Evaluation of Website Accessibility and Content for All Glaucoma Fellowship Programs in the United States

In the past decade, the proportion of ophthalmology residents applying for fellowships has increased drastically.¹ One of the most frequent specialties to which ophthalmology fellowship applicants match is glaucoma. From 2010 through 2017, glaucoma fellows comprised 20.8% of all ophthalmology fellows, trailing only retina (35.5%) and cornea and external disease (23.5%) as other popular ophthalmology fellowships.¹ As interest in glaucoma fellowship programs continues to rise, so, too, does the applicants’ need for tools to evaluate potential programs to make informed choices about where to apply.¹

The internet is an important source of information for trainees researching potential programs. Residency and fellowship program websites have been cited by applicants as an important factor when deciding where to apply and how to rank programs during the match process.² The coronavirus disease 2019 (COVID-19) pandemic has elevated the role of the fellowship program website as an information source for prospective applicants, with programs shifting to virtual interviews and often using online resources such as program websites and social media accounts to communicate with prospective applicants.³ Previous content analyses of fellowship websites suggest that program websites should relay both recruitment and education information to prospective applicants.⁴ As such, this cross-sectional study evaluated glaucoma fellowship websites for both (1) accessibility and (2) recruitment and education content.

The Stanford School of Medicine Institutional Review Board declared this study exempt from oversight because all data obtained were publicly available. All research adhered to the tenets of the Declaration of Helsinki. We used the Association of University Professors of Ophthalmology Fellowship Compliance Committee website (https://aupofcc.org/programs-in-compliance?institution=&state=All&sub_specialty%5B%5D=glaucoma) to obtain a list of glaucoma fellowship programs in compliance with Fellowship Compliance Committee guidelines. To evaluate website accessibility, a Google search was performed for each fellowship program with the following search terms: program name + glaucoma fellowship. A fellowship website was defined as one created with the purpose of providing information about the fellowship program, regardless of whether it was under the domain of a larger institution. If a glaucoma fellowship website was not found on the first page of the Google search, a manual search of the affiliated ophthalmology department website was conducted. If the glaucoma fellowship website still was not found, then the website was deemed inaccessible and excluded from the content analysis.

To evaluate website content, fellowship program websites were evaluated based on 10 criteria related to the recruitment of fellows and 10 criteria related to the educational experience of fellows. The 10 recruitment criteria consisted of the following: program description, salary and benefits, faculty listing, current fellow(s), program contact e-mail and phone, community demographic information, alumni job placement, prior fellow listing, application link, and video content. The 10 education criteria consisted of the following: rotation overview, evaluation criteria, research opportunities, journal club, operative experience, call schedule, academic meetings and conferences, affiliated hospital information, grand rounds, and resident teaching responsibilities.

Fellowship programs were grouped based on number of fellows, number of faculty, affiliation with a top 12 ophthalmology program, and geographic location. For number of fellows, programs were stratified in 2 groups: 1 fellow versus 2 or more fellows. For number of faculty, programs were stratified into 3 groups based on the number of clinical faculty affiliated with the program: 1 to 3, 4 to 5, or 6 or more. For affiliation with a top ophthalmology program, fellowships affiliated with ophthalmology programs that were ranked in the top 12 of the Ophthalmology Times 2020 rankings were compared with unranked programs.⁵ For geographic location, programs were divided into Midwest, Northeast, South, and West based on regions defined by the United States Census Bureau. We compared the number of educational, recruitment, and total content scores between programs of various sizes, affiliations, and locations based on the aforementioned stratified groups using the Mann–Whitney U test or Kruskal-Wallis test, as appropriate.

Slightly more than 90% of glaucoma fellowship programs (57/ 62) had a website with specific information pertaining to the fellowship. The large majority of programs (80.6%; n = 50) had a direct link to their fellowship website after a Google search for the program, with only a few programs (11.3%; n = 7) requiring multiple clicks after the Google search to reach the desired webpage.

Glaucoma fellowship program websites contained an average of 4.5 of a possible 10 recruitment criteria (standard deviation, 1.67; range, 2–9), 6.4 of a possible 10 education criteria (standard deviation, 2.15; range, 2–10), and 10.9 of a possible 20 total recruitment and education criteria (standard deviation, 3.02; range, 5–17). The percentage of fellowship program websites containing each of the 20 recruitment and education criteria can be observed in Tables 1 and 2. The distribution of total recruitment and education content sores can be observed in Figure S1 (available at www.ophthalmologyglaucoma.org).

Table 1:

Percentages of Fellowship Program Websites with Various Recruitment and Education Criteria

Recruitment Criteria	N (%)	Education Criteria	N(%)
Program Description	57 (100)	Rotation Overview	53 (93.0)
Faculty Listing	50 (87.7)	Affiliated Hospital Information	52 (91.2)
Program Contact Email/Phone	39 (68.4)	Research Opportunities	50 (87.7)
Application Link	32 (56.1)	Operative Experience	50 (87.7)
Current Fellow (s)	18 (31.6)	Resident Teaching Responsibilities	47 (82.5)
Community Demographic Information	17 (29.8)	Academic Meetings/Conferences	32 (56.1)
Salary/Benefits	17 (29.8)	Grand Rounds	29 (50.9)
Prior Fellow Listing	12 (21.1)	Journal Club	23 (40.4)
Video Content	12 (21.1)	Call Schedule	22 (38.6)
Prior Fellow Job Placement	5 (8.8)	Evaluation Criteria	4 (7.0)

Table 2:

Comparison of Website Content by Program Characteristics

Characteristic	# of Programs	Mean Education Content (SD)	p	Mean Recruitment Content (SD)	p	Mean Total Content (SD)	p
# of Fellows			0.652		0.242		0.384
1	32	6.3 (2.2)		4.3 (1.7)		10.6 (2.9)
2+	25	6.5 (2.1)		4.8 (1.7)		11.3 (3.1)
# of Faculty *
1–3	13	6.4 (1.9)	0.781	3.8 (1.1)	0.109	10.2 (2.5)	0.223
4–5	21	6.3 (2.4)		4.8 (1.6)		11.1 (2.6)
6+	17	6.8 (2.1)		5.1 (1.9)		11.9 (3.5)
Top 12 Affiliation			0.034		0.242		0.015
Yes	13**	7.5 (2.0)		5.2 (1.5)		12.7 (2.4)
No	44	6.0 (2.1)		4.3 (2.8)		10.4 (3.0)
Region			0.863		0.222		0.496
Northeast	10	6.4 (2.2)		5.1 (1.2)		11.5 (2.5)
Midwest	16	6.7 (2.2)		4.9 (1.9)		11.6 (3.4)
South	20	6.3 (1.9)		4.4 (2.9)		10.7 (2.6)
West	11	5.9 (2.6)		3.9 (1.6)		9.8 (3.5)

SD - standard deviation. Boldface indicates statistical significance

^*6 programs did not specify # of clinical faculty

^**two fellowships were associated with the same top 12 ophthalmology program, resulting in 13 programs affiliated with top 12 ophthalmology programs

Total number of fellows, total number of faculty, and geographic region did not impact fellowship program website education, recruitment, or total content scores (Tables 1 and 2). Notably, 6 programs did not include any information about faculty members. Fellowship programs affiliated with a top 12 ophthalmology program had greater education content scores (P = 0.034) as well as total content scores (P = 0.015) when compared with programs not affiliated with top 12 ophthalmology programs (Tables 1 and 2).

This cross-sectional analysis revealed differences in the accessibility and content of glaucoma fellowship program websites. Approximately 80% of glaucoma fellowship programs maintained an easily accessible website to display program information to potential applicants. Of those with websites, none contained all of the criteria we assessed, with most program websites containing approximately half of the 20 recruitment and education criteria included in this study, demonstrating highly variable websites with room for improvement. Additionally, we identified several recruitment and education criteria often missing from program websites that have been deemed important by graduate medical applicants, including fellow salary and benefits, alumni job placement, and call schedule.⁶

Study limitations include possible other criteria not considered in our website evaluation, binary (yes or no) scoring system used to evaluate each of the 20 recruitment and education criteria, and the dynamic nature of websites, which could have been updated since they were evaluated.

A concerted effort to improve program websites would require minimal investment, but would be beneficial to applicants and institutions alike, with the potential to result in applicants more easily comparing fellowship programs, making more informed decisions about where to apply, and optimizing matches between applicants and programs.