Melanie Cole, MS (Host): Welcome to Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole. And in this episode today, we have a panel of ophthalmologists from Northwestern Medicine sharing their key highlights and insights from this year's AUPO Annual Conference.

Joining me in this panel is Dr. Nicholas Volpe. He's the Chair of Ophthalmology and the George W. and Edwina S. Tarry Professor of Ophthalmology. He's also the President of the AUPO, Association of University Professors of Ophthalmology. Dr. Rukhsana Mirza, she's the Vice Chair of Faculty Affairs in the Department of Ophthalmology, the Ryan-Pusateri Professor of Ophthalmology, and the Director of Medical Student Education in Ophthalmology. And Dr. Dmitry Pyatetsky, he's an Associate Professor of Ophthalmology in Medical Education and Program Director of the Ophthalmology Residency Program at Northwestern Medicine.

Doctors, thank you so much for joining us today as we get into this topic and you are highlighting these things for other providers. Dr. Volpe, let's start with you. How was the event overall? Tell us a little bit about how you felt it went as far as organization, participants, presentation, diversity. Give us a little brief overview of the event itself.

Dr. Nick Volpe: Thank you very much, Melanie. It's really my pleasure to be here and to share with this audience what was, I think, certainly a highlight of my career and of the organization's history. This was our most widely attended AUPO meeting over the last 50 or so years. And what's important to recognize is that this organization is made up of a constituency that includes all different experts and leaders within the specialty of Ophthalmology, and particularly Academic Ophthalmology. You'll hear from my colleagues, Dr. Pyatetsky and Dr. Mirza, who are experts in the different spaces. One is residency, the other is in medical student education. But there's also a fair amount of scholarship around education that's presented.

There is an extensive program around administration for Departments of Ophthalmology. There are some research presentation. There are organizational reports. Our coordinators attend the meeting. And in the end, it really is, as we like to say, several meetings within a meeting. It really represents the growth of the organization over the last three decades. And if you think about the panoply of activities that represents what the AUPO does as representatives of the profession and particularly the training programs in Ophthalmology, there are a number of areas that we touch on.

This year was particularly exciting for me, obviously, as the president. I get to host the president symposium, which we'll talk about, I'm sure, over the next few minutes. And in addition, I was able to coordinate a number of different interactions between the various constituencies and a number of different meetings and interactions that allowed us to make some important decisions over the course of the four days.

This was an important meeting because we transitioned our Executive Vice President, who's Dr. Steve Felton, who did it for 10 years, to Dr. Paul Sternberg, who is now the new EVP and/or CEO, if you will, of our organization. And it was a meeting that was very much centered around the new strategic plan, which we rolled out over the last few years. It takes on a very consistent form that we can describe. I was particularly pleased with my involvement in something that's called the Chairs Bootcamp, which we have a program that is designed for new chairpersons of various departments of Ophthalmology, in which we, if you will, share our wisdom. Around the same time, you'll hear about the Educating the Educators meeting, which was ongoing. And then, we move into a number of sessions over the three days that include various parts of the constituent members that participate throughout the presentations.

So in the end, the widest attended meeting, we had lots of programming that include Breakfast With The Experts and Chats With Chairs. And many social events, as we all know in the medical business, some of the best parts of these meetings are just the chance to be together, to network, to be social, to get ideas from our colleagues. And then, there was a fair amount of good science and good research into education. A lot of important decisions were made. We heard a lot of great presentations, including a research presentation by one of our residents. And we tackled some important topics. Unique challenges to having a resident clinic, some of the challenges we face in the health equity space, all of these things were discussed and vetted in a very productive way in a meeting that I was very proud to be the, if you will, emcee and work closely with our program committee planning group that really set up a fantastic experience for our membership.

Melanie Cole, MS: I would imagine you are an outstanding emcee, Dr. Volpe, with your personality. And as the president of the AUPO, what are some of the outcomes the association looks to achieve with these annual conferences, the social factor and the educational factor? Tell us a little bit about why these are so important.

Dr. Nick Volpe: Thank you. That's an important question. And it's one that I think that is very much geared to accomplishing the goals of our strategic plan. And very much at the very top of that pillar, of course, is our vision, is to improve vision, right? That's ultimately what ophthalmologists and the people that train them and do research are doing. But a lot of what we do is really advocating for Academic Ophthalmology and communicating its value and helping to decide and shape what is the future of the profession.

As you'll hear from Dr. Mirza, another big focus is the career development of not only our academic faculty, but also our future leaders. There's a program within AUPO called the Leadership Development Program, in which we're specifically targeting the next generation of Ophthalmology leaders and creating impactful programming that allows a sense of belonging for all, so that you could be a medical student educator that is with 30 or 40 of his or her closest colleagues that are all trying to do research together and network together for best solutions. You could be a program director colleague and participate in an active discussion about whether we'll have virtual or in-person interviews during residency season. All of these things are different each year and each of the goals that we attempt to accomplish are different each year.

The ultimate goal is to have a very nimble organization that's able to have a structure that continuously improves, and change, adds program, stays fiscally responsible, decides the space that it wants to function in, decides what it's going to advocate for on a national level, and to bring as many people into our field as possible to get the next generation of leaders that are diverse, that come from different areas of expertise and that participate in all four of our missions of clinical care, education, research, and community service.

So, all of those things are happening at the same time. You could not possibly attend all of the content that exists because they're meetings that are going on simultaneously. But, ultimately, there are several times where we all come together, not only for dinner and receptions, but more for discussions that always leave time for audience comment, that always allow for free interaction both out loud in the symposium and sort of in the hallways as we do the things that we need to, to ensure Ophthalmology's future.

Melanie Cole, MS: Dr. Volpe, in addition to your role as emcee and president, you presented as well. Tell us about the topics that you presented on, give us a brief summary. And we'll talk about some of the notable presentations that you attended and what stood out there.

Dr. Nick Volpe: Sure. So as I mentioned, I was sort of at most of it all the time, but I had specific presentations that were part of first the Chairs Bootcamp, which is again this meeting that happens in the afternoon, right before the general meeting starts. We speak specifically to our fellow new chairpersons on topics that represent important parts of their skill set.

My particular area of interest and assigned topic that day was on gifts and endowments and building a fundraising team. There is no margin for our mission. And I personally believe that philanthropy fundraising and accessing our Grateful Patient pipeline and our Visionary Philanthropy pipeline to identify support for fundraising is important. And I clearly sent that message to my colleagues. We also had a small session on faculty compensation models, as you can imagine. You've seen one place, you've seen one place. And in this particular example, we had good discussion on the different models that departments and/or medical centers can choose to adopt in order to pay their faculty fairly competitively, and in a way that allows for a great feeling of productivity at the same time as being fiscally responsible.

And then, most important to me, of course, was, as the president, you get to organize the President's Symposium. And I, in particular, have great concerns about the future of our profession, the direction it's heading, and some of the unique challenges that we are facing in Academic Ophthalmology. And some of those are as simple as the health equity and pathways part of our profession, maybe not perceived by the lay public. There's the flight of ophthalmologists away from medical centers and away from their obligations to hospitals to just be in practice and work in surgery centers.

The challenge we have attracting physician scientists. We have certain specialties within Ophthalmology, particularly Pediatrics and Neuro-Ophthalmology, Uveitis, Pathology, which aren't attracting enough physicians for the future. And I particularly enjoyed this symposium because we had leaders from some of many of our important profile organizations like the American Academy of Ophthalmology and the ACGME participating in their version and their future predictions. And we capped it off by a presentation by Dr. Felton, who is the exiting EVP, who obviously has the perspective of the AUPO for 10 years and what its role might be in the future of our profession. So, those were the highlights. But obviously, I was there for all the main sessions in addition to some of the workshops and breakout sessions.

Melanie Cole, MS: Dr. Volpe, before we move on to Dr. Mirza and Dr. Pyatetsky, as the Department Chair at Northwestern Medicine, were there any presentations that stood out to how you can continue to enhance patient care? And as you're speaking to other ophthalmologists, what would you like them to know are the most important bits about these presentations, the research that you found interesting, the most exciting things that you learned?

Dr. Nick Volpe: I know, I have a very biased position as I sit at the perch in this department. And some of the stuff that I find most compelling and most interesting might not be as interesting to the other participants. And we have a session for a couple of hours in which we have organizational reports. And in this setting, for instance, we would get a what is on the minds of the American Board of Ophthalmology, what's on the minds of the AUPO, what's on the mind of our major advocacy group, AEVR/NAEVR. We did not have a presentation for various reasons from the National Eye Institute this cycle. But in those sessions, as a chair, you sit in the audience and say, "I didn't realize that that was on the horizon, or that was coming," or "We better prepare for that," or "How should we be pivoting in our residency to anticipate changes that occur in those ways?"

And then, quite frankly, you know, it's not a traditional scientific meeting in terms of new knowledge in my specialty, but I was particularly pleased and have always been with the partnership that the organization has with Research to Prevent Blindness, which is the largest private philanthropy-funding organization for vision research. And they host a couple of symposiums, including the week's lecture. And most exciting for us are the presentations by four residents or fellows from around the country that are selected for the outstanding work that they do. And as I mentioned, one of our residents, Drew Voigt, was fortunate enough to be selected to present some of his exciting work that he's doing with Dr. Levine. So, when we hear these presentations to me, it tells me the future is bright and that there is lots of talent that's interested in doing Vision Science and Ophthalmology.

Melanie Cole, MS: Thank you so much for really giving us a great overview of not only the presentations that you found interesting, but of the event itself. And Dr. Mirza, on to you. What topics did you present on? Give us a little bit of a summary.

Dr. Rukhsana Mirza: Thank you, Melanie. Well, this is, as Dr. Volpe mentioned, one of the best meetings that I feel I attend all year. I have been attending this meeting for more than a decade, probably over 15 years, and it really has been defining for me in my career. And it's all of the ability to network with not only directors of medical student education, but also program directors and chairmen and research directors and administrators. Even our coordinators attend these meetings. So, it's really the place where Education Ophthalmology is disseminated, the best practices, and the decision-makers. So, it's just really a joy to know what's going on in Ophthalmology.

I wear a couple hats in our department. So, one of the roles that I have is medical student education. So, those presentations related to how we're going to be doing our upcoming match and advising our students are particularly interesting to me. One of the things that I organize is a match webinar yearly to advise students who are pursuing the profession of Ophthalmology. And we do that with the AUPO as well as the AAO along with the SF Match Oversight committee. So, learning all of the things that our constituents are interested in learning really is one of the highlights of how I participate in this meeting.

In addition, one of the pillars of the AUPO or strategic priorities is faculty development, and there were quite a few faculty development talks. I was able to do a workshop session with one of our groups, which is called Investing, Training, Equipping, and Promoting Individuals for Distinction in Ophthalmology or INTREPID.

There are several faculty development groups. Dr. Volpe had touched upon the ALDP, which is the Academic Leadership Development Program, which has a reception. And as an alumni of that, it's always great to go back and see all of the new individuals who are participating in that program. I'm also one of the co-founders of the Women Professors of Ophthalmology Initiatives, which is an initiative underneath the AUPO, whose mission is to really advance the career of women and all phases of their career, and help women go through the promotion process. We have amazing partners in the AUPO and we hold a reception there.

So through those organizations, I was able to present an exercise for young faculty to learn how to map their network. The purpose of this really is to help mentors and mentees connect and understand how faculty can use their own network maps to take the initiative and develop their own careers. So, that was really, really meaningful for me.

In addition, I was asked to do a Breakfast With The Experts and it was on AI in Ophthalmology. And that is just such an exciting aspect of our profession right now, because we're so ripe to really take on the benefits of artificial intelligence. However, it's really emerging and there are so many questions about how it can be implemented, where it can be implemented. And some of the things that we're talking about is its growing role in health care, how AI can be used for retinal diseases and diagnostics. Some case studies related to that. In addition, AI is being used in surgical simulation. And that is a really fascinating aspect of how AI can be used. Certainly, it's used in retinal imaging, and we discussed how it could be used within education to help us with our residents and our fellows and our medical students and, really, how do we create a curriculum around this? So, those were some of the ways that I participated this year.

Dr. Nick Volpe: I think you can really get a sense from the things I said. And in a minute, you'll hear from Dmitry in a whole different direction based on Rukhsana's input. But there's just so many different things that are happening and going on. This is really the epicenter of Academic Ophthalmology and how we make decisions about what is the content, what's important, what are the logistics, what are the administrative challenges, in a way that allows us to make decisions together and to be distinct as a specialty within the Academic Medicine family, if you will.

Melanie Cole, MS: Such an interesting event. And Dr. Mirza, I agree with you. The AI in Ophthalmology, what an exciting way to look at this. And it's only moving quicker. And the advancements, the technology, it's absolutely fascinating. Can you tell us about some of the notable presentations that you attended? What stood out for them? Or any research breakthroughs that you found really fascinating?

Dr. Rukhsana Mirza: The first day of AUPO is called the Educating the Educators. And I really enjoy the way that our educators come together to make decisions. There was a discussion in the form of a debate as to how interviews should be undergone in the future. Post pandemic, our interviews have been virtual. So, there's discussion now of should they be virtual, should they return back to being in-person or should they be hybrid? And it was just really interesting to see the different perspectives and how the entire group came together to discuss those.

Other things that I found interesting were there's this session called Guidance With the Gurus, where you can table hop, and some of the sessions were about how to counsel students who may be struggling, how to counsel residents who may be struggling, how do you counsel people for a successful match, career counseling for faculty, simulation in education, and even ergonomics, and certainly wellness. So, the topics were just vast. And truly, as Dr. Volpe mentioned, you couldn't be everywhere, but it's truly all the relationships and all of the vastness of what you could take away that's just really awe-inspiring.

Melanie Cole, MS: Like a kid in an ophthalmology medical candy store, right? There's just so much exciting things going on in all of your fields. And Dr. Pyatetsky, what about some of the notable presentations that you attended? What stood out in them? And was there any research breakthroughs that you found fascinating?

Dr. Dmitry Pyatetsky: Melanie, thank you for having me on this podcast. I really enjoy going to AUPO. I've been going over 15 years now as well, similar to Dr. Mirza. And I always find that the meeting, there's always something new I learn. And, as the residency program director, I come to the meeting with essentially a very specific pragmatic purpose. It is critical for me to understand where residency education is going, what are some of the changes on the horizon so that I can be proactive in my residency program here at Northwestern to make sure that we are embracing where the field is going and we are well-prepared and we're not surprised, so to say. Because, you know, as an organization, it takes a little bit of time to pivot whenever changes happen, which they do all the time.

So, I come to the meeting, I listen. Some of the interesting discussions that were of most interest to me had to do once again with resident education. Specifically, there was a nice discussion that was already mentioned by Dr. Volpe, the notion of resident education. clinics in Ophthalmology and essentially the ethics of what it means to have a resident clinic.

It's very interesting to see how the field has adjusted over the years. Resident clinics used to be the cornerstone of Ophthalmology residency education throughout the country. And looking around and listening to the talks, it became pretty clear that specific resident clinics where patients are effectively tiered into a clinic due to their ability to pay or due to having their coverage essentially have fallen out of favor, understandably so. And I find it as a very positive development.

At the same time, resident clinics have not disappeared, but have essentially shifted in their focus to often become urgent care clinics supervised by fully-trained faculty where patients of any type and any ability to pay come through and receive care in similar ways. So, this is a model that we embraced at Northwestern probably over a decade ago. And it's interesting to see that so many more centers are embracing a similar model.

Another topic that I found interesting in terms of the discussions that I've heard was what is happening with veterans hospitals, which are a big part of resident education. Residents see patients at the veterans hospitals and participate in the care of the veterans. And it has become apparent that, over the years, many of the veterans are electing to go and get care in the community, that the volume of patients, at least in Ophthalmology, is going down at the veterans hospitals. And there was a little bit of discussion as to what that means, what may the impact be down the road on resident education due to the declining volumes in Ophthalmology residency clinics at the VA and due to changes in the surgical volumes coming through in the veteran's system.

Finally, I attended the Residency Review Committee Update, which occurs every year. And there, there were several things that were discussed. The one that really stood out to me was the notion of competency-based residency education, how it applies to ophthalmology and where it is headed.

Now, traditional residency program involves three or four years of ophthalmology training, and everybody goes through the same time, same curriculum and outcomes, an ophthalmologist. Well, with the competency-based curriculum, the thought is that the focus of the training should be the outcomes, and it should not necessarily be the time that a resident spends training in Ophthalmology, but rather how they're performing in any given aspect of what is expected of an ophthalmologist upon graduation.

So, the field is slowly moving to embrace this notion. More flexibility is being introduced through the Residency Review Committee in terms of what is allowed and what's not allowed within the curriculum, encouraging people to innovate. And one of the things that we have done, for example, at Northwestern is introduce a research track to keep individuals who are interested in a physician-scientist training career to keep them on this track of being not just a clinician, but also a scientist upon graduation from residency. So, this flexibility and the notion of competency-based education is making such tracks a reality. So, these were the highlights that I enjoyed listening to.

Dr. Nick Volpe: Dmitry, just along the lines about what you brought up about different pathways, you and I have had some preliminary discussions kind of matching the President's Symposium with the RRC about potentially developing a Pediatric Ophthalmology-specific pathway. That will allow medical students to identify early about going into Pediatrics, which is a very different field than Adult Ophthalmology. Do we have any further thoughts on how we might do that?

Dr. Dmitry Pyatetsky: Yeah. That was an incredibly exciting news that we heard from the conference, from the Residency Review Committee, embracing the notion of creating a track that's specifically focused on Pediatric Ophthalmology training. And a similar track, incidentally, for Neuro-Ophthalmology and Uveitis but from our perspective, that would allow a resident to complete their residency program and fellowship training all within the span of the same four years. Once again, piggybacking on the notion of competency-based education and flexible curricula that can be offered to individual residents.

So, this is something that we are certainly going to be looking into at Northwestern. I have already begun preliminary discussions with our partner, Lurie Children's Hospital, where they have expressed very significant interest, because everybody understands the dire need for Pediatric Ophthalmology and the concern for lack of qualified individuals going into this field.

The nice thing about the track like this is that it would save a person with interest in Pediatric Ophthalmology a whole year of training. It is thought that one of the major challenges in recruiting pediatric ophthalmologists is that, ultimately, the remuneration for this work is less than some of the other fields within Ophthalmology. By saving a whole year of training, the individual is thought to recoup at least some of the potential lost income.

Melanie Cole, MS: Well, that is so interesting. What a great idea, Dr. Pyatetsky. And I'd love to give you all a chance for final thoughts here. So, starting with Dr. Mirza, what are you looking forward to learning or hearing about more as a followup to this year's event? And if you could look to the future and say, "I really want to make sure that we...." what? What would you want other providers to know that couldn't attend the event? And what are you looking forward to in the future?

Dr. Rukhsana Mirza: Well, I'm really looking forward to the AUPO developing its programming related to faculty-- so, faculty who don't necessarily attend the AUPO meeting. It was actually described-- Laura Green described this in her ACGME talk is almost like having a program director for young faculty, to guide them through their careers. So, I'm really looking forward to the AUPO developing its programming related to improving faculty's ability to teach, how faculty navigate their careers, and how do we develop the next generation of leaders. So, those are the things that I'm really excited about, and I'm excited about participating in as well.

Melanie Cole, MS: Dr. Pyatetsky, it's up to you now. What would you like other providers to know about this event, the key takeaways, what you found most important? But also, as Dr. Mirza was just discussing, what are you looking forward to? What would you like to see happen in the future for these types of events for providers that weren't able to attend?

Dr. Dmitry Pyatetsky: Thank you, Melanie. Once again from my residency program director perspective, I think the AUPO meeting is absolutely critical for any educational leader within Ophthalmology. The information that gets disseminated and the thoughtful discussions that occur at this meeting are absolutely critical to understanding where the field is moving to. And I would absolutely encourage any individual who is interested in Ophthalmology leadership, in medical education to attend this program in the future.

I certainly hope that the embrace of the meeting leadership of the notion of flexibility in residency education curriculum continues, and I look forward to the various innovations that will come as a result of the flexibility in these curriculum.

Melanie Cole, MS: Dr. Volpe, last word to you as the president of the AUPO, as the expert that you are, the esteemed professor that you are, I'd like your thoughts and takes on what you would like to see going in the future for this organization and these events, what you would like other providers to know that couldn't attend this event. Give us the key takeaways and your best summary, doctor.

Dr. Nick Volpe: Well, I think the last word for me might be a few paragraphs, but I'll do my best to be as concise as I can. Obviously, as a president and board member, my most important message to our fellow ophthalmologists, of course, is that the AUPO is thriving, that it has expanded its activities to include many more things than just a simple meeting where chairs and program directors come together.

As you heard from Dr. Mirza, there's incredible content, both for students. And her important work is helping us develop these programs for all faculty, not just the faculty that are program directors and medical student educators. And from Dr. Pyatetsky, obviously, this is the place where residency education, its nuts, its bolts, its future, how it is nuanced, whether we can change it, all of these discussions happen there and it is going to be critically important going into the future that we don't just go back to our idealized past and think about the change that needs to happen to create a future that is compatible with the way the world is changing.

This organization has never been more important. There are numerous threats that are facing higher education and academic medicine that are on the horizon. And we need to work together as an organization to help each other be represented locally and as a group to ensure that we're there to take care of the public.

Along the way, we hadn't mentioned, but there's an entire curriculum within AUPO called SCOR, Surgical Curriculum for Ophthalmology Residents. It's an important group that we sponsor. This is a program to ensure that we're training the best possible surgeons. And that when surgeons leave their training, that they've all been assessed and get to the right level to know that they're the kind of people that we all want operating on our family members.

We have a unique opportunity here at Northwestern, I think, to be thought leaders. Our system has evolved so effectively to incorporate education, community service, having a big program spreading out. In fact, our department administrator, Meg Templeton, gave an in-your-backyard presentation where she spoke about all of the various activities that Northwestern does and does to promote great patients first, discovery-driven care, that I think stole the show for a lot of her colleagues and feel how well positioned we are.

So, you know, my charge to the profession and the people that weren't there is to lean in, to check the website, to get involved if you can. And then, my charge to my colleagues-- Rukhsana and Dmitry have been incredible partners to me over the last 15 years-- is to let's take what Northwestern does, especially uniquely, its resources, our willingness to take a risk and be innovative, and really take the lead on the future of how this department teaches, researches, educates, and cares for the entire Chicagoland community.

Melanie Cole, MS: Wow. So well said. And this is why Northwestern Medicine is really leading the way in the field of Ophthalmology. What an interesting discussion this was today. I want to thank you all for joining us and sharing your expertise and highlighting this conference for us.

To refer your patient or for more information, please visit our website at breakthroughsforphysicians.nm.org/ophthalmology to get connected with one of our providers. That concludes today's episode of Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole. Thanks so very much for joining us today.