Table 3 Themes, subthemes, and exemplary quotes highlighting ViSION volunteers’ experiences and perceptions regarding the impact of ViSION participation on their medical education

Motives for joining ViSION

  Exploring interest in ophthalmology

“I was interested in ophthalmology and I thought it would be a good way to confirm or deny, if I was interested. And secondly, if I was interested, I knew it would give me, like, good skills that would be useful for my career.”

“I would say the primary reason was because it was related to ophthalmology… I got to practice my skills in the ophthalmic exam and I got to learn more about the field. And those were really meaningful…as a first year med student [since] you don't get to do a whole lot in general that's clinically relevant so [ViSION] was something unique there.”

  Service

“…it's not just a program that's doing a health fair and screening individuals for vision problems but there is a clear continuity of follow up that we try for all patients…I thought it was really special that patients could get free glasses if they wanted from Wilmer, they could get pro bono care if they didn't have health insurance, and there was even a fund for patients to have surgery if they needed that… I was like, ‘Wow, that's really cool. I want to be involved in something like this.’”

“The main motivation was just really being—being able to be a part of the community that we are currently living in, and doing something that is impactful, not only for our own education but for the people that we serve.”

Educational value within ophthalmology

  Active engagement with ophthalmology

“I didn't know anything about this equipment, before doing [ViSION]. So I think it really helped like to hear about the different tools that are used… and then using that knowledge…going into for example [the neurology curriculum], like where they were talking about using the OCT to look at the thickness of the retina, to look at the different layers. Also, just like peripheral fields, like [for] things like that…if I didn't go through [ViSION]…, I feel like it would have been really hard for me to understand what they were talking about. So I think it did give me a leg up for [the neurology curriculum]…”

“As you continue to go to these events, you start piecing the different puzzles together, [such as how] visual acuity loss in the setting of high intraocular pressure with some fundoscopic changes [is a] hallmark for glaucoma…[that understanding] evolves over time…and I think that was very useful and unique about [ViSION] that you don't necessarily get to appreciate in just a classroom setting.”

“Because when you're shadowing or when you're on your elective, …a lot of the times, most of the role is the attending or the resident who's performing the surgery or seeing the patient in the clinic, and you can jump in, when it's like practical for you to do so, but you really can't have as active of a role in the ophthalmology clinic or OR so I feel like [ViSION] really allows you to take ownership of your like little station, or the like 20 patients you're seeing that day, and make sure that what you're seeing and recording and interpreting is correct.”

“I do feel like the ophthalmology portion that we get in didactics is quite limited, which is unfortunate…it really was [at ViSION screening events] where we got to dive into [ophthalmology] in person…[and assess] visual acuity, visual fields, [and] intraocular pressures, [perform] the fundoscopic exam, [see] the OCT images, and then [acquire and interpret] all that data, [make] something meaningful out of it, and [learn about] the disease process [with the help of] the faculty mentors…”

  Exposure to faculty

“I think it's so good to see role models like our own faculty, showing up and actually like dedicating their time, and like that sets precedence for like the next generation of people who are going to be in that position.”

“I think it was really interesting to see the unique differences that different attendings brought, so of course, some of the glaucoma people of course offered a lot of insights on ‘Hmm, this visual field looks a little bit weird. Let's do a second one instead.’ Whereas some of the retina people were really, really helpful in looking at some of the OCTs and saying, ‘You know, that looks really strange. I actually would want to see them in my clinic.’ And so it was really cool to have people from a variety of different subspecialties.”

Educational value outside of ophthalmology

  Early patient interaction

“…in terms of rotations, I think just being able to have experiences with patients really helped… you are talking to the patients and you're figuring out what their main worries are…a lot of that is very applicable to an actual rotation, especially the physical exam portion like you have to explain exactly…what the patient needs to do, and ophthalmology is really complicated so your instructions have to be really clear, and so that skill also helped in rotations when you're trying to get [patients] to like, follow a neuro exam or something and you don't really know how to explain it to them but you've already had experience with like translating the [ophthalmic] exam to them so that was pretty helpful.”

“This is one of the only student groups where you can actually learn a new skill and work…in a medical setting with patients. [I’ve seen other groups, where] you can do blood pressure testing, but it's not the same, I've been doing that since I was…17. But this was different. [With ViSION, I was] using a physical exam and diagnostic kind of reasoning for the first time, and…doing it in a volunteer setting, and that was just so unique.”

“So it really, I think, was helpful just learning how to talk to people from a different walk of life about their medical issues and trying to get personal information. And then there was also the aspect of dealing with people who had vision impairment—in my own life that's not something I've really dealt with, so I think just learning how to make it a comfortable and safe environment…for them and how to interact with them, was something that I got out of it.”

“If I remember first year, I don't think there were a lot of chances to speak to…real patients…You speak to…standardized patients which is…different…[But with ViSION, I was]…speaking to them and taking their history…When… directing them, I [gained] some experience…explaining to them how to do something…in an understandable way for… a lay person.”

  Meaningful service

“I felt like from the different organizations, I joined and sort of volunteered with, it felt like it was more for …students… trying to improve our clinical skills, learn how to just talk to patients. But it was really [ViSION] where I felt like, wow, we are actually providing a really helpful service to people in the community, like we get to go out to the community, do these amazing screenings, identify all this crazy pathology because they have basically no access to eye care, and then seeing the faculty actually take these people back to Wilmer, being able to follow up with those patients. I thought that was just extraordinary…”

“I would say the most valuable part is being able to see a patient who would not have normally gotten seen and screened for an ophth[almology] problem, and then being able to get them the…clinic appointment that they need…[T]hat value… that rewarding feeling you don't really get [in any other setting]…at least in your first and second year because you're really not seeing that many patients…”

“I was able to go to a local like retirement center a couple blocks from Hopkins and like, see where patients live, and that was very important, because it's much different from any experience I've ever had.”

“The most unique thing was really serving an underserved population. I guess I was pretty sheltered before it and it was really eye opening…to work with people [for whom] literally the only health care they got at all during that year was seeing [ViSION]. So I think that in terms of opening my eyes to the needs that exist and kind of disparities in Baltimore that was something I wouldn't have necessarily gotten in any other way. Because when you're in the clinic you're only seeing patients who go to clinic. Whereas when you're in…a housing facility in Baltimore, you're getting a lot of people who probably wouldn't otherwise see anybody. I think that was the most unique part.”

  Impact of leadership

“…when you're on the other end of it, …it just seems pretty straightforward and like seamless and like, easy to do, but when you're actually planning [screening events], it's a lot more difficult and there's a lot of things that you have to think about… you can do even more in the position of being on the board in terms of like helping future students by, and helping future patients by different initiatives that you can put forward.”

“It was always either at the training sessions where you're teaching, or actually at the events when you're teaching the students to, you know, review how to use each of the different devices, what the actual measurements, or values mean, when we should refer, what are the cut offs. So yeah, you're constantly teaching, and I think that's great, I think that's a fantastic part.”

Impact on career

  Increased interest in ophthalmology

I met my research mentor at one of our screenings, and I worked with him to this day almost four and a half years later. A lot of the work I do right now with [him], is about increasing accessibility and affordability of ophthalmic imaging technology. So I think it had a very direct impact on my research interest too.”

“I will certainly say that it wasn't [ViSION] that was…the tipping point for my decision [to go] into ophthalmology, [but] it was definitely a contributing component….I loved the fact that, [ViSION] taught me that there's this huge public health dimension in ophthalmology, that you can actually do this kind of work with the community… But for me personally… basic science vision research was [also] a huge factor.”

“I think it did confirm that I was interested in ophthalmology, and it also kind of helped me decide what area of ophthalmology I was interested in, like, I just loved, looking at the back of the eye [during screenings]. That was like one of my favorite screening days, so I was like “oh maybe glaucoma”, and I ended up doing a research project in glaucoma that summer.”

  Interest in public health

“When I'm hopefully a resident, …I would want to be the person who still like stays involved in those activities and organizations, like want to teach the med students, get them like excited by ophthalmology, do good work with the community, get them involved into the resident clinic, see them later when I'm a fellow or faculty member, so yeah I think that's going to be a long term kind of thing, and I do think that [ViSION] helped shape that, for sure.”

“[ViSION] really was informative for me personally, because it showed me how ophthalmologists can serve those who are less fortunate. There's a perception that I've encountered of surgical subspecialties in general, that it is difficult for them to make [an] impact in those types of communities. And I saw that was definitely not the case…I had mentors and role models and experience to show me that was definitely feasible…That's something I envision for my future career, and it's something that I [now] know I can achieve in a career in ophthalmology.”

“[ViSION] really, I think, for the first time made me interested in kind of public health and serving underserved populations… from the engineering background, …you work in high tech by working with people who have the money to pay for it. But I think I found through [ViSION] I learned about this whole other side of medicine and the whole interest I didn't know I had…on my rotations, it made me a lot more focused on like social determinants of health… I'm doing a master's in BME right now, and one of my projects is related to hearing health, and I've really taken that project in like a community health direction specifically to… help deliver hearing care to underserved communities in Baltimore because I had such a rewarding experience with [ViSION]…I can definitely draw a direct line between that and what I'm doing now.”

“I would love in my future career to be a mentor for a group like this… there's a special role for the students being the primary actors or the primary caregivers in this situation, there's a lot for them to learn and to gain from that.”