Vol 33 No. 2 Guest Editorial PDF

Ophthalmic-residency training: a view from the trenches

Jose Ma. Martinez, MD

Correspondence to:
Jose Ma. Martinez, MD
Department of Ophthalmology
East Avenue Medical Center
East Avenue, Diliman
Quezon City, Philippines
E-mail : eyesmart@gmail.com

We are not rating residents as often as we can.
Performance assessment with adequate immediate feedback is
a powerful tool for enriching the learning experience. There
are numerous validated assessment tools tailored for
ophthalmology and designed to test the various competencies.

OPHTHALMOLOGY training in the Philippines has
certainly evolved through the years. During my time as
a resident, all it took were a handful of diligent mentors,
a study guide, robust caseload, and hands-on skills
training. “See one, do one, teach one” was very much
the mantra of training. After 3 years of exposure, we
looked at the Philippine Board of Ophthalmology
(PBO) syllabus, went back to the books, studied
together, and successfully hurdled the PBO diplomate
Fast forward to the present. As a residency-training
officer (RTO), I now find myself applying the same
formula with the added benefit of more teachers, more
didactic examinations, and more access to medical
information through the Internet. Are we more successful now? Ironically, I think not. I am wary of two
alarming trends: increasing failures in the specialty
board examinations and more graduates opting not to
even take the board exams (but practicing nonetheless). In my institution from 2001 to 2007, around
38% of graduates (16/42) have not passed the board
exams (includes failed takers + non-takers). The PBO
figures validate this observation. In 1995, Fajardo noted
an average failure rate of 28% (1985-1991.)
In 2007,
Tuaño reported the examination trends from 1995 to
2006 and quoted an average failure rate of 25%.
Moreover, 18% (131/727) of graduates did not take
the exams, bringing the total of nondiplomates (those
who failed or did not take the tests) to 316 (43%).
Most of these nondiplomates are actively practicing.
The Philippine Academy of Ophthalmology (PAO), on
the other hand, has had to deal with issues such as
unethical practice in missions, cataract sweepers, and
fraudulent PhilHealth claims. Is this in some way related
to our current woes on residency training? Are we
producing truly competent and ethical eye practitioners?
Obviously, the solutions to these issues are complex
and will involve numerous stakeholders. The PBO is
currently updating its training requirements and
curriculum. The PAO is stepping up efforts to provide
more scientific activities for both residents and
practitioners. The RTOs, being the main implementors
of training policies, are vital cogs in the ophthalmiceducation system. We can initiate changes in the
trenches that can affect ophthalmic education in no
small part. To do this on a major scale, the efforts
should be coordinated and organized. Let me share
with you some of the measures that I think will enhance
ophthalmic residency training in the country.
Define learning objectives. Every learning activity should
have a desired outcome. If you are on a journey, having
a roadmap may serve you well; but if you don’t have a
destination, how will you know you have arrived? Such
is the logic of competency-based education. In this
system, the final outcome behaviors are defined clearly.
Learning activities and assessments are designed to
achieve those goals. The PBO is working on a
standardized competency-based curriculum for this purpose; but admittedly, this will take time to develop.
What we can do in the meantime is review all the
resident activities and define learning objectives for all
of them.
Teach other competencies. A single written or oral examination does not define what an ideal ophthalmologist
is. There are other attributes like professionalism, work
ethic, and interpersonal skills that must be developed
in every trainee. However, most training programs rely
heavily on medical knowledge to determine the competence of residents. The US Accreditation Council for
Graduate Medical Education (ACGME) has identified
6 core competencies that define residency training in
any medical specialty.
These are patient care, medical
knowledge, practice-based learning and improvement,
interpersonal and communication skills, professionalism, and systems-based practice. A written exam
measures only medical knowledge. Teaching professionalism and ethics may require other techniques such as
role-playing and mentoring. These attributes are as
valuable in practice as medical knowledge.
Measure performance regularly during training. Every
resident activity is a chance to perform. I personally feel
we are not rating residents as often as we can.
Performance assessment with adequate immediate
feedback is a powerful tool for enriching the learning
experience. There are numerous validated assessment
tools tailored for ophthalmology and designed to test
the various competencies (OCEX, GRASIS, OASIS,
We can employ these assessment tools early
on in training and track the progress of each resident
as they go through the program. Remedial measures
may then be given at the proper time before they even
step into the PBO board-examination room.
As in any endeavor, meaningful change comes from
within. I urge training officers to look into your system,
compare it with others, and share successes and failures.
Let’s make a united effort to standardize the residency
experience. I enjoin all training officers to take the big
step towards competency-based education. I always tell
my trainees: the resident that you are now is the
consultant that you will be. Let’s invest in improving
the residency experience for them. It could make a
difference in our collective future as a profession.

1. Fajardo R. Nature of residency training and board failures. Philipp J Ophthalmol
1996; 21: 23-25.

2. Tuaño PMC. The challenges of ophthalmic-residency education in the Philippines.
Philipp J Ophthalmol 2008; 33: 73-83.

3. The ACGME Outcome Project. http://www.acgme.org/outcome (accessed
November 8, 2008).

4. ACGME Ophthalmology Competency Assessment. http://www.acgme.org/
acWebsite/RRC_240/240_compAssessment.asp (accessed November 8, 2008).

ERRATUM In Vol. 33, Issue No. 1, the article “Ahmed glaucoma valve tube erosion: a retrospective review of autologous scleral flap versus donor scleral graft,” pages
17-21, should have listed the following as authors:
Edgar Leuenberger, MD1, 2
Jonathan Rivera, MD2
Janet Ongkeko-Perez, MD1
Ma. Imelda Yap-Veloso, MD1
Asian Eye Institute
Makati, Philippines
University of the East Ramon Magsaysay
Memorial Medical Center
The corresponding author should have been:
Edgar Leuenberger, MD
Asian Eye Institute
9/F Phinma Building
Rockwell Center
Makati, Philippines
Telephone : +63-2-8982020
E-mail : EUL@asianeyeinstitute.com