The department also attempted to use the NEON series from the American Academy of Ophthalmology but found it unwieldy and the residents resistant to using it consistently. More recently, we have been tracking the performance of our graduates on their written and oral boards examinations, modified our previous evaluation forms to address the new general competences, developed a computer-based oral boards examination and started formally evaluating resident presentations such as Grand Rounds.

Finally, the clinical skills cards provide an opportunity to assess areas not easily measured through OKAP'S, orals or in the direct supervision of operative skills. These fundamental skills, tailored to each year of development of the resident, must be demonstrated to the appropriate sub-specialist, who then signs off or requests that the resident return for re-testing after appropriate study and/or practice. This assortment of measures assures excellent assessment of the cognitive, reasoning and clinical and surgical skills of our residents. We also utilize 360 degree evaluations, including peer assessment (resident evaluating one another), and patient satisfaction surveys. 

Assessment of surgical competence, a vitally important area of patient care in ophthalmology is done in several ways. Every surgical experience is directly observed by a faculty member and the global evaluation of these skills included in the six-month global evaluation. These evaluations tend to be too infrequent and distant from the event to be useful to the learner. For the past several years we have utilized the resident surgical skills assessment form to provide immediate, documented feed-back, and the resident saves these in their portfolios. Complications are reviewed individually or in M&M conferences.

The Surgical Experience policy requires a graduated approach to surgery, including practice time in the wet lab. Early results from the use of the Resident Surgical Skills Assessment form have resulted in a committee developing a formal practice lab curriculum, to include knowledge of surgical instruments, ability to pass sutures, capsulorhexis on a model system, and other graduated skills.Finally, we track the performance of our graduates on their board certification exam as another measure of the educational outcomes of the program. In the most recent five-year performance report from the American Board of Ophthalmology, dated Aug. 9, 2005, our graduates did very well, with a first time failure rate of 20% versus a national rate of 27%. 100% passed their orals on the first (83%) or second attempt. We will continue to strive to improve this performance.