Establishing Consensus on Tele-Ophthalology Competencies for Resident Training

Authors: Gareth D. Mercer, Sheetal Pundir, Carlos Gomez-Garibello, Daniela Toffoli, Hady Saheb. 

Author Disclosures: G.D. Mercer:  None.  S. Pundir:  None.  C. Gomez-Garibello:  None.  D. Toffoli:  None.  H. Saheb: None.

Abstract Body:

Purpose: Telemedicine is anticipated to play an important role in future delivery of ophthalmic care. In this study, we developed a set of telemedicine competencies for ophthalmology resident education.  

Study Design:  Literature review and Delphi process  

Methods:  We reviewed the peer-reviewed and grey literature, from 2016-2021, for examples of professional competencies in telemedicine. Guided by the Royal College’s Competence By Design (CBD) framework, we synthesized the published competencies into a draft set of Entrustable Professional Activities (EPAs), and associated CanMEDS milestones, organized by stage of training. We attempted to match the level of detail in the EPAs being developed for the renewed CBD ophthalmology residency curriculum. Using a Delphi process, we asked medial education and teleophthalmology experts to revise our draft until they reached consensus on the competencies desirable for Canadian ophthalmology residents.  

Results:  From a total of 374 abstracts reviewed, we included data from 33 articles. Most articles targeted either medical students or residents (n=24), with internal medicine (6), neurology (4), psychiatry (4) and paediatrics (3) being the most common medical specialties. We did not identify any published competencies specifically targeting ophthalmologists. From our review of the literature, we developed one EPA for each stage of training: “Communicating with off-site health care providers and patients” (Foundations of Discipline); “Providing consultation and advice to off-site health care providers and patients” (Core of Discipline); and “Integrating teleophthalmology (virtual care) into existing care pathways.” (Transition of Practice) We specified between three to six milestones to guide trainees and clinical educators in attaining and evaluating each EPA.  

Conclusions:  During the Covid-19 pandemic, many ophthalmologists began offering telemedicine services for the first time. To the extent that it is able to improve efficiency in care delivery, and decreased barriers to access, the scope for telemedicine in ophthalmology is anticipated to grow exponentially. Based on expert consensus, we developed a set of educational competencies to help prepare ophthalmology residents to lead this future growth and deliver safe, high-quality virtual care. This is an area we found to be currently lacking in the published literature. It is our hope that by structuring our proposed competencies according to the CBD framework, they may readily be incorporated into the ongoing renewal of Canadian ophthalmology residency curricula.