We note with concern, for ophthalmology, the results of round-1 seat allotment for National Eligibility-cum-Entrance Test—Post-Graduation (NEET-PG) 2020, declared in April 2020.[1] Except for a few institutions, all-India ranks (AIRs) on the NEET-PG perform as the sole admission criterion to the majority of residency positions in India, and thereby to a career as specialist. Top rankers here represent the finest candidates offered by our medical education system. Currently, India has 1616 MD/MS, 103 Diploma, and 292 DNB (post-MBBS) positions for ophthalmology training.[2] Unfortunately, top AIRs have continued to ignore ophthalmology, as per last available data since NEET-PG 2017, when the exam began. In 2020, not a single examinee under-100 AIR chose ophthalmology, while seven of top-10 AIRs picked general medicine.[1] Similarly, no more than 2 in top-500 AIR and 10 in top-1000 AIR in each year have chosen ophthalmology. This year also saw the least number of candidates in both top-2500 and top-5000 AIRs choosing ophthalmology [Figure 1].

1. 2316 Indian Journal of Ophthalmology Volume 68 Issue 10
apart from performing our routine duties as Ophthalmologists.
The pandemic is here to stay and therefore, our role as frontline
warriors at COVID hospital will continue. In times to come,
Ophthalmologists and other non‑core branch specialists in
other institutes as well will have to play a major role in fighting
the pandemic apart from managing their respective speciality
cases.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Amit Kumar Deb, Tanmay N Gokhale,
Malavika Mani, Sandip Sarkar
Department of Ophthalmology, JIPMER Hospital, Puducherry, India
Correspondence to: Dr. Tanmay N Gokhale,
Department of Ophthalmology, 1st
Floor, Institute Block, JIPMER
Campus, Dhanvantari Nagar, Puducherry - 605 006, India.
E‑mail: tangokhale26@gmail.com
References
1. #IndiaFightsCorona COVID‑19 [Internet]. MyGov.in 2020.
Available from: https://mygov.in/covid‑19/. [Last cited on
2020 Jul 28].
2. LabTestingAdvisory.pdf [Internet]. Available from: https://www.
mohfw.gov.in/pdf/LabTestingAdvisory.pdf. [Last cited on 2020
Jun 30].
3. Guidelinesforhomequarantine.pdf [Internet]. Available from:
https://www.mohfw.gov.in/pdf/Guidelinesforhomequarantine.
pdf. [Last cited on 2020 Jun 30].
4. Gupta V, Rajendran A, Narayanan R, Chawla S, Kumar A,
Palanivelu MS, et al. Evolving consensus on managing vitreo‑retina
and uvea practice in post‑COVID‑19 pandemic era. Indian J
Ophthalmol 2020;68:962‑73.
This is an open access journal, and articles are distributed under the terms of
the Creative Commons Attribution‑NonCommercial‑ShareAlike 4.0 License,
which allows others to remix, tweak, and build upon the work non‑commercially,
as long as appropriate credit is given and the new creations are licensed under
the identical terms.
Cite this article as: Deb AK, Gokhale TN, Mani M, Sarkar S. Perspective
of ophthalmologists providing direct care to COVID-19 positive patients at
JIPMER, Puducherry. Indian J Ophthalmol 2020;68:2315-6.
© 2020 Indian Journal of Ophthalmology | Published by Wolters Kluwer - Medknow
Access this article online
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DOI:
10.4103/ijo.IJO_2157_20
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Academic quality of incoming
ophthalmology residents in India:
Concerns for the future
Dear Editor:
We note with concern, for ophthalmology, the results of round‑1
seat allotment for National Eligibility‑cum‑Entrance Test—
Post‑Graduation (NEET‑PG)2020,declaredinApril2020.[1]
Except
for a few institutions, all-India ranks (AIRs) on the NEET-PG
performasthesoleadmissioncriteriontothemajorityofresidency
positionsinIndia,andtherebytoacareerasspecialist.Toprankers
here represent the finest candidates offered by our medical
educationsystem.Currently,Indiahas1616MD/MS,103Diploma,
and292DNB(post-MBBS)positionsforophthalmologytraining.[2]
Unfortunately, top AIRs have continued to ignore
ophthalmology, as per last available data since NEET‑PG 2017,
when the exam began. In 2020, not a single examinee under‑100
AIR chose ophthalmology, while seven of top‑10 AIRs picked
general medicine.[1]
Similarly, no more than 2 in top‑500AIR and
10 in top‑1000 AIR in each year have chosen ophthalmology.
This year also saw the least number of candidates in both
top‑2500 and top‑5000 AIRs choosing ophthalmology [Fig. 1].
Regarding the academic quality of incoming ophthalmology
residents in India, these observations are perturbing,
considering the speciality’s extremely competitive nature in
developed nations. In the USA, where US Medical Licensing
Examination Step‑1 scores serve as a critical surrogate of
competitiveness, average score for applicants accepted to
ophthalmology usually hovers amongst the highest of all
specialities.[3,4]
Similarly, in the UK, as per “competition ratios”,
i.e., number of applicants per training position, ophthalmology
is highly preferred as a speciality.[5]
Urgent action on multiple fronts, led by All India
Ophthalmological Society, is warranted to encourage the best
candidates to choose ophthalmology. While we have been
addressing ways to improve our residency and fellowship
programmes, time and again, this important aspect has been
largely ignored.[6,7]
These unfortunate findings and ignorance
of non-preference for speciality training have been true for
otorhinolaryngology (ENT) as well, a field that is taught to
MBBS students in the same year as ophthalmology.[8]
Good
quality seeds grow into the greatest trees; and the time has
come to actively work towards acquiring them. Highlighting
the obvious advantages of our field to the undergraduates,
encouraging greater participation in clinical work, and having
online career counselling prior to NEET‑PG seat selection are
some of the suggestions. We also need to widely promote the
virtues of our profession through greater engagement on social
media. By viewing third‑year students as future trainees and
treating them so, we shall go a long way.
Financial support and sponsorship
Nil.
[Downloaded free from http://www.ijo.in on Thursday, September 24, 2020, IP: 103.109.216.95]

2. October 2020 2317
Letters to the Editor
Conflicts of interest
There are no conflicts of interest.
Ahmad Ozair, Kaushal K Singh, Siddharth Agrawal1
Faculty of Medicine, and 1
Department of Ophthalmology,
King George's Medical University, Lucknow,
Uttar Pradesh, India
Correspondence to: Dr. Siddharth Agrawal,
Department of Ophthalmology, King George’s Medical University,
Lucknow ‑ 226 003, Uttar Pradesh, India.
E‑mail: agrawalsiddharth@rediffmail.com
References
1. Medical Counselling Committee. [Internet] India: Medical
Counselling Committee. Final Result Round 1 PG 2020 (Medical):
PG Medical Counselling. Available from: https://mcc.nic.in/
PGCounselling/Home/ShowPdf?Type=50C9E8D5FC98727B4B
BC93CF5D64A68DB647F04F and ID=7EE51D9582EF3D3B56E
C2FC25B77FC147D8563E5. [Last cited on 2020 Apr 19].
2. Medical Council of India (MCI). [Internet] India: Medical Council
of India. College and Course Search. Information desk. Available
from: https://www.mciindia.org/CMS/informa tion‑desk/
college‑an d‑course‑search. [Last cited on 2020 Apr 17].
3. SF Match, US. [Internet] SF Match. Ophthalmology Residency
Match Summary Report 2019. Available from: https://www.
sfmatch.org/PDFFilesDisplay/Oph thalmology_Residency_
Stats_2019.pdf. [Last cited on 2020 Apr 18].
4. National Resident Matching Program, US. [Internet]
National Resident Matching Program. Charting Outcomes
in the Match: U.S. Allopathic Seniors. Available from:
https://mk0nrmp3oyqui6wqfm.kinstacdn.com/w p‑content/
uploads/2019/10/Charting‑Outcomes‑in‑the‑Mat ch‑2018_
Seniors‑1.pdf. [Published 2018 Jul, Last cited on 2020 Apr 18].
5. Competition Ratios 2019. National Health Service. [Internet].
Available from: https://specialtytraining.hee.nhs.uk/Por tals/1/
Competition%20Ratios%202019_1.pdf. [Last cited on 2020 Apr 17].
6. Grover AK. Residency training in India: Time for a course
correction. Indian J Ophthalmol 2018;66:743‑4.
7. Narayanan R, Gupta SR, Honavar SG. Fellowship training in India:
How to produce leaders? Indian J Ophthalmol 2018;66:1671‑2.
Figure 1: The graphs provide data of the number of candidates preferring ophthalmology residency via the NEET‑PG, from its introduction as
NEET‑PG 2017, till the year 2020, amongst (a) the top‑500 all‑India ranks (AIRs); (b) the top‑1000 AIRs; (c) the top‑2500 AIRS; and (d) the
top‑5000 AIRs
d
c
b
a
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3. 2318 Indian Journal of Ophthalmology Volume 68 Issue 10
8. Ozair A, Singh AB. Why are India’s best medical graduates not
preferring ENT for postgraduate training through NEET-PG?
Indian J Otolaryngol Head Neck Surg. Published 30 Jun 2020.
Epub ahead of Print, Available from: http://link.springer.com/
article/10.1007/s12070-020-01926-6
Cite this article as: Ozair A, Singh KK, Agrawal S. Academic quality of
incoming ophthalmology residents in India: Concerns for the future. Indian J
Ophthalmol 2020;68:2316-8.
© 2020 Indian Journal of Ophthalmology | Published by Wolters Kluwer - Medknow
This is an open access journal, and articles are distributed under the terms of
the Creative Commons Attribution‑NonCommercial‑ShareAlike 4.0 License,
which allows others to remix, tweak, and build upon the work non‑commercially,
as long as appropriate credit is given and the new creations are licensed under
the identical terms.
Access this article online
Quick Response Code: Website:
www.ijo.in
DOI:
10.4103/ijo.IJO_1154_20
PMID:
***
Project ECHO (extension for
community health care outcomes, An
online tool for residents’ education:
A pilot study
Dear Editor:
Project ECHO (extension for community healthcare outcomes)
facilitates upskilling of heath care workforce by interactive
sharing of knowledge using an internet‑based platform. This
model originated at the University of New Mexico (UNM)
Health Sciences Centre, USA in 2003, to address shortage of
trained health care providers to treat hepatitis C across the
rural regions of the state and a later study showed equally
efficient care between the ECHO‑trained care providers and
UNM specialists.[1]
Currently ECHO programs have trained
over 90,000 caregivers in 800 programs spanning 39 countries
across the globe in various medical specialities.[2]
This has been not been tried in ophthalmology residents
education (Medline search). We used the ECHO platform
with twin objectives of supplementing the current residency
teaching in India and bridge the existing gaps between many
teaching programs.[3,4]
The model consisted of a host, a tertiary
super‑specialty teaching eye institute, and the residents in
several training programs. Every fortnightly session of one
hour featured topics selected by the majority of participants
from their curricula. All participation was voluntary and on
informed consent.
The program started in April 2017 with 121 residents from
13 medical schools. We evaluated its utility in supplementing
resident’s teaching. This was an anonymous electronic survey
and was approved by the Institutional Review Board (IRB; LEC
01‑19‑207). The questionnaire consisted of ten multiple‑choice
questions addressing the appropriateness of technology, the
relevance of study topics, and meeting the requirements of
the residents.
Fifty‑three of 121 residents (43.8%) responded to the
questionnaire. Outcomes of the self‑reported degree of
satisfaction are summarized in Fig. 1. Briefly, 80% of residents
found it useful, 88% were comfortable in seeking clarifications
from faculty and 96% recommended to other residents. The
limitations of this self‑reported study are a small sample size,
self‑bias, and poor response rate. Those not satisfied with the
Figure 1: Degree of satisfaction with the ECHO model of teaching
program may not have responded.A distance education model
may have limitations in the availability of certain faculty and
students due to prior commitments.
While recognizing that the ECHO model is a good
distance education tool in medicine (and ophthalmology)
it does not replace bedside teaching, because an important
component of medical training is physical examination of
patients. ECHO is only a supplement to teaching and is not
a replacement of age‑old medical teaching methods. The
Kirkpatrick’s model recommends that reaction, learning,
behavior, and results are effective means of analyzing a
training program.[5]
The ECHO model compares favorably
with regard to the components of reaction and learning at
least in the short term.
Tele ECHO models of teaching provide a promising
alternative in tele‑teaching at a health related quarantine
time (such as the COVID 19 now). The ECHO model shows
a promising concept of teaching ophthalmology to a large
number of residents across a wide geographic area.
Acknowledgements
Dr Taraprasad Das, MD, FRCS, KAR Campus, L V Prasad
Eye Institute, Road No 2, Banjara Hills, Hyderabad, Telengana,
India 500034.
Dr Sanjeev Arora, MD, ECHO Institute, University of New
Mexico Health Sciences Center,Albuquerque, NM, USA, 87131.
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