development. 4.5 (0.56)The course materials were valuable for learning. 4.4 (0.73)The lecture series and pre-residency lectures enhanced my learning. 4.6 (0.60)I was satisfied with the lecture series overall. 4.3 (0.71)The manuscript-workshop series enhanced my learning. 4.0 (0.80)I was satisfied with the manuscript workshop series overall. 4.6 (0.88)The abstract and poster development sessions enhanced my learning. 4.0 (0.79)I was satisfied with the editing/feedback process to prepare the manuscript. 4.4 (0.67)I was satisfied with the program supervision. 4.5 (0.61)

Evaluation ConclusionsThe Wills Eye Clinical Vision Research Training and Mentoring Program provided an evidence-based foundation in critical thinking, research methods, and manuscript development for students interested in careers in ophthalmology. Students emerge with clinical research skills and an increased understanding and appreciation of vision research.

Outcomes 2013-2015: Student Authorship on 43 Manuscripts

  •17 Manuscripts Accepted/Published•11 Manuscripts Submitted for Publication •15 Manuscripts in Progress

 JAMA Ophthalmology, American Journal of Ophthalmology, Survey of Ophthalmology, Journal of

Glaucoma, Retina and others

•  • 1. Waisbourd M, Bond E, Sullivan T, Hu W, Shah S, Molineaux J, Sembhi H, Spaeth GL, Myers, JS; Hark LA,  Katz LJ  MD. Evaluation of Non-Mydriatic Hand-Held Optic Disc Photography Grading in the Philadelphia Glaucoma Detection and Treatment Project . J 

Glaucoma, Accepted for publication. •  • 2. Fudemberg S, Lee B, Waisbourd M, Murphy R,  Dai Y,  Leiby, Hark LA. Factors contributing to nonadherence to follow-up appointments in a resident glaucoma clinic versus primary eye care clinic. Patient Preference and Adherence, Accepted for publication.•  • 3. Hu WD, Moster MR, Zheng CX, Sabherwal N, Pequignot E, Cvintal V, Ekici F, Waisbourd M. Outcomes of Sequential Glaucoma Drainage Implants in Refractory Glaucoma. J Glaucoma. 2015 Dec 24. [Epub ahead of print] PubMed PMID: 26709499.   •  • 4. Sun Y, Lin C, Waisbourd M, Ekici F, Erdem E, Wizov SS, Hark LA, Spaeth GL. The Impact of Visual Field Clusters on Performance-Based Measures and Vision-Related  Quality of Life in Patients with Glaucoma. Am J Ophthalmol. 2015 Dec 14. pii: S0002-

9394(15)30003-9. doi: 10.1016/j.ajo.2015.12.006. [Epub ahead of print] PubMed PMID: 26701273.   •  • 5. Johnson DM, Stratford S, Shyu AP, Sembhi H, Molineaux J, Reamer C, Spaeth GL,  Myers JS, Hark LA, Katz LJ, Waisbourd M. The impact of educational workshops on individuals at risk for glaucoma in the Philadelphia Glaucoma Detection and Treatment 

Project. Patient Educ Couns. 2015 Nov 27. pii: S0738-3991(15)30142-7. doi: 10.1016/j.pec.2015.11.026. [Epub ahead of print] PubMed PMID: 26686991. •  • 6. Patel V, El Hawy E, Waisbourd M, Zangalli C, Shapiro DM, Gupta L, Hsieh M, Kasprenski A, Katz LJ, Spaeth GL. Long-term outcomes in patients initially responsive to selective laser trabeculoplasty. Int J Ophthalmol. 2015 Oct 18;8(5):960-4. doi: 

10.3980/j.issn.2222-3959.2015.05.19. eCollection 2015. PubMed PMID: 26558209; PubMed Central PMCID: PMC4631010. •  • 7. Zangalli CS, Ahmed OM, Waisbourd M, H Ali M, Cvintal V, Affel E, Gupta L, Katz LJ, C Sergott R. Segmental Analysis of Macular Layers in Patients With Unilateral Primary Open-Angle Glaucoma. J Glaucoma. 2015 Nov 6. [Epub ahead of print]•  • 8. Waisbourd M, Lee B, Ali MH, Lu L, Martinez P, Faria B, Williams A, Moster MR, • Katz LJ, Spaeth GL. Detection of asymmetric glaucomatous damage using automated pupillography, the swinging flashlight method and the magnified-assisted swinging flashlight method. Eye (Lond). 2015 Oct;29(10):1321-8.

•  

9. Zheng CX, Hu WD, Tran J, Siam L, Berardi GG, Sembhi H, Hark LA, Katz LJ,Waisbourd M. Barriers to Receiving Follow-Up Eye Care and Detection of Non-Glaucomatous Ocular Pathology in the Philadelphia Glaucoma Detection and Treatment Project. J Community Health. 2015 Oct 23.  10. Waisbourd M, Savant SV, Sun Y, Martinez P, Myers JS. Water-drinking test in primary angle-closure suspect before and after laser peripheral iridotomy. ClinExperiment Ophthalmol. 2015 Sep 1. doi: 10.1111/ceo.12639. [Epub ahead of print]

 11. Ekici F, Loh R, Waisbourd M, Sun Y, Martinez P, Nayak N, Wizov SS, Hegarty S,  Hark LA, Spaeth GL. Relationships Between Measures of the Ability to Perform Vision-Related Activities, Vision-Related Quality of Life, and Clinical Findings  in Patients With Glaucoma. JAMA Ophthalmol. 2015 Dec 1;133(12): 12. Faria BM, Duman F, Zheng CX, Waisbourd M, Gupta L, Ali M, Zangalli C, Lu L, Wizov SS, Spaeth E, Richman J, Spaeth GL. EVALUATING CONTRAST SENSITIVITY IN AGE-RELATED MACULAR DEGENERATION USING A NOVEL COMPUTER-BASED TEST, THE SPAETH/RICHMAN CONTRAST SENSITIVITY TEST. Retina. 2015 Jul;35(7):1465-73. doi: 10.1097/IAE.0000000000000474. PubMed PMID: 25658175.  13. Waisbourd M, Parker S, Ekici F, Martinez P, Murphy R, Scully K, Wizov SS, Hark LA, Spaeth GL. A prospective, longitudinal, observational cohort study examining how glaucoma affects quality of life and visually-related function over 4 years:  design and methodology. BMC Ophthalmol. 2015 Aug 1;15:91. doi: 10.1186/s12886-015-0088-x. PubMed PMID: 26231376; PubMed Central PMCID: PMC4522094.  14. Cvintal V, Moster MR, Shyu AP, McDermott K, Ekici F, Pro MJ, Waisbourd M. Initial Experience With the New Ahmed Glaucoma Valve Model M4: Short-term Results. J Glaucoma. 2015 Sep 22. [Epub ahead of print]. 15. Ichhpujani P, Lo DC, Cvintal V, Waisbourd M, Averbuch A, Leiby BE, Myers JS, Spaeth GL, Katz LJ. Flicker defined form, standard perimetry and Heidelberg retinal tomography: Structure-function relationships. Can J Ophthalmol. 2015 Aug;50(4):290-6.  16. Wright C, Tawfik MA, Waisbourd M, Katz LJ. Primary angle-closure glaucoma: an update. Acta Ophthalmol. 2015 Jun 27. doi: 10.1111/aos.12784. [Epub ahead of print]  17. Hu CX, Zangalli C, Hsieh M, Gupta L, Williams AL, Richman J, Spaeth GL. What do patients with glaucoma see? Visual symptoms reported by patients with glaucoma. Am J Med Sci. 2014 Nov;348(5):403-9. doi: 10.1097/MAJ.0000000000000319. PubMed PMID: 24992392; PubMed Central PMCID: PMC4206382. 

Outcomes 2013-2015: Student Authorship on 43

Manuscripts   

•17 Manuscripts Accepted/Published•11 Manuscripts Submitted for Publication •15 Manuscripts in Progress

 JAMA Ophthalmology, American Journal of Ophthalmology, Survey of Ophthalmology, Journal of Glaucoma, Retina and

others

Outcomes and ConclusionsThe Wills Eye Clinical Vision Research Training and Mentoring Program provided an evidence-based foundation in critical thinking, research methods, and manuscript development.Students emerged with clinical research skills and an increased understanding and appreciation of vision research. Academic productivity: Student authorship on 43 manuscripts.

Outcomes and Conclusions

Ultimately the success of the program will be judged by whether students pursue careers as clinician-scientists.

Potential model for developing clinician-scientists in ophthalmology and other medical and surgical subspecialties.

As long as there is an unconquered disease, an injury that cannot be repaired, or a method of prevention that remains beyond reach, we have an obligation to conduct research. Research represents HOPE, and for many patients and families, hope is the best thing we have to offer. We pursue investigations so that one day we can offer health.

Judah Folkman, M.D

Thank youwww.aupo.org