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Letters to the Editor

COVID-19 and the medical education system in ophthalmology – Lessons learned and future directions

Parija, Sucheta; Das, Sujata1,

Author Information
Indian Journal of Ophthalmology: May 2021 - Volume 69 - Issue 5 - p 1332-1333
doi: 10.4103/ijo.IJO_540_21
  • Open

Dear Editor,

COVID-19 pandemic has impacted not only the healthcare system but also the education system globally. In the process, medical teaching has also suffered. The conventional classroom teaching, bedside teaching, clinical grand rounds, and surgical training were completely stopped. The ophthalmology curriculum is an integral part of the undergraduate teaching program and imparts basic knowledge to promising doctors to serve the community in the future. It also forms the fundamental basis of future ophthalmology training if pursued at the postgraduate level.[1]

All healthcare resources are channelled to combat this outbreak, largely affecting the teaching activities. Medical education and patient care must receive equal weightage and should continue simultaneously. To address these issues and to ensure that the students continue with their academics without losing precious time, there has been a paradigm shift toward online teaching classes, webinars, surgical video sessions, and interactive tutorial sessions. Furthermore, this is an opportunity for medical educators to plan various innovative methods that can help to ensure quality medical education during the crisis period and prepare for unpredictable outbreaks in the future.

Technology should be leveraged and used to the maximum during the pandemic.[2] The traditional classroom lectures, where face-to-face interactions in large-group settings can potentially be the hotspots for the spread and transmission of the disease, cannot be conducted. There is a need for change in the mindset to transform in-person to online teaching, which is the new paradigm shift that has occurred recently and will stay in the future. With different e-learning platforms, weblinks and videoconferencing can be used to deliver lectures or conduct tutorials remotely with the students by using laptops and smartphone devices.[3] Furthermore, teleconsultation and teleconferencing can be adopted to demonstrate medical procedures and surgical techniques.[4] Thus, centralized teaching shall continue even with the cessation of in-person lectures and interhospital movements. Remote instruction via instructional videos or online webinars can be integrated into the training programs. The students may be followed by the faculty members with online discussions to assess their state of learning and progression. The study conducted by Chatziralli et al. has stated the significant increase of e-learning tools during the pandemic.[5]

Challenges to online education reported in the medical literature so far include issues relating to time management, use of technology tools, students’ assessment, communication, and the lack of in-person interaction.[67] Grand rounds are conducted via online platforms. This has opened new facilities to invite national and international faculties to share their knowledge and discuss the cases at reduced cost and travel time. A variety of online teaching materials can be available in the e-library where students can access and learn at their convenient time. Time management and quality video-based teaching can be a valuable learning experience for the students. Furthermore, the use of digital tutorials shall enable the students to send live questions to their clinical tutors, who in turn shall explain to the entire group.

Virtual conferences with online access to video teaching sessions can be attended both at the national and international level with reduced cost and have a positive impact on the students. A disadvantage is that it reduces the opportunity for residents to network with senior ophthalmologists, some of whom may become fellowship preceptors. In the future, models for massive online interactive conferencing, which will help students to make social connections, will be much encouraged.

Ophthalmic surgery requires additional skills of hand–eye coordination compared to other surgical specialties. A study by Mishra et al. reported that 80.7% of the trainees experienced a negative impact on their surgical training and 54.8% had a stressful life during this period.[8] Wet-lab training helps residents to master microsurgical steps before they perform the actual surgery. There are certain tools such as surgical simulation for cataract and vitreoretinal surgeries and wet-labs to practice the steps of surgical procedures and suturing.

Online theory examination may be held as per the schedule. Multiple choice question-based and online objective-structured clinical examinations may be conducted for undergraduate medical students as part of their formative assessment. Competency-based ophthalmology training for residents must be the focus now.

Teleophthalmology and digital technology can help in establishing virtual clinics as part of the clinical practice for screening and monitoring of stable patients. This can make the residents deal with low-risk patients independently and become experts in preventive and telemedicine for the masses at remote places. A strong networking system can be constructed from primary to secondary and tertiary care levels to provide expert opinions. This change in the clinical practice will accelerate the incorporation of artificial intelligence into the system. To assist with the safety standards for routine elective surgeries, and robotic surgeries can come into play in the future.

The COVID-19 pandemic has challenged the education system. Based on the institutional needs, the ophthalmology departments can prepare a list of priorities to guide the decision-makers to adapt to the changing needs. Amidst the uncertainty, there are unique opportunities in the form of virtual learning platforms, surgical simulations, and e-learning materials that can be adopted for imparting knowledge to undergraduate students and residents in ophthalmology. Embracing these changes will enable training programs to rise to the challenges of COVID-19 and ensure the provision of high-quality education for the future.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


1. Sud R, Sharma P, Budhwar V, Khanduja S Undergraduate ophthalmology teaching in COVID-19 times:Students'perspective and feedback Indian J Ophthalmol 2020 68 1490 1
2. Moran J, Briscoe G, Peglow S Current technology in advancing medical education:Perspectives for learning and providing care Acad Psychiatry 2018 42 796 9
3. Kaup S, Jain R, Shivalli S, Pandey S, Kaup S Sustaining academics during COVID-19 pandemic:The role of online teaching-learning Indian J Ophthalmol 2020 68 1220 1
4. Chick RC, Clifton GT, Peace KM, Propper BW, Hale DF, Alseidi AA, et al. Using Technology to maintain the education of residents during the COVID-19 pandemic J Surg Educ 2020 77 729 32
5. Chatziralli I, Ventura CV, Touhami S, Reynolds R, Nassisi M, Weinberg T, et al. Transforming ophthalmic education into virtual learning during COVID-19 pandemic:A global perspective Eye 2020 doi:10.1038/s41433-020-1080-0
6. Rajab MH, Gazal AM, Alkattan K Challenges to online medical education during the COVID-19 pandemic Cureus 2020 12 e8966
7. Mian A, Khan S Medical education during pandemics:A UK perspective BMC Med 2020 18 100
8. Mishra D, Nair AG, Gandhi RA, Gogate PJ, Mathur S, Bhushan P, et al. The impact of COVID-19 related lockdown on ophthalmology training programs in India-Outcomes of a survey Indian J Ophthalmol 2020 68 999 1004
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