Abstract
Objective This article examines models of patient care and supervision for hospital-based ophthalmology
consultation in teaching institutions.
Design This is a cross-sectional survey.
Methods An anonymous survey was distributed to residency program directors at 119 Accreditation
Council for Graduated Medical Education accredited U.S. ophthalmology programs in
the spring of 2018. Survey questions covered consult volume, rotational schedules
of staffing providers, methods of supervision (direct vs. indirect), and utilization
of consult-dedicated didactics and resident competency assessments.
Results Of the 119 program directors, 48 (41%) completed the survey. Programs most frequently
reported receiving 4 to 6 consults per day from the emergency department (27, 55.1%)
and 4 to 6 consults per day from inpatient services (26, 53.1%). Forty-seven percent
of programs reported that postgraduate year one (PGY-1) or PGY-2 residents on a dedicated
consult rotation initially evaluate patients. Supervising faculty backgrounds included
neuro-ophthalmology, cornea, comprehensive, or a designated chief of service. Staffing
responsibility is typically shared by multiple faculty on a daily or weekly rotation.
Direct supervision was provided for fewer of emergency room consults (1–30%) than
for inpatient consults (71–99%). The majority of programs reported no dedicated didactics
for consultation activities (27, 55.1%) or formal assessment for proficiency (33,
67.4%) prior to the initiation of call-related activities without direct supervision.
Billing submission for consults was inconsistent and many consults may go financially
uncompensated (18, 36.7%).
Conclusion The majority of hospital-based ophthalmic consultation at academic centers is provided
by a rotating pool of physicians supervising a lower level resident. Few programs
validate increased levels of graduated independence using specific assessments.
Keywords
hospital consultation - graduate medical education
