Meeting and Teaching in the VIrtual space: Dawn of a new era in Ophthalmic education

Dr. Meenakshi Swaminathan
Published Online: July 1st, 2020 | Read Time: 22 minutes, 10 seconds

The whole world is passing through an unprecedented crisis due to CoVid19. During such difficult times, education and academics have also suffered and undergone tremendous changes worldwide. Innovations and adapting to newer technology has been the key to keeping continuous teaching and learning. Here we have a look at a conversation involving two academicians and global teachers discussing how to overcome the issues at hand during these difficult times. On our request, Meenakshi Swaminathan spoke toKarl Golnik, MD, MEd, Chair, Education Coordinating Committee, International Council of Ophthalmology.

Karl Golnik, MD, MEd is a neuro-ophthalmologist at the University of Cincinnati Gardner Neuroscience Institute; a professor of ophthalmology, neurology and neurosurgery at the Cincinnati Eye Institute and the University of Cincinnati; and professor of Ophthalmology at the University of Louisville. He is also Chairman of the department of ophthalmology at the University of Cincinnati. Currently, he is the director for education for the International Council of Ophthalmology, past-president of the Joint Commission on Allied Health Personnel in Ophthalmology, and chair of the Pan-American Association of Ophthalmology’s Resident Education Committee. He has received numerous resident teaching awards and has more than 150 publications in the fields of neuro-ophthalmology and medical education. Aside from neuro-ophthalmology, Dr. Golnik has a strong interest in medical education; in particular, teaching doctors how to teach. Through the International Council of Ophthalmology, he volunteers one week per month traveling internationally and conducting meetings to teach residency program directors how to be more effective educators.

Meenakshi Swaminathan: What impact can we expect on ophthalmic academic activities around the world due to the current COVID crisis?

Karl Golnik: Well, I have had 15 different international meetings canceled starting in early April and so obviously there’s been a huge impact. As you probably know, the World Congress will be virtual, which I think is certainly as far as I know, certainly the biggest ophthalmology conference to go virtual. I am not sure about other medical conferences, so the World Conference will be delivered virtually. It willbe very interesting, and we willtalk about the future too later on, but the ICO has learnt a lot about how to do it, and I think it will run pretty smoothly. I think there are some innovative things they’re trying as well with the live sessions and so on. So certainly, one huge impact is, of course, all of the meetings. And will that result in people realizing ‘Hey I don’t NEED to spend a lot of money to travel, I don’t NEED to spend a lot of money for a hotel, I can just tune in” because I suspect that when this is all said and done probably most big meetings that occur face to face will also have a virtual component? And we’ll see what happens…. Will that lead to big meetings becoming smaller in terms of face to face stuff…. so that’s certainly one thing. Another big thing that we’re certainly experiencing with the current shutdown which is loosening up where I live, is of course resident education. Because there are definitely places in the United States where Ophthalmology residents were pulled to go work in wards or in units. And certainly not doing what they’re being taught to do, which is Ophthalmology, but doing general medical care. So that’s a concern. Our residents were never pulled, we never got that busy but of course, there were a lot less patients, there was no elective surgery, so we had to really scramble to make sure that the residents were hopefully graduating on time. In most places it is difficult to keep residents longer than their prescribed time because you have new residents coming in, and so on and so forth, all the rotations and everything. So certainly we’ve done pretty well with that I think. And thankfully in the U.S. we have minimum numbers of cases, and all our graduating residents (and they’re graduating this week) all of them have met their minimum numbers. That said, I know the ACGME accrediting bodies are relaxing those minimum numbers for this year’s graduates. So certainly it has a big impact on academic activities in terms of the residents, in terms of their cases. It’s also required for us to convert completely to online lectures and conferences which again I think will continue after this. But I know one of the other questions would be about ‘what’s the best way to do that’ so I think all programs in the U.S. are doing their programs virtually. Interestingly, things like our grand rounds, the attendance is gone way up from our face to face. Because you know the time is not convenient for everybody in town, so outside doctors can now tune in and so our attendance for all of our online conferences other than the specific resident things, the attendance has gone way up. Ditto I should mention just for webinars. So webinars I’ve done um probably a dozen ORBIS webinars over the last few years. And a typical webinar might have a few 100, 200, 250 people sign up. The one I did during COVID a few weeks ago had 2500 people sign up. And I ask ‘hey is that just because of me’ or…. And they said ‘no it is because of COVID’. They said all of the webinars are having a much higher attendance. So once people get used to that, it’ll be something they like as well. And it also has an impact on medical students. So medical students who are trying to do their senior electives in Ophthalmology, and medical students who’re applying for residency, all of our interviews, you know we usually have 3 full days of interviews where we interview 48 people for our spots. That’s all going to be done virtually this year. So that’s impacting things and all of those resident applicants who’d normally come, see the program, and so on won’t be there face to face. They won’t even see the facilities and so on unless they decide to make a special trip. It will be much less expensive for resident applicants because it really can cost a lot. I think those are some of the really big items on ophthalmic academic changes.

Meenakshi Swaminathan: In India as well, most of the educational activities have become online. Do you think there’s any down-side to that? How does it compare to traditional teaching methods by going pretty much completely online?

Karl Golnik: Well, of course, there’s some content that’s very difficult to do online, like learning skills and things like that, practicing in the wet lab and so on. In terms of the didactic portions of it, the biggest downside is interacting with your audience. And hopefully these days most educators are interacting and not just sitting up there and talking, spewing out information. So that’s the challenge, trying to keep it very interactive. And there’s a number of ways to do that. And there may be another question about that down the road. But interactivity is the biggest challenge, of course in some parts of the world, INTERNET is a bigger challenge. So if you don’t have good connectivity then clearly that’s an issue. But I think that, I hope, we are developing a course on Flipped classroom, but I hope it actually improves people’s ability to teach when we get back to face to face. I recently have been a big proponent of Flipped classroom which basically means giving the students some knowledge, a short narrated powerpoint with the facts, things they could read in books. And then having the face to face, or the interactive webinar being time you’re really are using the expert’s expertise in figuring out things. Not just spewing out data, not the lower levels on Bloom’s taxonomy but the higher levels and so those things can be done. I have a neuro-jeopardy games we do at the end of each year. And the teams are residents. We have our 1st year vs 2nd year vs 3rd year which doesn’t sound fair but they get different questions. So if they pick pupils for a 100 points, there are 3 questions. And when its live, face to face, they sit in their little groups, the 1st year residents see the question, and then they talk amongst themselves, and they use their own and each other’s knowledge and learn from one another. And it is very competitive. But this year we couldn’t do it face to face. So what we did instead, we did the same things online but the teams just communicated via their phones. So they muted their computer while they talked and then they gave the answers. So it worked very well. So I think there are things that you can do to keep the interactivity even if tis online.

Meenakshi Swaminathan: Recently, not too long ago, I was introduced to a similar thing on the zoom platform where the speaker was a non-medical audience but they broke us into something called ‘break room’ or something like that where they put us away into little groups, and at the point your interaction will be only with the group and when the break room ends, you come back to the main room. So it was kind of cool, and there is provision for those kinds of things in the future.

Karl Golnik: Right and I am not yet savvy enough with Zoom for that. There are many ways to increase interactivity depending upon your personal style and how it was, and I suspect there will be a number of courses that could be taken to increase your ability to deliver virtual education. So I think that could be very positive. And there are a lot of places where Ophthalmology residents are spread out in a city and they can’t all make it to the conference. So I think as people get better at doing this and it becomes more routine, it could even improve the availability of education, and possibly improve the interactivity of education. So I think it could be one of those hidden benefits.

Meenakshi Swaminathan: So, I am going to club the next 2 questions: what practices would you advice the academic leaders to follow during the coronavirus pandemic crisis? And, the importance of collaboration and shared academic leadership? So, you’ve been around the world and I know that you’re familiar with the residency programs in pretty much every country. So do you look at how this is going to have an impact worldwide? And do you envision any sort of collaboration between local programs, local leadership, and perhaps even with the U.S. and us? What do you envision?

Karl Golnik : Well I think the main big push is this you know, virtual education. And obviously if I’m doing a conference virtually, it can be shown anywhere in the world. And I know that Wills has a Grand Rounds that has been broadcast to Africa and so on. But with everybody being forced to use this kind of virtual teaching, the opportunities along those lines are huge. And not just in places like the U.S. where maybe you can share these things, but how many places in Africa have neuro-ophthalmologists or a uveitis specialist? So they have big challenges, one of their big challenges just before all of this was getting sub-specialty expertise to train their residents. This could be huge, with everybody doing it. You should be able to theoretically hook up every program in Africa with a program somewhere else. Hook them up, provide the same didactic stuff that you are doing and you have all the expertise. So that’s something very important, and academic leaders should really be looking to that.

Meenakshi Swaminathan: The next two questions are inter-linked, what are the innovative ways in which remote teaching and learning can work? And you’ve expanded on the Flip classroom, I’m also wondering if future programs will have a lot more blended learning? Like you mentioned, a lot more online content before the actual hands-on happens?

Karl Golnik: I think the main thing, the innovative things are the collaboration and the interactivity. But as we get more familiar with it, as you mentioned, the chatroom thing, privately talking about a problem or a case to figure out what is going on, I think that can help. Now the other thing is procedural skills and surgical training. I think, if you don’t have patients to operate on, that’s a problem which may really force people towards simulation and wetlab and improving their wetlabs because in order to get that sort of procedural skill acquisition, you may need more simulation and more wetlabs than usual. So that may help popularize that whole simulation side of things. It could also lead to better training methods, better assessment methods, etc. The surgical training with no patients is going to force us to think of other materials which could be used instead.

Meenakshi Swaminathan: The other issue is, around the world, it is possible that many academicians and teachers who’re very good at traditional bed-side or clinic teaching may not be that comfortable with digital teaching. So, what are your tips, how do people update themselves? Will ICO be rolling out programs to help these people get themselves up there?

Karl Golnik: The real basic answer is, you’ll probably get better like you get better at doing anything else. Like you could read things, you could google things. The ICO already has some content on the ICO website that addresses just being an effective educator. So hopefully that’ll push it. We do have something on the Flip classroom but we don’t have anything else yet on the specifics of how do you improve interactivity online. That would be something fairly easy to produce. So I think my advice would be, I’m sure as we’re speaking, people are developing this type of a module. The ICO, we will be, we’re eager to work with member societies about starting webinar series if they’re interested. We have an email ‘e-learning’, just ‘’. That’s Eduardo Mayorga who’s the head of the ICO IT, he’s happy to help people, he’s helped number of societies with their programs to get their virtual stuff up and running, and it’s a great resource. So we will be addressing this. It is happening everywhere, I’m sure there will be plenty of stuff out there. But I bet you’ll find a whole bunch of stuff about giving better virtual presentations.

Meenakshi Swaminathan: So, one last word to residents or those undergoing training, who’re kind of stuck right now?

Karl Golnik: I think this will end. You will get your education, there will be new innovations, this may well result in more accessibility to great education worldwide. I don’t think it’s the end of face to face meetings, I don’t think it’s going to hurt your training specifically. I am sure depending on where you are, it's possible your training might need to be extended a little bit but when all is said and done, I suspect that Ophthalmology training programs around the world will be leaner and meaner, will be more efficient and more effective in their training by utilizing both face to face AND virtual training available. There will be more resources available to training and it might just be a good thing, when all is said and done, not to make light of a pandemic, but from an educational standpoint, it is going to force us to be innovative.

Special Thanks to : Ms. Rasika Goplakrishnan

Dr. Meenakshi Swaminathan
Senior Consultant, Department of Paediatric Ophthalmology, Sankara Nethralaya, Chennai
Dr. Meenakshi Swaminathan did her residency from the PGIMER, Chandigarh and the University of Louisville, Kentucky. She did her fellowship in Pediatric Ophthalmology at the University of Iowa. She works at Sankara Nethralaya, Chennai, India, which is a tertiary care teaching hospital which trains residents and fellows. She is also the Director of Academics for over a decade. She has been working with the ICO in conducting several Teachers in Ophthalmology programs both in India and other countries
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