Associations between medical education reforms and trends in the ophthalmology workforce and cataract surgery...

In 2008, Kazakhstan introduced a structured ophthalmology residency program. Between 2008 and 2020, two parallel training pathways coexisted: a three-year residency program and short-term ophthalmology training courses lasting up to six months. After 2020, only the residency program remained in place. This study aims to examine the associations between these medical education reforms and the observed trends in the absolute numbers and per million population (PMP) rates of ophthalmologists in Kazakhstan from 1998 to 2022. Furthermore, it explores temporal patterns in cataract surgery performance by ophthalmologists across the country.

Interrupted Time Series (ITS) analysis using ARIMA models was conducted to examine the associations between medical education reforms and the number and PMP rates of ophthalmologists in Kazakhstan, as well as their performance in conducting cataract surgeries.

Throughout the study period, the PMP rates of ophthalmologists ranged from 59.73 to 90.48, demonstrating an overall upward trend. The ITS model identified a statistically significant negative level change in both the number and PMP rates of rural ophthalmologists at the time of the residency program's introduction in 2008, whereas no statistically significant association was observed for urban ophthalmologists. The discontinuation of short-term training courses exerted a minor, statistically insignificant negative effect on the numbers and PMP rates of ophthalmologists. The number of cataract surgeries performed varied between 9,550 and 19,018, corresponding to a cataract surgical rate ranging from 639.72 to 1,067.88, with marked regional disparities.

This evaluation provides exploratory evidence on how medical education reforms may be associated with temporal changes in the ophthalmology workforce and cataract surgery performance, and can inform future policy discussions on ophthalmology training and service provision in Kazakhstan.