Standardizing Glaucoma Fellowship Evaluation: Analysis of Goals, Objectives, and Fellowship Evaluation Criteria Across United States Programs.

PURPOSE: To evaluate the variability and alignment of learning objectives and evaluation practices across US glaucoma fellowship programs, including an assessment of goal and evaluation quality using SMART (Specific, Measurable, Achievable, Relevant, Time-bound) criteria to inform the development of a standardized evaluation rubric.

DESIGN

Cross-sectional qualitative study.

PARTICIPANTS

Twenty-three of 70 US glaucoma fellowship programs (32.9%) responding to a survey distributed to fellowship directors.

METHODS

Fellowship directors submitted program goals and 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 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

In total, 30.4% of responding programs lacked formal goals/objectives or evaluation forms. Goals varied widely in length (55-3382 words) and detail. Common themes in goals included diagnostic acumen, medical and surgical management, and professional development. Evaluation criteria commonly aligned with Accreditation Council for Graduate Medical Education 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 nonstandardized 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 and teaching responsibilities, were not explicitly assessed.

CONCLUSIONS

United States 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.

FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.