John A. Moran Eye Center Education Focus 2022

Education FOCUS

Moran Eye Center

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Supporting and Connecting Trainees

M E S S A G E F R O M T H E C H A IR

Connecting to Make a Difference If we’re lucky, we carry the connections we make during our years of ophthalmic training throughout our lives. They can make all the difference in our careers—how we approach challenges, where and how we practice, what we care about, who we turn to for advice.

But connections don’t always happen on their own.

Developing them requires time, intention, and nurturing.

Vice Chair of Education Jeff Pettey, MD, MBA, excels at making connections. As the nationally respected leader of our Top 10 educational program, he makes sure we listen to our trainees and support their unique goals by connecting them to the people, resources, information, and communities that will help them succeed.

This issue of Education FOCUS features some of the ways we offer that support. They range from sharing bold, resident-driven initiatives and research at the Association of University Professors of Ophthalmology to leading the way with an expanded Global Ophthalmology Summit adopted by the American Academy of Ophthalmology.

Our resident-initiated survey of community health needs will impact underserved regions and populations in Utah.

This ongoing effort has connected groups of stakeholders, and opened the door for more meaningful relationships among peers and the communities they serve.

Trainees continue to champion equity, diversity, and inclusion in medicine by offering actionable strategies to effect change while bringing us closer together.

It’s also humbling to hear that alumni John Haines, MD, says conversations with Moran faculty still influence how he listens and talks to patients in his practice and outreach work.

I could not be prouder of our education program and its progress in shaping compassionate physicians, confident leaders, and bold innovators.

Thanks to all connected to Moran, our national residency program rankings speak for themselves.

Sincerely,

Randall J Olson, MD Distinguished Professor and Chair, Department of Ophthalmology and Visual Sciences, University of Utah The Cumming Presidential Endowed Chair CEO, John A. Moran Eye Center Director, University of Utah Vision Institute

N AT ION A L R A NK INGS

DOXIMITY

No. 6 Nationwide for Residency Education No. 2 in the West

OPHTHALMOLOGY TIMES

No. 10 Nationwide for Residency Education Program

Residents Driving Innovation From the Desk of Vice Chair of Education Jeff Pettey, MD, MBA Along with superb technical training, the Moran Eye Center’s cultural mission is focused on giving trainees the support and connections they need to take bold steps in driving positive change—both internally and in the world.

Moran residents, from left, Mubarik Mohamed, MD, fellow Rachel Patel, MD, Katherine Hu, MD, and Brandon Kennedy, MD, at the 2021 AUPO meeting.

Case in point: continue reading for highlights from our impactful resident-driven initiatives, research, and results presented at the Association of University Professors of Ophthalmology (AUPO) 2021 meeting.

Katherine Hu, MD, PGY-3, recounted resident and faculty experiences with our Moran Ophthalmology Learning Experience (MOLE) curriculum overhaul. Basically a “flipped classroom” rooted in pre-work assignments and interactive classes, the resident-led initiative proved highly satisfying to faculty and students, who agreed the experience increased learning efficacy.

Since we began implementing and sharing the MOLE model in 2020, program directors and medical education leaders from all over the country have reached out to us. In response, we created a section on Moran CORE, our online ophthalmic education site (morancore.utah.edu), to share faculty development videos and roadmaps for each ophthalmology subspecialty. Now, other programs may use and tailor these resources rather than reinventing a program from scratch.

Pettey currently serves as President of the AUPO Program Director’s Council.

Brandon Kennedy, MD, PGY-1, tackled “A Paradigm Shift in the Moran PGY-1 Ophthalmology Experience.”

Kennedy and his team’s research revealed that although PGY-1 residents felt well-prepared with a breadth of clinical and procedural experience in ophthalmology, they felt burdened with administrative duties with relatively little educational benefit. Now, faculty and residents of all training levels are working to overhaul the PGY-1 curriculum with a range of improvements, including PGY-4-PGY-1 mentorships.

Kennedy also presented “Language Used to Consent Patients for Trainee Involvement in Surgery: Patient Comprehension.” His research revealed lack of universal language guidelines often leads to patient misunderstanding of consent. His team set out to revamp terms used to describe trainee involvement, preserve patient autonomy, and minimize harm.

Mubarik Mohamed, MD, PGY-1, researched refractive outcomes in early resident cataract surgeries and the VA Medical Center in Salt Lake City. Proud brag: they are excellent!

It’s my honor to share these and other stories of ongoing innovation in our Top 10 educational program.

Leading the Way: Assessing Utah’s Eye Care Needs Moran Eye Center residents selected to receive an Achievement Rewards for College Scientists (ARCS) scholarship gain a unique ability to jump-start their research.

When then-first-year resident Sean Collon, MD, received the award in 2020, he used part of the funds and the support of Moran's Medical Director of Global Outreach Craig J. Chaya, MD, to launch the first study of its kind in the state. The Utah Assessment and Review of Community Health Eye Care Study (ARCHES) has now gathered data that will guide more efficient and effective eye care delivery to underserved regions and residents.

Collon, Chaya, and University of Utah Division of Public Health Assistant Professor Sharon Talboys, PhD, brought together local stakeholders to survey the eye care needs of those living in the Navajo Nation, people experiencing homelessness, former refugees, and the underinsured or uninsured.

Among other findings, the survey identified the top priority for vision health as diabetic retinopathy screening and care, followed closely by vision screening for children, access to eyeglasses, and improved access to and awareness of vision care services.

Although Moran’s Global Outreach Division provides donor-supported care to thousands of Utahns each year, including free or low-cost eye exams, surgeries, and eyeglasses at clinics around the state and the Navajo Nation, the need outpaces capacity.

“The survey is just the beginning,” said Collon. “It provides useful insights that we can turn into action.”

“We needed to better understand the issues underserved individuals face regarding eye health so we could use it to create an organized, unified response among all providers,” said Collon.

“Sean’s research is a great example of how Moran residents are connecting in the community and to health issues that are important to them,” said Chaya.

The next steps include sharing findings with state agencies and legislators to help them understand the need for eye care services among Utah’s most underserved communities.

Moran resident Sean Collon, MD, meets with a patient during a 2021 clinic on the Navajo Nation.

LOCAL OUTREACH 2021

BY THE NUMBERS 943 Comprehensive Eye Exams for Adults and Children 428 Adult and Pediatric Glasses 124 Eye Surgeries

E Q U I T Y, D I V E R S I T Y, A N D IN C L U S I O N

Our Changing Vision

By Abigail Jebaraj, MD

One of the greatest public health challenges is ensuring that every individual has access to the care they inherently deserve. Disparities in healthcare are disproportionally prevalent in minority populations.

This difference is further mirrored in the demographics of U.S. medical practitioners. Eye care is no exception.

Working towards a culture that embraces diversity can bridge access for underserved populations and optimize eye care in our nation. Implicit biases can subconsciously influence medical decision-making and patientphysician interactions. Addressing these with cultural competency training can equip providers with a greater understanding of how to approach patient interactions for a more successful, comprehensive clinical practice.

The first step to improving barriers to eye care is organization-specific strategizing. Institutions can form committees to develop actionable strategies to eliminate implicit biases and promote diversity. Formal discussions led by these committees can train providers to develop cultural sensitivity through seminars, book clubs, or role-play workshops.

Resident Abigail Jebaraj, MD, left, and Liliana Werner, MD, PhD, Moran's Vice-Chair for Equity, Diversity, and Inclusion.

Jebaraj is a second-year resident at the Moran Eye Center and an inaugural member of Moran’s Equity, Diversity, and Inclusion (EDI) Committee.

She was recently selected to be the Women in Ophthalmology’s 2022 Advocacy Ambassador to

Partnering with local organizations by contributing volunteers and resources for vision screenings or community clinics can put this training into practice. Institutions can review their hiring practices and make goals to interview a certain percentage of qualified applicants from underrepresented minorities.

A pipeline strategy to increase representation is to inspire interest in eye care in students from underrepresented backgrounds. Recruiting can be accomplished by mentorship or scholarship programs from the high school level and on up that provide clinical or research experience to further career goals and promote leadership skills.

These are a few examples of conscientious changes that can promote accessible eye care.

the American Academy of Ophthalmology (AAO).

The Advocacy Ambassador Program provides residents and those in fellowship training an opportunity to participate in AAO’s annual Mid-Year Forum with seasoned advocates and leaders.

Scan to read Jebaraj's essay in full.

ALUMNI PROFILE

A Conversation with John Haines, MD A Eugene, Oregon-based comprehensive ophthalmologist who has practiced for 40 years, Haines credits his Moran mentors for supporting a career founded in compassion and service.

John Haines, MD, examines a patient during an outreach clinic in Myanmar in 2016.

What drew you to ophthalmology?

I chose ophthalmology for its ability to impact so many people in low-resource countries. Growing up in Malaysia, where my parents were stationed as missionaries, I saw the desperate need for basic medical care.

Why did you choose the Moran Eye Center for your residency?

At the time of my residency, 1987-1991, the department was led by Dr. Randall Olson and his dear friend, Dr. Alan Crandall. I chose to train with them because I felt the esprit de corps as soon as I entered the department and because of the significant volume of surgeries residents could perform.

Who or what was your greatest influence during your residency?

Many, if not all, of the faculty were a powerful influence.

But uveitis specialist Paul Zimmerman, MD, was particularly so. He had a gentle, compassionate approach to his patients. This was the beginning of the AIDS epidemic, and

his clinics were overflowing with frightened young people.

He would skillfully navigate their care, giving them hope.

Many of my conversations with patients have been “borrowed” from Paul, Drs. Randy Olson, Alan Crandall, Nick Mamalis, Kathleen Digre, Jane Kivlin, Jane Durcan, and Mike Teske.

How and where have you been involved in global outreach during your career?

The biggest part of my practice, certainly the most fulfilling, has been global outreach.

I have participated in or led 35 sight-restoring eye camps in Asia, Africa, Eastern Europe, and Central and South America. In 2011, my wife, Joy, a registered nurse, helped set up our own foundation, GIVEMESIGHT.org. Through it, we have brought much-needed equipment to hospitals in Myanmar and Thailand.

HIGHLIGHTS

New Glaucoma Research Fellowship Moran recently created a glaucoma research pre-residency fellowship, a position that will work closely with the new Alan S. Crandall Center for Glaucoma Innovation.

Directed by Iqbal “Ike” K. Ahmed, MD, FRCSC, the Crandall Center seeks new and improved ways to diagnose, treat, and prevent glaucoma. Moran glaucoma faculty and researchers collaborate in therapeutics, global care, translational research, and neuroprotection-based therapy initiatives.

Inaugural fellow John A. Musser, MD, MPH, is a graduate of the University of Arkansas for Medical Sciences School of Medicine and College of Public Health.

He will be involved in multiple projects with the Center, including opportunities for publications and presentations at national and international meetings.

John A. Musser, MD, MPH.

AAO Partners with Global Ophthalmology Summit What started as the first global ophthalmology symposium virtually co-hosted by Moran and Emory University in 2020 transitioned into a two-day retreat in Utah in 2021. Global ophthalmology fellows met to discuss key issues with experts and also spent time in Moran’s wet lab and on the HelpMeSee surgical simulator, designed to help surgeons develop their skills in manual small-incision cataract surgery, a technique often used in low-resource parts of the world.

Scan for more information.

Now, with the mission of “improving eye health and eliminating vision loss through public health advocacy global ophthalmology education, research, collaboration and bridging global eye care stakeholders,” the American Academy of Ophthalmology (AAO) is bringing all ophthalmology subspecialties and any interested eye care professional to the table at a Global Ophthalmology Summit in Park City, Utah, August 12-13, 2022.

Unique Global Fellowship The Alcon Foundation supported Moran’s 2021-2022 global fellow, Nathan Gebhard, MD. The foundation works to help people around the world by increasing access to quality eye care, driving eye care provider training and skills-transfer, and strengthening communities.

Gebhard took a one-year leave from his clinical faculty position at Oregon Health and Science University (OHSU) to focus on skills transfer with Moran partners abroad. The experience will inform his efforts to build an outreach program at OHSU. Gebhard began his fellowship training at Tilganga Institute of Ophthalmology and the Hetauda Community Eye Hospital in Nepal and also joined the Moran outreach team for a teaching and training mission in Mwanza, Tanzania in March 2022.

Nathan Gebhard, MD, center, performs surgery with one of his mentors, surgeon Sunil Thakali at right, in Nepal.

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Moran Eye Center Program Features High Surgical Volumes Clinical faculty members perform more than 9,000 surgeries annually and see about 157,000 patients. In a typical three-year period, one Moran resident, on average, performs about 740 surgeries and procedures. More than 300 are cataract surgeries—86 is the national requirement. A wet lab and surgical simulators give residents additional opportunities for hands-on experience.

Integrated Intern Year A required intern year at Moran in ophthalmology and internal medicine means residents understand the University of Utah Health system from the start and are well prepared.

Resident Continuity Clinic From day one, interns manage a patient’s eye care throughout their ophthalmology rotation under the supervision of a board-certified ophthalmologist.

Innovative Curriculum Moran goes beyond the traditional, didactic teaching model to foster a dynamic, interactive ophthalmology curriculum, including a wellness program with protected academic time.

Online Publishing—CORE Residents publish on Moran’s multimedia, peer-reviewed educational website: the Clinical Ophthalmology Resource for Education at morancore.utah.edu.

Quality Improvement Residents design quality improvement projects as part of value training to provide the best patient outcomes at the lowest possible cost.

Dedicated Research Time Moran residents may receive up to one-half day of dedicated research time per week for projects. Moran also provides funding opportunities such as the Achievement Rewards for College Scientists (ARCS) Foundation’s scholars program.

Elective Time Third-year residents can tailor three months of elective time to their interests and participate in local and international outreach work with Moran’s Global Outreach Division.

Program Growth Moran received 678 resident applications for four spots in 2021. Including interns, Moran trains 16 residents and up to 12 fellows in specialties like cornea and refractive surgery, glaucoma, neuro-ophthalmology, retina and vitreous surgery, and uveitis.