COVID-19 creates disruption, opportunity for ophthalmology

Summer is typically a busy and spirited season for Ophthalmology Match candidates: Medical students endeavor to build a personal brand, draft their personal statements, update their curriculum vitae, and secure letters of recommendation in preparation for their ophthalmology residency applications.

The greater Houston-Galveston region is blessed to have 4 medical schools: Baylor College of Medicine, the University of Texas Medical Branch at Galveston, the University of Texas Health Science Center at Houston, and Texas A & M University College of Medicine. Each year dozens of medical students drawn from our 4 medical schools apply for the ophthalmology match.

The Houston Methodist Blanton Eye Institute is proud to serve as a career resource for these young people and I have been privileged over the past 25 years to provide individual and collective faculty mentorship to the ophthalmology interest groups as well as personalized career counseling, individual brand development consulting, and mock interviews to prospective applicants for ophthalmology residency. Last year, we matched 27 of 30 applicants from our Houston area to ophthalmology in the United States. This year however has been different. Coronavirus disease 2019 (COVID-19) has complicated this time-honored process, creating both disruption and opportunity for this year’s ophthalmology applicant class and beyond. We discuss the impact that COVID19 has had on our ophthalmology process for our medical students this cycle.

Unique challenges

Ophthalmology applicants are facing novel challenges stemming from COVID-19 disruption

Many US medical schools delayed or canceled their clinical rotations at the start of the outbreak. After their local academic institution rotations resumed, some students discovered their updated schedules now conflicted with ophthalmology’s early application deadlines, restricting opportunities to complete ophthalmology electives before applying.

Social distancing measures have reduced testing site availability nationwide, rescheduling and in many cases preventing many students from taking United States Medical Licensing Examination (USMLE) STEP 1 and STEP 2 CK exams.

Domestic and international travel restrictions have hindered medical students from enrolling in away rotations (most of which were canceled for away students anyway). Applicants who do not have a home ophthalmology program rely heavily on these away rotations to grow their network and secure letters of recommendation. In addition, although “audition electives” are officially discouraged, many applicants from lesser known medical schools rely upon these away rotations in order to prove their worth at desirable residency programs.

In response to the disruption of COVID19, the Association of University Professors of Ophthalmology (AUPO) and the San Francisco (SF) Match announced several modifications to this year’s application cycle, including the following:

• Application deadlines will be extended by 2-4 weeks to adjust for delayed rotations.
• STEP 2 CK scores and away rotations are not required in the application process
• Just 1 letter of recommendation from an ophthalmologist will be required.

Accelerated Innovation

This fall, many residency programs will implement a remote interviewing model, replacing the traditional in-person visit with video interviews, virtual tours, and supplemental online information. Remote interviewing will undoubtedly reduce financial costs for interviewees (averaging $5,704), but may incentivize an increase in overall applications, exacerbating the already onerous review process for ophthalmology program directors .

For the Ophthalmology Match, the validity, reliability, and efficacy of a face-to-face vs. virtual interview remains unclear. Programs’ ability to recruit top applicants may be particularly be affected: A 2010 pilot study at the University of Arizona showed no differences in the ophthalmology program’s ranking for face-to-face vs. video interviewees. However, a majority of these interviewees recommended a mandatory facility tour to supplement their virtual interview, demonstrating the value placed on in-person experiences by applicants.

Prior studies have identified numerous drivers for a successful ophthalmology match including Alpha Omega Alpha Society (AOA) status, USMLE scores, geography, medical school ranking, research publications, and presence of a home ophthalmology program . However, given the increased uncertainty and projected variability in this cycle’s applications, program directors may be inclined to weigh quantitative factors such as grades and test scores more strongly than in prior years. Alternatively, “known commodity” candidates, such as applicants from their own institution, may be perceived as less risky and more attractive to programs.

It remains to be seen which, if any, of these modifications will continue once the COVID-19 crisis subsides. One thing is certain: The results from this year’s match will be heavily analyzed for years to come, as the debates on application volume, interview scheduling, and holistic review continue.

Inspiration

Li Wenliang, MD, a Wuhan ophthalmologist, was the first physician to notify the world of COVID-19. Months later, he tpassed away after contracting the virus while treating patients. His story may inevitably be hammered into cliché by the end of this application cycle, but his legacy has created a genuine impact on this year’s class of applicants.

For many candidates, COVID-19 has confirmed the global need for ophthalmologists and reinforced its vital impact on public health . For many others, COVID-19 has showcased the future of ophthalmology and the necessity of innovation beyond just the clinic, from delivery models such as telemedicine , to policy advocacy such as the Paycheck Protection Program.

Though facing unprecedented COVID-19 challenges, we believe this year’s ophthalmology match class will be better equipped, informed, and inspired to tackle the future of ophthalmology than any class ever before.

REFERENCES

1. Rose S. Medical student education in the time of COVID-19. JAMA. 2020;323(21):2131-2132. doi:10.1001/jama.2020.5227

2. Akers A, Blough C, Iyer MS. COVID-19 Implications on clinical clerkships and the residency application process for medical students. Cureus. 2020;12(4):e7800. doi:10.7759/cureus.7800

3. Boyd CJ, Inglesby DC, Corey B, et al. Impact of COVID-19 on away rotations in surgical fields. J Surg Res. 2020;255:96-98. doi:10.1016/j.jss.2020.05.049

4. 2021 ophthalmology match updates. Association of University Professors of Ophthalmology. May 9, 2020. Accessed TK. https://aupo.org/news/2020-05/2021-ophthalmology-match-updates

5. Venincasa MJ, Cai LZ, Gedde SJ, Uhler T, Sridhar J. Current applicant perceptions of the ophthalmology residency match. JAMA Ophthalmol. 2020;138(5):1‐7. doi:10.1001/jamaophthalmol.2020.0252

6. Hammoud MM, Standiford T, Carmody JB. Potential implications of COVID-19 for the 2020-2021 residency application cycle. JAMA. Published online June 3, 2020. doi:10.1001/jama.2020.8911

7. Pasadhika S, Altenbernd T, Ober RR, Harvey EM, Miller JM. Residency interview video conferencing. Ophthalmology. 2012;119(2):426‐426.e5. doi:10.1016/j.ophtha.2011.09.032

8. Siatkowski RM, Mian SI, Culican SM, et al. Probability of success in the ophthalmology residency match: three-year outcomes analysis of San Francisco matching program data. J Acad Ophthalmol. 2018;10(1):e150‐e157. doi:10.1055/s-0038-1673675

9. Loh AR, Joseph D, Keenan JD, Lietman TM, Naseri A. Predictors of matching in an ophthalmology residency program. Ophthalmology. 2013;120(4):865‐870. doi:10.1016/j.ophtha.2012.09.028

10. Petersen E, Hui D, Hamer DH, et al. Li Wenliang, a face to the frontline healthcare worker. the first doctor to notify the emergence of the SARS-CoV-2, (COVID-19), outbreak. Int J Infect Dis. 2020;93:205‐207. doi:10.1016/j.ijid.2020.02.052

11. Wu P, Duan F, Luo C, et al. Characteristics of Ocular findings of patients with coronavirus disease 2019 (COVID-19) in Hubei Province, China. JAMA Ophthalmol. 2020;138(5):575‐578. doi:10.1001/jamaophthalmol.2020.1291

12. Saleem SM, Pasquale LR, Sidoti PA, Tsai JC. Virtual ophthalmology: telemedicine in a COVID-19 era. Am J Ophthalmol. 2020;S0002-9394(20)30214-2. doi:10.1016/j.ajo.2020.04.029

13. Linnehan R. AAO COVID-19 survey shows revenue losses for private practices. Healio. May 21, 2020. Accessed TK. https://www.healio.com/news/ophthalmology/20200521/aao-covid19-survey-shows-revenue-losses-for-private-practices