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A Novel Curriculum for Ophthalmology Training of Emergency Medicine Residents (COPTER)
Andrea Bouman, MD MBA, Nikhil Goyal, MD, Christopher Guyer, MD, Anju Goyal, MD, Henry Huitsing, MD, Caroline Dowers, MD, Christopher Clark, MD, Samantha Noll, MD, Michael Harrison, MD PhD, Nathan Farley, David Goldman, MD MBA, Stephanie Stokes-Buzzelli, MD
Ophthalmologic complaints are common in the emergency department, comprising 1.2% - 1.5% of ED visits in the United States. Literature has suggested that ophthalmology education in medical schools is inconsistent, leading to residents who may be inadequately prepared to manage ophthalmologic complaints.2-6 Historically, the ophthalmology curriculum for EM residents at our institution consisted of a 2-week apprenticeship with ophthalmology residents and faculty. However, the exposure to ophthalmologic complaints and equipment varied widely. We hypothesized that introduction of a longitudinal curriculum would provide improved knowledge and self-perceived competency.
COPTER was introduced as an 18 month curriculum that was designed to include all of the ophthalmology content as outlined in the ABEM Model of EM. The content is delivered through a variety of lectures, hands-on equipment training, and procedure didactics including foreign body removal and laceration repair. Each session lasts approximately 5 hours and occurs every 6 months. The 18-month curriculum design allows for two full iterations of the content in a 3-year residency program
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2 week rotation in Ophthalmology clinic
Apprenticeship model
Inconsistent exposure
Old Curriculum
Introduction
COPTER
18 month curriculum
All Ophthalmology content in ABEM Model of EM
Lectures, equipment training,
& procedure didactics
5 hour sessions every 6 months
Two iterations in a 3-year residency program
Ophthalmologic complaints are common 1,2
Medical school ophthalmology teaching is limited and variable 3
Innovative teaching methods may improve resident competency in treating eye complaints

2. Methods
To assess knowledge gained from COPTER participation, a 12-question multiple-choice ophthalmology knowledge test was administered to 16 incoming PGY1 emergency medicine residents before and after participating in COPTER (Cohort A). This assessed knowledge on diagnosis and management of a variety of medical and traumatic ocular complaints. The same test was taken by these residents eight months later to assess knowledge retention. Additionally, these residents received an 11-question comfort survey at the end of their PGY1 year to assess self-perceived competency. The same comfort survey was also administered to 16 PGY2 residents after completing the old curriculum and again after completing a COPTER session to assess for a change in comfort.

3. Results Knowledge Test mean score when taken by Cohort A.
Pre-Test: before COPTER
Post-Test: immediately after COPTER session #1
Remote Post-Test: 8 months after COPTER session #1
Pre-Test to Post-Test mean score increased by 12% (p=0.0012)
Pre-Test to Remote Post-Test mean score increased by 8% (p=0.0261)
Residents had a higher mean posttest score than pretest score, indicating a gain in knowledge after completing the first session of COPTER (p=0.0012).  Additionally, the mean score of the remote post-test was higher than the pretest score (p=0.0261), suggesting knowledge retention.​

4. Results Comfort Survey Results
From the comfort survey, a statistically significant difference was found between self-perceived competency in evaluating medical (non-traumatic) eye complaints in the ED between the Mixed Curriculum and the Old Curriculum (p= ) Additionally, a similar difference was found in self-perceived competency in diagnosing and managing Glaucoma (p= ) There were no statistically significant differences in comfort when comparing COPTER to the old curriculum.
Comfort Survey Results
Old vs Mixed Curriculum, statistically significant difference in:
Comfort of evaluating medical eye complaints (p=0.0493)
Comfort in diagnosing and treating glaucoma (p=0.0221)
No statistically significant difference comparing COPTER to Old Curriculum
COPTER .
Old curriculum
Mixed curriculum
Statistically significant difference between Old curriculum and Mixed curriculum
Very uncomfortable Neither Very comfortable

5. Conclusion References
COPTER improved EM resident knowledge of diagnosis and management of ophthalmologic emergencies
Enhanced self-reported comfort in managing medical eye complaints
We concluded that an innovative, multi-modal ophthalmology curriculum improved EM resident knowledge of the diagnosis and management of ophthalmologic complaints. When compared to an apprenticeship model, this curriculum also enhanced self-reported competency. COPTER may improve the care of patients with ophthalmologic emergencies. Limitations of this study included a small sample size, incomplete survey response rate, variation in post-graduate training level and individual learning styles, as well as the timing of when residents completed the old curriculum. Additionally, the test and survey were administered less than halfway through the first iteration of COPTER. These results are promising and point toward the continuation of COPTER. In the future, we hope to continue these assessments as COPTER progresses, and continuously expand the didactics offered.
References
1] Kam J, Branzetti J, Taravati P. Ophthalmology training in emergency medicine residency programs in the United States. ARVO Annual Meeting Abstract
2] Chan TY, Rai AS, Lee E, Glicksman JT, Hutnik CM. Needs assessment of ophthalmology education for primary care physicians in training: comparison with the International Council of Ophthalmology recommendations. Clin Ophthalmol. 2011;5:311-9.
3] Esparaz ES, Binder SB, Borges NJ. How prepared are medical students to diagnose and manage common ocular conditions. J Educ Eval Health Prof. 2014;11:29.
4] Jacobs DS. Teaching doctors about the eye: trends in the education of medical students and primary care residents. Surv Ophthalmol. 1998;42(4):383-9.
5] Mottow-lippa L. Ophthalmology in the medical school curriculum: reestablishing our value and effecting change. Ophthalmology. 2009;116(7):1235-6, 1236.e1.
6] Quillen DA, Cantore WA. Impact of a 1-day ophthalmology experience on medical students. Ophthalmology. 2006;113(12):