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Cataract Surgery | Jun 2011

The ICO’s Residency Program Director Course

These instructional tracks reflect the ICO's philosophy on resident training.

Academic ophthalmologists are expected to be effective teachers, yet few receive any formal instruction in how to teach. Additionally, there is great global variability in the methods of instruction and assessment and in requirements for adequately training ophthalmology residents. With these issues in mind, the International Council of Ophthalmology (ICO) formed the Task Force on the Education of Program Directors of Ophthalmic Residencies in 2004. The first order of business was to develop and deliver 2-day instructional courses for residency program directors. Designed to improve educational effectiveness, these courses encompass an overview of best practices and encourage their adoption, utilization, and ultimately dissemination into program directors’ own institutions.

The content of these meetings reflects the ICO’s philosophy on resident training and includes adult learning principles, curriculum development, teaching and communication skills, assessment techniques, professionalism, and e-learning resources. Prior to every course, the host country or region completes an educational needs assessment that allows the ICO to tailor the coursework to that group of program directors. A sample of the goals and objectives and selected agenda items from a recent course are shown in Table 1.


The courses rely on a variety of teaching methods, including traditional didactic lectures, small group breakout sessions, and large group discussions. Attendance is capped at 50 program directors, with participants first working through curriculum development and addressing educational problems in small groups. Subsequently, large group discussion delineates the group’s suggestions and concerns. Only a small portion of the course (25%) is didactic lecture, with small and large group discussions comprising the majority of the teaching time (35% and 40%, respectively).

Approximately 600 ophthalmic educators have attended meetings in Mexico City, Mexico; Lima, Peru; Cairo, Egypt; Lahore, Pakistan; Buenos Aires, Argentina; Brasilia, Brazil; Addis Ababa, Ethiopia; PortoroÏ, Slovenia; Florianopolis, Brazil; Bogota, Columbia; Bali, Indonesia; Beijing; Ankara, Turkey; Xi’an, China; and Hyderabad, India. Upcoming meetings are being planned in Crete, Greece, and Guangzhou, China.

Many program directors have returned to their institutions and implemented ideas presented at these courses. Concrete examples of success include participants’ presentations from past meetings at the World Ophthalmology Congress in Hong Kong (2008) and the Pan-American Association of Ophthalmology annual meeting in Cancun (2007). Program director groups have been formed in Brazil and Columbia, and they continue to hold annual educational meetings.

Participation in these meetings has led us to believe that many people are interested in improving resident education, although some may not themselves be program directors. Therefore, the ICO Task Force on Conferences for Ophthalmic Educators has been established to design meetings to address educational issues relevant to all types of ophthalmic educators, including residents, medical students, and paraophthalmic personnel. Table 2 shows the goals and objectives and selected agenda items from the first such meeting, which was held prior to the Asian-Pacific Academy of Ophthalmology meeting in Sydney, Australia, in March 2011. We plan to host these meetings prior to every supranational congress, with the next meeting to take place on July 5, in Buenos Aires, Argentina, prior to the Pan-American Academy of Ophthalmology Congress.


We believe that standardized regional curricula assure training equivalency. Curriculum development should not merely be defined as a list of relevant content but rather as a planned educational experience that includes teaching and assessment methods. If a standardized curriculum list is not available in a specific country or region, the ICO’s Resident Specialist Curriculum1 can be modified as needed, and teaching and assessment methods can be adopted from best practices and published literature.2-14 Additionally, the ICO is developing the Ophthalmology Surgical Competency Rubrics (ICO-OSCAR), a toolbox of globally applicable surgical skill assessment methods. ICO-OSCARs should be discussed with the resident immediately following a relevant case, thus providing immediate and formative feedback. Rubrics for phaco and for endocapsular cataract extraction have already been published,15 and others for strabismus and small incision cataract surgery have been submitted for publication. Future ICO-OSCARs will address other commonly performed resident procedures.

Karl C. Golnik, MD, practices in the Department of Ophthalmology, University of Cincinnati, the Cincinnati Eye Institute, is a Professor of Ophthalmology, Neurology and Neurosurgery, University of Cincinnati, Ohio; and is an Adjunct Professor of Ophthalmology, University of Louisville, Kentucky. Dr. Golnik may be reached at tel: +1 513 984 5133; fax: +1 513 475 7369; e-mail: kgolnik@fuse.net.

Andrew G. Lee, MD, is Chair of the Department of Ophthalmology, The Methodist Hospital, Houston; and is a Professor of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medical College of Cornell University; an Adjunct Professor of Ophthalmology, Baylor College of Medicine, Houston; an Adjunct Professor of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa; and a Clinical Professor of Ophthalmology, UTMB Galveston, Texas. Dr. Lee may be reached at tel: +1 713 441 8823; e-mail: aglee@tmhs.org.

Bruce E. Spivey, MD, was the founding Chief Executive Officer of the American Academy of Ophthalmology. He currently serves as the President of the International Council of Ophthalmology and as Deputy Executive President of the Council of Medical Specialty Societies. Dr. Spivey may be reached at e-mail: bruce@spivey.org.


Program Goals:

  • The participant will be able to implement a stepwise approach to curriculum development.
  • The participant will learn techniques to improve teaching effectiveness.
  • The participant will gain the knowledge and ophthalmology-specific tools to assess the resident’s competence.


Program Objectives:

  • Outline the steps to develop a curriculum in ophthalmic resident education.
  • List three ways to improve teaching skills in ophthalmology.
  • Discuss the importance of formative and summative feedback.
  • Describe new competency assessment tools.
  • List ways to improve resident surgical teaching and surgical curriculum.


Selected Topics/Activities:

  • Small breakout groups charged to review the cataract ICO curriculum for adaptation to region.
  • Identification of major resident education problems in the region (group discussion).
  • Large group/panel discussion on best practices.
  • Teaching in the operating room.
  • The good doctor: More than medical knowledge and patient care.




  • To help ophthalmic educators learn more about modern educational theory and methods and tools for education.
  • To help ophthalmic educators develop relationships that will enable them to enhance educational programs and ultimately raise the level of eye care in their region.

Program Goals:

  • To inform educators about adult learning and new teaching methods and tools and resources that will help them enhance ophthalmic education.
  • To meet identified needs of participants for information and training related to specific aspects of education (eg, needs assessment, curriculum development, teaching techniques, evaluation).
  • To stimulate and support formation of ongoing relationships and collaboration among educators in the region with common interests.
  • To provide input to other ophthalmologic societies on how they can support enhancement of ophthalmic education.


Selected Topics/Activities:

  • What are the crucial obstacles to providing education in the Asia-Pacific region? (Large group discussion with audience response system)
  • Teaching professionalism and communication skills (workshop).
  • E-learning and the new ICO Web-based teaching course (plenary session).


  1. ICO Web site.ICO Curriculum.http://archive.icoph.org/ed/icoresident.html.Accessed May 5,2011.
  2. Golnik KC,Goldenhar LM,Gittinger JW Jr,Lustbader JM.The ophthalmic clinical evaluation exercise (OCEX). Ophthalmology.2004;111:1271-1274.
  3. Lee AG.Using the American Journal of Ophthalmology’s website for assessing residency subcompetencies in practice- based learning. Am J Ophthalmol.2004;137:206-207.
  4. Lee AG,Boldt CH,Golnik KC,et al.Using the journal club to teach and assess competence in practice-based learning and improvement:A literature review and recommendation for implementation.Surv Ophthalmol.2005;50:542- 548.
  5. Golnik KC,Lee AG,Carter K.Assessment of ophthalmology resident on-call performance.Ophthalmology. 2005;112:1242-1246.
  6. Golnik KC,Goldenhar L.The ophthalmic clinical evaluation exercise (OCEX):Interrater reliability determination. Ophthalmology.2005;112:1649-1654.
  7. Lee AG,Boldt HC,Golnik KC,et al.Structured journal club as a tool to teach and assess resident competence in practice based learning and improvement.Ophthalmology.2006;113:497-500.
  8. Cremers SL,Ciolino JB,Ferrufino-Ponce ZK,Henderson BA.Objective assessment of skills in intraocular surgery. Ophthalmology.2005;112:1236-1241.
  9. Cremers SL,Lora AN,Ferrufino-Ponce ZK.Global rating assessment of skills in intraocular surgery.Ophthalmology. 2005;112:1655-1660.
  10. Feldman BE,Geist CG.Assessing residents in phacoemulsification.Ophthalmology.2007;114(8):1586.
  11. Fisher JB,Binenbaum G,Tapino P,Volpe NJ.Development and face and content validity of an eye surgical skills assessment test for ophthalmology residents. Ophthalmology.2006;113:2364-2370.
  12. Lee AG,Greenlee E,Oetting TA,et al.The Iowa ophthalmology wet laboratory curriculum for teaching and assessing cataract surgical competency.Ophthalmology.2007;114:21-26.
  13. Saleh GM,Gauba V,Mitra A,Litwin AS,Chung AKK,Benjamin L.Objective structured assessment of cataract surgical skill. Arch Ophthalmol.2007;125:363-366.
  14. Pilling RF,Bradbury JA,Reddy AR.Strabismus surgical skills assessment tool:Development of a surgical assessment tool for strabismus surgery training.Am J Ophthalmol.2010;150:275-278.
  15. Golnik KC,Beaver H,Gauba V,et al.Cataract surgical skill assessment.Ophthalmology.2011;118:427.