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Standardizing Glaucoma Fellowship Evaluation: Analysis of Goals, Objectives, and Fellowship Evaluation Criteria
Anna Haeyoon Kim1, Pradeep Ramulu1, Mary Qiu2
1Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD.
Purpose:
To evaluate the variability and alignment of learning objectives and evaluation practices across U.S. glaucoma fellowship programs, including an assessment of goal and evaluation quality using SMART criteria to inform the development of a standardized evaluation rubric.
Design:
Cross-sectional qualitative study.
Participants:
Twenty-three of 70 U.S. glaucoma fellowship programs (32.9%) responding to a survey distributed to fellowship directors.
Methods:
Fellowship directors submitted program goals/objectives and fellow evaluation forms. Documents underwent qualitative content analysis to characterize themes, granularity and alignment between objectives and evaluations. Goals and evaluation items were graded using SMART (Specific, Measurable, Achievable, Relevant, Time-bound) criteria on a 0-25 scale. Alignment was assessed by determining the proportion of stated objectives that were evaluated.
Main Outcome Measures:
(1) Thematic categories of learning objectives, (2) degree of detail in goals and evaluation rubrics, (3) SMART scores, and (4) alignment between goals and evaluation tools.
Results:
30.4% of responding programs lacked formal goals/objectives or evaluation forms. Goals varied widely in length (55-3,382 words) and detail. Common themes in goals included diagnostic acumen, medical and surgical management and professional development. Evaluation criteria commonly aligned with ACGME criteria. Mean SMART scores were 9.1/25 (range: 6.9-10.6) for goals documents, and 7.7/25 (range: 4.6-12.3) for evaluations, with lowest performance in the Measurable and Time-bound domains. Among six programs providing both goals and evaluations, a median of 83.4% of objectives were evaluated; however, evaluations frequently relied on broad non-standardized domains (e.g. "Patient Care", "Medical Knowledge") rather than milestone- or competency-based categories with behavioral anchors. Many specific competencies, such as office-based laser procedure proficiency or leadership/teaching responsibilities, were not explicitly assessed.
Conclusions:
U.S. glaucoma fellowship programs demonstrate substantial variability in goals and evaluation tools. Qualitative analysis revealed poor alignment between training objectives and assessment practices, with SMART criteria grading highlighting limited measurability and lack of time-bound expectations in both goals and evaluations. These findings underscore the need for a standardized, competency-based rubric with clear behavioral anchors to support consistent fellow training and evaluation across programs.