a questionnaire cum feedback form was circulated to 
 ophthalmology residents in west maharashtra ( appendix 1 ) . 

students were asked to gauge didactic lectures , 
 lectures with power point presentations , seminars , journal 
 club , case presentations , and wet lab on a scale of 0 ( most 
 unsatisfactory ) to 4 ( best ) .
they were asked how many surgeries 
 they had seen , how many they needed to assist and to perform 
 to be considered confident and trained in that technique .
there 
 were open - ended questions regarding the library facilities , 
 teaching basic techniques of examination of patient , outreach 
 camps , eye banking , wet laboratory and other diagnostic aids . 

the form was developed at the community eye care department 
 of the hospital and piloted on the residents of the same institute . 

it was administered to the resident doctors by giving it to them 
 and asking for the completed form after three days .
if they had 
 not filled it , the request was repeated after a week .
the request 
 was made through a social worker or a fellow resident , but was 
 not directed through the department head or the postgraduate 
 teacher .
the residents were free not to put their name at the 
 end , but had to fill in details of age , sex and number of years 
 of residency completed .
the average age was 25 years ( range 2234 years , 95% ci 21 to 
 29 ) .
the minimum number of residents in a program was three , 
 and the maximum 18 .
the distribution of residency programs 
 was government medical college ( one ) , private medical college 
 ( two ) tertiary private general hospital ( one ) and eye hospitals 
 ( three ) , two of them being community eye care centers .
the residents graded lectures with power point presentations 
 ( on a scale of 0 to 4 ) with median as 4 and didactic lectures 
 ( without power point ) with median as 2 .
thirty - eight out of 67 
 ( 56.7% ) gave the maximum 4 points to power point presentation 
 lecture , while only 4/67 ( 6% ) gave it for the didactic lecture .
the 
 median of seminar , case presentation with discussion , wet lab 
 and journal club was 3 , 4 , 3 and 3 respectively .
twenty - seven out 
 of 67 ( 40.3% ) gave full marks to the seminar .
fifty - seven out of 
 67 ( 85.1% ) gave the maximum points ( 4 ) for case presentation . 

twenty out of 67 were unaware of wet lab facilities , but 29/47 
 ( 61.7% ) who were aware of it gave full marks to wet lab . 

twelve ( 17.1% ) were unaware about the journal club and three 
 institutions did not have it as a method of teaching .
twenty- 
 seven of the 55 were aware of it ( 49.1% ) , gave the maximum 
 points ( 4 ) to a journal club .
all ( 67/67 ) residents were in favor of regular objectively 
 structured clinical examination ( osce ) tests or viva voce 
 examination .
thirty - eight out of 67 wanted to be tested 
 every six months , 10/67 monthly , while 4 /67 were for weekly 
 assessments .
only 
 three institutions ( all eye hospitals ) had more than 100 books 
 on ophthalmology in their library .
all had internet facilities 
 but 42/67 ( 61.2% ) of students complained of lack of access to 
 it .
residents also desired to be taught separately to handle 
 perimetry , b - scan , neodymium yttrium argon garnet ( nd : 
 yag ) laser and ultrasonic biomicroscopy .
thirty - two out of 67 wanted to learn more about eye donation 
 and enucleation .
the surgeries observed and those actually performed by the 
 resident doctors are shown in table 1 along with the number 
 they perceived they ought to assist and independently perform 
 to gain mastery in it .
the figures are of surgeries performed 
 by second- and third - year residents only during their 
 residency tenure .
most students wanted basic ophthalmology 
 and refraction to be taught more with emphasis on squint 
 and neuro - ophthalmology .
they wanted more hands - on 
 experience in using basic diagnostic aids like 90d , 78d , indirect 
 ophthalmoscope , gonioscopy , applanation tonometry and 
 perimetry .
the case presentation in which a resident doctor presented a 
 patient history and examination before a professor or a tutor 
 in the presence of other residents was the most popular form 
 of teaching for the trainees .
the discussion regarding lacuna 
 in history - taking , examination and possible investigations and 
 management that followed the presentation was considered 
 most rewarding .
the resident doctors were not enamored 
 by didactic lectures which are common in most medical 
 schools , especially for undergraduates and they need to be 
 supplemented with more audio - visual aids .
the seminar 
 in which one or more resident doctors made audiovisual 
 presentations about a certain topic , with a tutor as facilitator , 
 was popular .
an indian study reported that almost one - third 
 of the institutions had a wet lab facility.2 the journal club in which a resident doctor summarized 
 or read an article from a peer - reviewed journal in presence 
 of a tutor and other residents was graded an average of 3.14 . 

a structured journal club was found to be a useful tool for 
 practice - based learning in the us.3 an indian study showed 
 that only 51/128 ( 41.4% ) institutions subscribed to more than 
 two international journals.2 an austrian study showed three - dimensional animated 
 teaching to be a useful adjunct to surgical videos , especially 
 for female medical students.4 virtual reality training as used 
 by trainee pilots has been proposed as a method to teach 
 surgical competence in the us.5 a three - dimensional computer 
 animation technology was shown to significantly increase 
 the quality and efficiency of education and demonstration of 
 complex topics in ophthalmology in austria.6 but only three 
 eye hospitals in our study had video libraries . though all the institutions had internet access ,
the majority 
 of the students ( 42/67 , 61.2% ) in all except two institutions 
 complained about lack of adequate access .
erratic connections , 
 limited library hours and restrictions on trainee doctors using 
 the web were cited as reasons for lack of access .
as more 
 and more information is available on the internet , this seems 
 paradoxical and unfortunate .
none of the teaching programs 
 had structured curriculum for basic skills like history - taking 
 and ocular examination .
but 
 a us study had reported worrisome erosion of acquired skills 
 of eye examination amongst their students.7 there is a huge variation in the actual number of surgeries 
 performed [ table 1 ] .
but the variation is still large even after 
 allowing for the exceptions . a study in 2002
had shown 
 that an average surgery per trainee in an institution per 
 year was 111 cataract surgeries , 4.8 glaucoma surgeries , 2.2 
 squint surgeries , 4 lid surgeries , 2.2 keratoplasty and 0.8 
 dacryocystorhinostomy surgeries.2 even though there seems to 
 be an adequate number of surgeries being performed annually 
 per student in an institution , the large range and median of 
 zero for most surgery types denotes the enormous difference 
 between various institutions . and
the resident doctors 
 perceptions differ significantly from what was reported 
 by the heads of ophthalmology .
half the residents had not 
 performed any kind of surgery other than cataract surgery . 

the students expectations in the number needed to perform 
 to be considered adequately trained were not met , even after 
 considering that few had unrealistic expectations .
non - cataract surgical training is neglected and this shows 
 the training program in poor light .
except two , none of the 
 teaching programs had any emphasis on surgeries other 
 than cataract .
nearly one - third of the residents enrolling for 
 ophthalmology resident programs do not graduate into eye 
 surgeons in the us but continue as medical ophthalmologists.8 
 some are unable to improve their surgical skills even after 
 repeated training for surgical skills and 12% were asked to leave 
 the residency .
one study promotes the use of an aptitude test to 
 assess basic surgical inclination / competence like the american 
 dental associations dental ( sample ) admission test.9 a larger 
 turnover of cases and easier acceptance of complications in 
 the indian setting may be responsible for most of the trainees 
 metamorphosizing into eye surgeons .
clinical audit should 
 be employed to monitor and improve surgical outcome of 
 ophthalmology trainess.10 preferred practice patterns put forth 
 by the american academy of ophthalmology can be modified 
 and used in indian settings .
it is concluded that the residency program in ophthalmology 
 is not up to the expectations of postgraduate students in many 
 teaching centers in most of maharashtra .
a study conducted 
 by thomas et al . revealed that despite provision of adequate 
 resources to funded medical colleges , their quality of residency 
 training was inadequate.11 the new curriculum and manual 
 proposed by the national board of examination , new delhi 
 addresses many of these issues .
the national board has strived 
 to streamline and standardize postgraduate medical education 
 all over india .
we hope that other universities in the country shall 
 also follow a similar pattern .
 the study aimed to gauge ophthalmology resident doctors 
 perception of their teaching programs and various methods 
 used in it and to formulate a well structured program for 
 teaching ophthalmology . closed ended and open - ended 
 questionnaires were used for survey of ophthalmology residents 
 in west maharashtra , india . 
 sixty - seven out of 69 residents of 
 seven residency programs completed the questionnaire . on 
 a 
 scale of 0 ( most unsatisfactory ) to 4 ( best ) , lectures with power 
 point presentation had a median score of 4 , didactic lectures 2 , 
 seminar 3 , case presentation 4 , wet lab 3 and journal club 3 . 
 
 there was a discrepancy in the actual number of surgeries 
 performed by the resident doctors and their perception of the 
 number needed to master those surgeries . 
 phacoemulsification 
 and non - cataract surgery training was neglected in most 
 programs . 
 the residents wanted to be evaluated regularly and 
 taught basic ophthalmic examination , use of equipments and 
 procedures in greater depth . 