The results show that the level of satisfaction from the perspective of recent graduates of Ophthalmology residency training was high: 89.1% were very satisfied or extremely satisfied with the acquisition of clinical knowledge and 93.4% were very satisfied or extremely satisfied with the acquisition of surgical skills. Only one study  has looked at the satisfaction with the post graduation in ophthalmology (83%), and this showed results similar to ours findings.
We found a moderate positive correlation between the level of satisfaction with acquisition of clinical knowledge and the development of the doctor-patient relationship, and weak positive correlations between the level of satisfaction with acquisition of surgical skills and the development of the doctor-patient relationship, as well as between the level of satisfaction with acquisition of clinical knowledge and the acquisition of surgical skills. This is probably because the subjects that were more satisfied perceived more satisfaction in all aspects.
Despite the satisfaction with the acquisition of clinical knowledge being high, the subjects identified some deficient areas, especially orbit (48.3%) and ophthalmic pathology (47.9%). This is probably because these areas are not traditionally emphasized in ophthalmology residency programs in Brazil, despite the recommendations of the Brazilian Council of Ophthalmology. There are few ophthalmologists in Brazil that have experience in orbit.
In the assessment of surgical skills, analysis showed that the areas that were perceived as more deficient were refractive surgery (65.9%) and orbit (59.2%). One possible reason for deficiency in orbit may be that in Brazil, few ophthalmologists perform orbital surgery and that many refer their patients to other professionals, such as oral and maxillofacial surgeons. However, the residency training programs evaluated in this study are the main centers in ophthalmology in Brazil, where the most complex surgeries are performed. That even graduates of these programs would feel deficient in orbital surgery would indicate that surgery should be more emphasized in residency training. In the case of refractive surgery, another perceived area of deficiency, only one residency program in Brazil that was evaluated in this study has training in this type of surgery, even though this is a frequently performed surgery in Brazil. Besides that, the training in refractive surgery is mandatory for the accreditation of residency training programs in Brazil.
Results also show the odds ratio (OR) for perceiving deficiency in some specific surgical area when it had been perceived deficiency in clinical knowledge. Because of the correlation between a specific clinical area and its respective surgical area, when the subjects had perceived that clinical knowledge was deficient, they also had perceived similar deficiency in the surgery. This is an expected result because the acquisition of surgical skills has to be preceded of clinical knowledge, especially in some areas such as oculoplastic (OR: 227.14) and strabismus (OR: 50.56). These are areas where the clinical knowledge is much correlated to the surgery. It just did not happen with the area of optics/refraction and refractive surgery because the teaching of this surgery was inadequate not due to lack of clinical knowledge, but due to lack of infrastructure for teaching this surgery.
We found that the satisfaction with the development of the doctor-patient relationship (74.9%) was not as high as satisfaction with clinical knowledge and surgical skills possibly because the evaluated residency programs are not working well or are not thorough enough in this area.
Limitations of this type of study
All data collection instruments which use only the perceptions of the research subjects have high subjectivity, which may reflect more or less accurately the reality. Thus, perceptions of graduates may not be the best tool to objectively measure the quality of medical residencies, because at this point, objective examinations performed by Brazilian Council of Ophthalmology would be more appropriate. Nevertheless, the views and perceptions of graduates provide some useful information to assess whether the residency programs are preparing them adequately for the practice from their perspectives. The perceptions of graduates are rarely considered to assess residency programs and, to our knowledge, this is the first study on perceptions of graduates of medical residencies in ophthalmology in Brazil.