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Spencer SKR, Ireland PA, Braden J, Hepschke JL, Lin M, Zhang H, Channell J, Razavi H, Turner AW, Coroneo MT, Shulruf B, Agar A. A Systematic Review of Ophthalmology Education in Medical Schools: The Global Decline. Ophthalmology 2024; 131:855-863. [PMID: 38185285 DOI: 10.1016/j.ophtha.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 12/15/2023] [Accepted: 01/02/2024] [Indexed: 01/09/2024] Open
Abstract
TOPIC This systematic review examined geographical and temporal trends in medical school ophthalmology education in relationship to course and student outcomes. CLINICAL RELEVANCE Evidence suggesting a decline in ophthalmology teaching in medical schools is increasing, raising concern for the adequacy of eye knowledge across the rest of the medical profession. METHODS Systematic review of Embase and SCOPUS, with inclusion of studies containing data on medical school ophthalmic course length; 1 or more outcome measures on student ophthalmology knowledge, skills, self-evaluation of knowledge or skills, or student course appraisal; or both. The systematic review was registered prospectively on the International Prospective Register of Systematic Reviews (identifier, CRD42022323865). Results were aggregated with outcome subgroup analysis and description in relationship to geographical and temporal trends. Descriptive statistics, including nonparametric correlations, were used to analyze data and trends. RESULTS Systematic review yielded 4596 publication titles, of which 52 were included in the analysis, with data from 19 countries. Average course length ranged from 12.5 to 208.7 hours, with significant continental disparity among mean course lengths. Africa reported the longest average course length at 103.3 hours, and North America reported the shortest at 36.4 hours. On average, course lengths have been declining over the last 2 decades, from an average overall course length of 92.9 hours in the 2000s to 52.9 hours in the 2020s. Mean student self-evaluation of skills was 51.3%, and mean student self-evaluation of knowledge was 55.4%. Objective mean assessment mark of skills was 57.5% and that of knowledge was 71.7%, compared with an average pass mark of 66.7%. On average, 26.4% of students felt confident in their ophthalmology knowledge and 34.5% felt confident in their skills. DISCUSSION Most evidence describes declining length of courses devoted to ophthalmology in the last 20 years, significant student dissatisfaction with courses and content, and suboptimal knowledge and confidence. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Sascha K R Spencer
- The University of New South Wales, Sydney, Australia; Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Patrick A Ireland
- The University of New South Wales, Sydney, Australia; Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Jorja Braden
- The University of Sydney, Sydney, New South Wales, Australia; Melanoma Institute of Australia, Sydney, New South Wales, Australia
| | - Jenny L Hepschke
- The University of New South Wales, Sydney, Australia; Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Michael Lin
- The University of New South Wales, Sydney, Australia
| | - Helen Zhang
- The University of New South Wales, Sydney, Australia
| | - Jessie Channell
- University of Western Australia, Perth, Western Australia, Australia; Lions Eye Institute, Perth, Western Australia, Australia
| | - Hessom Razavi
- University of Western Australia, Perth, Western Australia, Australia; Lions Eye Institute, Perth, Western Australia, Australia
| | - Angus W Turner
- University of Western Australia, Perth, Western Australia, Australia; Lions Eye Institute, Perth, Western Australia, Australia
| | - Minas T Coroneo
- The University of New South Wales, Sydney, Australia; Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Boaz Shulruf
- The University of New South Wales, Sydney, Australia
| | - Ashish Agar
- The University of New South Wales, Sydney, Australia; Prince of Wales Hospital, Sydney, New South Wales, Australia.
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Deuchler S, Dail YA, Berger T, Sneyers A, Koch F, Buedel C, Ackermann H, Flockerzi E, Seitz B. Simulator-Based Versus Traditional Training of Fundus Biomicroscopy for Medical Students: A Prospective Randomized Trial. Ophthalmol Ther 2024; 13:1601-1617. [PMID: 38615132 PMCID: PMC11109054 DOI: 10.1007/s40123-024-00944-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 03/25/2024] [Indexed: 04/15/2024] Open
Abstract
INTRODUCTION Simulation training is an important component of medical education. In former studies, diagnostic simulation training for direct and indirect funduscopy was already proven to be an effective training method. In this prospective controlled trial, we investigated the effect of simulator-based fundus biomicroscopy training. METHODS After completing a 1-week ophthalmology clerkship, medical students at Saarland University Medical Center (n = 30) were block-randomized into two groups: The traditional group received supervised training examining the fundus of classmates using a slit lamp; the simulator group was trained using the Slit Lamp Simulator. All participants had to pass an Objective Structured Clinical Examination (OSCE); two masked ophthalmological faculty trainers graded the students' skills when examining patient's fundus using a slit lamp. A subjective assessment form and post-assessment surveys were obtained. Data were described using median (interquartile range [IQR]). RESULTS Twenty-five students (n = 14 in the simulator group, n = 11 in the traditional group) (n = 11) were eligible for statistical analysis. Interrater reliability was verified as significant for the overall score as well as for all subtasks (≤ 0.002) except subtask 1 (p = 0.12). The overall performance of medical students in the fundus biomicroscopy OSCE was statistically ranked significantly higher in the simulator group (27.0 [5.25]/28.0 [3.0] vs. 20.0 [7.5]/16.0 [10.0]) by both observers with an interrater reliability of IRR < 0.001 and a significance level of p = 0.003 for observer 1 and p < 0.001 for observer 2. For all subtasks, the scores given to students trained using the simulator were consistently higher than those given to students trained traditionally. The students' post-assessment forms confirmed these results. Students could learn the practical backgrounds of fundus biomicroscopy (p = 0.04), the identification (p < 0.001), and localization (p < 0.001) of pathologies significantly better with the simulator. CONCLUSIONS Traditional supervised methods are well complemented by simulation training. Our data indicate that the simulator helps with first patient contacts and enhances students' capacity to examine the fundus biomicroscopically.
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Affiliation(s)
- Svenja Deuchler
- Augenzentrum Frankfurt, Georg-Baumgarten-Straße 3, 60549, Frankfurt am Main, Germany.
- Department of Ophthalmology, Saarland University Medical Center, 66424, Homburg, Saar, Germany.
| | - Yaser Abu Dail
- Department of Ophthalmology, Saarland University Medical Center, 66424, Homburg, Saar, Germany
| | - Tim Berger
- Department of Ophthalmology, Saarland University Medical Center, 66424, Homburg, Saar, Germany
| | - Albéric Sneyers
- Department of Ophthalmology, Saarland University Medical Center, 66424, Homburg, Saar, Germany
| | - Frank Koch
- Augenzentrum Frankfurt, Georg-Baumgarten-Straße 3, 60549, Frankfurt am Main, Germany
| | - Claudia Buedel
- Augenzentrum Frankfurt, Georg-Baumgarten-Straße 3, 60549, Frankfurt am Main, Germany
| | - Hanns Ackermann
- Institute of Biostatistics, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Elias Flockerzi
- Department of Ophthalmology, Saarland University Medical Center, 66424, Homburg, Saar, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, 66424, Homburg, Saar, Germany
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Campion JR, Cantillon P. A corporeal conundrum: Challenges posed by remote consultation for postgraduate medical education. CLINICAL TEACHER 2024; 21:e13672. [PMID: 37811728 DOI: 10.1111/tct.13672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/08/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND The COVID-19 pandemic accelerated the use of remote consultation in hospital outpatient clinics. Remote consultation alters the clinical environment and the learning environment in ways that are incompletely understood. This research sought to explore how trainees negotiate training and learning in such an environment when it is novel to them. METHODS Purposive sampling was used to recruit eight doctors from the gastroenterology department of an academic teaching hospital. Four consultants and four trainees participated in individual, semi-structured interviews. Interpretative phenomenological analysis of interview transcripts was employed and themes developed from the analysis, to characterise the experience of learning and teaching in remote consultation clinics, as described by participants. RESULTS Participants described how they try to create mental representations of each patient they review by remote consultation. Whilst consultants found this task relatively easy, trainee physicians found remote consultation more challenging and highlighted the importance of the physical presence of the patient to help them form a holistic sense of the patient's condition. Doctors in training also struggled to develop a workable mental model of the patient's condition when physical examination was precluded by remote consultation. CONCLUSIONS This study highlights the place of the patient's physical presence as an essential educational stimulus to facilitate teaching and learning. Further research is needed to characterise the processes clinicians use to formulate mental models of patients who are physically absent from the consultation room.
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Affiliation(s)
- John R Campion
- School of Medicine, University of Galway, Galway, Ireland
| | - Peter Cantillon
- Discipline of General Practice, University of Galway, Galway, Ireland
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Vilela MAP, Arrigo A, Parodi MB, da Silva Mengue C. Smartphone Eye Examination: Artificial Intelligence and Telemedicine. Telemed J E Health 2024; 30:341-353. [PMID: 37585566 DOI: 10.1089/tmj.2023.0041] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023] Open
Abstract
Background: The current medical scenario is closely linked to recent progress in telecommunications, photodocumentation, and artificial intelligence (AI). Smartphone eye examination may represent a promising tool in the technological spectrum, with special interest for primary health care services. Obtaining fundus imaging with this technique has improved and democratized the teaching of fundoscopy, but in particular, it contributes greatly to screening diseases with high rates of blindness. Eye examination using smartphones essentially represents a cheap and safe method, thus contributing to public policies on population screening. This review aims to provide an update on the use of this resource and its future prospects, especially as a screening and ophthalmic diagnostic tool. Methods: In this review, we surveyed major published advances in retinal and anterior segment analysis using AI. We performed an electronic search on the Medical Literature Analysis and Retrieval System Online (MEDLINE), EMBASE, and Cochrane Library for published literature without a deadline. We included studies that compared the diagnostic accuracy of smartphone ophthalmoscopy for detecting prevalent diseases with an accurate or commonly employed reference standard. Results: There are few databases with complete metadata, providing demographic data, and few databases with sufficient images involving current or new therapies. It should be taken into consideration that these are databases containing images captured using different systems and formats, with information often being excluded without essential detailing of the reasons for exclusion, which further distances them from real-life conditions. The safety, portability, low cost, and reproducibility of smartphone eye images are discussed in several studies, with encouraging results. Conclusions: The high level of agreement between conventional and a smartphone method shows a powerful arsenal for screening and early diagnosis of the main causes of blindness, such as cataract, glaucoma, diabetic retinopathy, and age-related macular degeneration. In addition to streamlining the medical workflow and bringing benefits for public health policies, smartphone eye examination can make safe and quality assessment available to the population.
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Affiliation(s)
| | - Alessandro Arrigo
- Department of Ophthalmology, Scientific Institute San Raffaele, Milan, Italy
- University Vita-Salute, Milan, Italy
| | - Maurizio Battaglia Parodi
- Department of Ophthalmology, Scientific Institute San Raffaele, Milan, Italy
- University Vita-Salute, Milan, Italy
| | - Carolina da Silva Mengue
- Post-Graduation Ophthalmological School, Ivo Corrêa-Meyer/Cardiology Institute, Porto Alegre, Brazil
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Deuchler S, Dail YA, Koch F, Buedel C, Ackermann H, Flockerzi E, Seitz B. Efficacy of Simulator-Based Slit Lamp Training for Medical Students: A Prospective, Randomized Trial. Ophthalmol Ther 2023; 12:2171-2186. [PMID: 37294522 PMCID: PMC10287863 DOI: 10.1007/s40123-023-00733-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 05/11/2023] [Indexed: 06/10/2023] Open
Abstract
INTRODUCTION Simulation training has an important role in medical education. In ophthalmology, simulation-based training has been shown to be significantly effective for surgical and diagnostic training in direct and indirect ophthalmoscopy. In this study, we analysed the effects of simulator-based slit lamp training. METHODS In this prospective controlled trial, medical students in their eighth semester at Saarland University Medical Center (n = 24) who had attended a 1-week ophthalmological internship were randomized into two groups: The traditional group (n = 12) was examined directly after the 1-week internship; the simulator group (n = 12) was trained with the slit lamp simulator before passing an objective structured clinical examination (OSCE). A masked ophthalmological faculty trainer assessed the students' slit lamp skills (maximum total score 42 points [pts]): preparation (5 pts), clinical examination (9.5 pts), assessment of findings (9.5 pts), diagnosis (3 pts), commentary on the examination approach (8 pts), measurement of structures (2 pts) and recognition of five diagnoses (5 pts). All students completed post-assessment surveys. Examination grades and survey responses were compared between the groups. RESULTS The overall performance of the slit lamp OSCE was significantly better (p < 0.001) in the simulator group than in the traditional group (29.75 [7.88] vs. 17.00 [4.75]) with significantly higher scores for the preparation and assessment of slit lamp controls (5.0 [0.0] vs. 3.0 [3.5]; p = 0.008) and localization of relevant structures (6.75 [3.13] vs. 4.0 [1.5]; p = 0.008). Consistently higher scores, but not significant, were assigned for the description of structures found (4.5 [3.38] vs. 3.25 [2.13]; p = 0.09) and the correct diagnosis (3.0 [0.0] vs. 3.0 [0.0]; p = 0.48). Surveys reflected the students' subjectively perceived knowledge gain during the simulator training for slit lamp illumination techniques (p = 0.002), recognition (p < 0.001), and assessment of the correct localization of pathologies (p < 0.001). CONCLUSION Slit lamp examination is an important diagnostic method in ophthalmology. Simulator-based training improved students' examination techniques for localizing anatomical structures and pathological lesions. The transfer of theoretical knowledge into practice can be achieved in a stress-free atmosphere.
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Affiliation(s)
- Svenja Deuchler
- Augenzentrum Frankfurt, Georg-Baumgarten-Straße 3, 60549, Frankfurt am Main, Germany.
- Department of Ophthalmology, Saarland University Medical Center, 66424, Homburg/Saar, Germany.
| | - Yaser Abu Dail
- Department of Ophthalmology, Saarland University Medical Center, 66424, Homburg/Saar, Germany
| | - Frank Koch
- Augenzentrum Frankfurt, Georg-Baumgarten-Straße 3, 60549, Frankfurt am Main, Germany
- Department of Ophthalmology, University Hospital, Goethe University Frankfurt, 60590, Frankfurt am Main, Germany
| | - Claudia Buedel
- Augenzentrum Frankfurt, Georg-Baumgarten-Straße 3, 60549, Frankfurt am Main, Germany
| | - Hanns Ackermann
- Institute of Biostatistics, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Elias Flockerzi
- Department of Ophthalmology, Saarland University Medical Center, 66424, Homburg/Saar, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, 66424, Homburg/Saar, Germany
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Faro JM, Pbert L, Crawford S, Frisard CF, Pendharkar JA, Sadasivam RS, Geller AC, Mazor KM, Ockene JK. U.S. medical students personal health behaviors, attitudes and perceived skills towards weight management counseling. Prev Med Rep 2022; 27:101814. [PMID: 35656208 PMCID: PMC9152782 DOI: 10.1016/j.pmedr.2022.101814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 03/28/2022] [Accepted: 04/30/2022] [Indexed: 11/16/2022] Open
Abstract
Physicians' abilities to address obesity in routine care may be affected by their own health behaviors, skills in and attitudes toward weight management counseling (WMC). Gender differences have been noted amongst these factors as well. We examined gender differences in personal health behaviors and predictors of perceived WMC skills and attitudes of medical students enrolled in a WMC trial. Enrollment took place in 2020 and consisted of students from eight U.S. medical schools. Baseline measures included demographics, exercise, and weight management behaviors, WMC attitudes and perceived skills. Descriptive statistics were calculated, and linear mixed models used to assess the effect of personal health behaviors on outcomes of WMC attitudes and perceived skills. Complete data were available for 1145 medical students. More males reported exercising 4 or more days/week (58.6% v. 41.4%), being more likely to monitor their weight (75.6% v. 70.3%) and less likely to intentionally attempt weight loss in the past (50.3% v. 65.3%) compared to females (all p's < 0.05). Exercising 4 or more days per week was positively associated with perceived WMC skills in the adjusted model (β = 0.10, CI 0.06 to 0.14, p < 0.01). Exercise frequency was positively associated with perceived WMC skills, regardless of gender. WMC curriculum may consider focusing on personal health behaviors such as exercise to increase perceived WMC skills.
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Affiliation(s)
- Jamie M. Faro
- University of Massachusetts Chan Medical School, Department of Population and Quantitative Health Sciences, 368 Plantation St., Worcester, MA, United States
- Corresponding author.
| | - Lori Pbert
- University of Massachusetts Chan Medical School, Department of Population and Quantitative Health Sciences, 368 Plantation St., Worcester, MA, United States
| | - Sybil Crawford
- University of Massachusetts Chan Medical School, Department of Population and Quantitative Health Sciences, 368 Plantation St., Worcester, MA, United States
| | - Christine F. Frisard
- University of Massachusetts Chan Medical School, Department of Population and Quantitative Health Sciences, 368 Plantation St., Worcester, MA, United States
| | - Jyothi A. Pendharkar
- University of Massachusetts Chan Medical School, Department of Population and Quantitative Health Sciences, 368 Plantation St., Worcester, MA, United States
| | - Rajani S. Sadasivam
- University of Massachusetts Chan Medical School, Department of Population and Quantitative Health Sciences, 368 Plantation St., Worcester, MA, United States
| | - Alan C. Geller
- Harvard School of Public Health, Department of Social and Behavioral Sciences, 677 Huntington Ave., Cambridge, MA, United States
| | - Kathleen M. Mazor
- Meyers Health Care Institute, University of Massachusetts Medical School, 385 Grove St., Worcester, MA, United States
- University of Massachusetts Chan Medical School, Department of Medicine, 55 N Lake Ave., Worcester, MA, United States
| | - Judith K. Ockene
- University of Massachusetts Chan Medical School, Department of Population and Quantitative Health Sciences, 368 Plantation St., Worcester, MA, United States
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Howell GL, Chávez G, McCannel CA, Quiros PA, Al-Hashimi S, Yu F, Fung S, DeGiorgio CM, Huang YM, Straatsma BR, Braddock CH, Holland GN. Prospective, Randomized Trial Comparing Simulator-based versus Traditional Teaching of Direct Ophthalmoscopy for Medical Students. Am J Ophthalmol 2022; 238:187-196. [PMID: 34801508 DOI: 10.1016/j.ajo.2021.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 10/30/2021] [Accepted: 11/09/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare results of simulator-based vs traditional training of medical students in direct ophthalmoscopy. DESIGN Randomized controlled trial. METHODS First-year medical student volunteers completed 1 hour of didactic instruction regarding direct ophthalmoscopes, fundus anatomy, and signs of disease. Students were randomized to an additional hour of training on a direct ophthalmoscope simulator (n = 17) or supervised practice examining classmates (traditional method, n = 16). After 1 week of independent student practice using assigned training methods, masked ophthalmologist observers assessed student ophthalmoscopy skills (technique, efficiency, and global performance) during examination of 5 patient volunteers, using 5-point Likert scales. Students recorded findings and lesion location for each patient. Two masked ophthalmologists graded answer sheets independently using 3-point scales. Students completed surveys before randomization and after assessments. Training groups were compared for grades, observer- and patient-assigned scores, and survey responses. RESULTS The simulator group reported longer practice times than the traditional group (P = .002). Observers assigned higher technique scores to the simulator group after adjustment for practice time (P = .034). Combined grades (maximum points = 20) were higher for the simulator group (median: 5.0, range: 0.0-11.0) than for the traditional group (median: 4.0, range: 0.0-9.0), although the difference was not significant. The simulator group was less likely to mistake the location of a macular scar in 1 patient (odds ratio: 0.28, 95% confidence interval: 0.056-1.35, P = .013). CONCLUSIONS Direct ophthalmoscopy is difficult, regardless of training technique, but simulator-based training has apparent advantages, including improved technique, the ability to localize fundus lesions, and a fostering of interest in learning ophthalmoscopy, reflected by increased practice time.
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Song A, Lusk JB, Roh KM, Jackson KJ, Scherr KA, McNabb RP, Chatterjee R, Kuo AN. Practice Patterns of Fundoscopic Examination for Diabetic Retinopathy Screening in Primary Care. JAMA Netw Open 2022; 5:e2218753. [PMID: 35759262 PMCID: PMC9237789 DOI: 10.1001/jamanetworkopen.2022.18753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
IMPORTANCE Primary care professionals (PCPs) have a central role in screening for diabetic retinopathy (DR), especially in settings where access to specialty eye care is limited. Data on current DR screening practice patterns in primary care are needed to inform screening strategies. OBJECTIVES To assess the practice patterns of fundoscopic examination for DR screening in a large primary care network and to evaluate the sensitivity and accuracy of PCP fundoscopy for detecting DR. DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study was performed using random sampling and manual review of electronic health records of PCP fundoscopic examination documentation compared with documentation of an examination performed by an eye care professional (ophthalmologist or optometrist) within 2 years before or after primary care encounters. From a single-institution primary care network of 28 clinics, 7449 adult patients with diabetes seen at least once in the primary care network in 2019 were eligible for this study. Data from 2001 encounters were abstracted from the electronic health record for a random sample of 767 patients. Data analysis was performed from January 2021 to May 2022. EXPOSURE Fundoscopic examination by PCPs. MAIN OUTCOMES AND MEASURES The frequency of PCPs performing fundoscopy at least once in the calendar year for patients with diabetes. Univariate and multivariable logistic regression analyses were performed to identify patient, clinician, and clinic factors associated with PCPs performing fundoscopy at least once in the calendar year. The PCP examination results were compared with diagnoses made by eye care professionals to assess the sensitivity and accuracy of the findings from PCP examinations. RESULTS Among the 767 adult patients with diabetes included in the analysis, 387 (50.5%) were female, and the median age was 64 years (IQR, 54-71 years). Primary care professionals documented a fundoscopic examination for 93 patients (12.1%); all results were documented as normal. When eye care professional examination results were used as the reference standard, the accuracy of PCP fundoscopic examination was 62.7% (95% CI, 50.0%-73.9%) and sensitivity for detecting disease was 0.0% (95% CI, 0.0%-14.9%). No patient demographic or clinical characteristics were associated with PCPs performing fundoscopy. In multivariable logistic regression, the number of PCP years in practice was associated with greater odds of patients receiving fundoscopy at least once in the year (adjusted odds ratio per 10 years in practice, 1.26; 95% CI, 1.01-1.59; P = .04); having nurse practitioner credentials was associated with lower odds of receiving fundoscopy (adjusted odds ratio, 0.23; 95% CI, 0.04-0.79; P = .049; compared with having physician credentials); after adjusting for rural clinic location, clinic location in a primary care shortage area, and documentation of an up-to-date eye care professional examination by a PCP in the study year. CONCLUSIONS AND RELEVANCE In this cohort study, fundoscopic examination was rarely performed and was not sensitive for detecting DR in primary care practice. Because the rate of DR screening by eye care professionals remains low, research to explore and break down barriers to the implementation of effective primary care-based DR screening strategies, such as teleretinal imaging, is needed to prevent vision loss from undiagnosed DR.
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Affiliation(s)
- Ailin Song
- Duke University School of Medicine, Durham, North Carolina
| | - Jay B. Lusk
- Duke University School of Medicine, Durham, North Carolina
- Duke University Fuqua School of Business, Durham, North Carolina
| | - Kyung-Min Roh
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Kevin J. Jackson
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | - Karen A. Scherr
- Department of Family Medicine and Community Health, Duke University, Durham, North Carolina
| | - Ryan P. McNabb
- Department of Ophthalmology, Duke University, Durham, North Carolina
| | | | - Anthony N. Kuo
- Department of Ophthalmology, Duke University, Durham, North Carolina
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
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He G, Dunn HP, Ahmad KE, Watson E, Henderson A, Tynan D, Leaney J, White AJ, Hewitt AW, Fraser CL. Fundoscopy Use in Neurology Departments and the Utility of Smartphone photography (
FUNDUS
): A prospective prevalence and crossover diagnostic accuracy study amongst neurology inpatients. Eur J Neurol 2022; 29:2463-2472. [PMID: 35531644 PMCID: PMC9541490 DOI: 10.1111/ene.15390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/13/2022] [Accepted: 05/05/2022] [Indexed: 11/30/2022]
Abstract
Background and purpose Although fundoscopy is a crucial part of the neurological examination, it is challenging, under‐utilized and unreliably performed. The aim was to determine the prevalence of fundus pathology amongst neurology inpatients and the diagnostic accuracy of current fundoscopy practice compared with systematic screening with smartphone fundoscopy (SF) and portable non‐mydriatic fundus photography (NMFP). Methods This was a prospective cross‐sectional surveillance and diagnostic accuracy study on adult patients admitted under neurology in an Australian hospital. Inpatients were randomized to initial NMFP (RetinaVue 100, Welch Allyn) or SF (D‐EYE) followed by a crossover to the alternative modality. Images were graded by neurology doctors, using telemedicine consensus neuro‐ophthalmology NMFP grading as the reference standard. Feasibility parameters included ease, comfort and speed. Results Of 79 enrolled patients, 14.1% had neurologically relevant pathology (seven, disc pallor; one, hypertensive retinopathy; three, disc swelling). The neurology team performed direct ophthalmoscopy in 6.6% of cases and missed all abnormalities. SF had a sensitivity of 30%–40% compared with NMFP (45.5%); however, it had a lower rate of screening failure (1% vs. 13%, p < 0.001), a shorter examination time (1.10 vs. 2.25 min, p < 0.001) and a slightly higher patient comfort rating (9.2 vs. 8/10, p < 0.001). Conclusion Our study demonstrates a clinically significant prevalence of fundus pathology amongst neurology inpatients which was missed by current fundoscopy practices. Portable NMFP screening appears more accurate than SF, whilst both are diagnostically superior to routine fundoscopic practice, feasible and well tolerated by patients.
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Affiliation(s)
- George He
- The University of Melbourne Melbourne (Vic) Australia
| | - Hamish P. Dunn
- The University of Sydney (Faculty of Medicine & Health), Sydney, (NSW) Australia
- Westmead Hospital, (Department of Ophthalmology), Sydney, (NSW) Australia
- The University of New South Wales (Rural Clinical School) Port Macquarie (NSW) Australia
| | - Kate E. Ahmad
- Royal North Shore Hospital, (Department of Neurology), Sydney, (NSW) Australia
| | - Eloise Watson
- Royal North Shore Hospital, (Department of Neurology), Sydney, (NSW) Australia
| | - Andrew Henderson
- Westmead Hospital, (Department of Neurology), Sydney, (NSW) Australia
| | - Dominique Tynan
- The University of Sydney (Faculty of Medicine & Health), Sydney, (NSW) Australia
- Royal Victorian Eye & Ear Hospital, (Vic) Australia
| | - John Leaney
- The University of Sydney (Faculty of Medicine & Health), Sydney, (NSW) Australia
- Westmead Hospital, (Department of Ophthalmology), Sydney, (NSW) Australia
| | - Andrew J. White
- The University of Sydney (Faculty of Medicine & Health), Sydney, (NSW) Australia
- Westmead Hospital, (Department of Ophthalmology), Sydney, (NSW) Australia
- Centre for Vision Research Westmead Institute for Medical Research Sydney
| | - Alex W. Hewitt
- The University of Melbourne Melbourne (Vic) Australia
- Centre for Eye Research Melbourne (Vic) Australia
| | - Clare L. Fraser
- The University of Sydney (Faculty of Medicine & Health), Sydney, (NSW) Australia
- Save Sight Institute Sydney, The University of Sydney, (NSW) Australia
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Reeve J, Hibbert A. Evaluation of the Attitudes and Confidence of Veterinary Undergraduates toward Working with Cats in the Veterinary Hospital Environment. JOURNAL OF VETERINARY MEDICAL EDUCATION 2022; 49:45-50. [PMID: 33970837 DOI: 10.3138/jvme-2020-0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
An understanding of feline behavior is required to successfully handle cats in the hospital environment and avoid triggering escalation to fear-aggression due to heightened anxiety. Some veterinary students appear to misinterpret feline behavioral cues, resulting in frustration and poor success when performing basic handling. This article investigates the following in regard to veterinary students and feline handling: (a) attitudes toward working with feline patients in the hospital environment; (b) experience of working with feline patients; (c) satisfaction in acquisition of feline handling and examination skills; and, (d) confidence in feline handling skills; and to explore influencing factors. An electronic questionnaire was circulated to fourth and final year veterinary students (May 2012) and final year students (June 2013) for anonymous voluntary completion. One hundred and seventy-three of 293 students completed the questionnaire. Of final year respondents, 87/115 (75.7%) indicated that they enjoy interacting with cats in veterinary hospitals; 95/115 (82.6%) indicated that they were satisfied with their cat handling skills; 105/115 (91.3%) felt confident handling quiet and wriggly cats; significantly fewer 63/115 (54.8%) felt confident handling unpredictable cats (p < .05). Factors significantly affecting confidence in handling unpredictable cats included: frequency of examination practice during extra-mural studies (p < .05), enjoyment of interacting with cats in veterinary hospitals (p < .05), self-perceived understanding of feline behavior (p < .05), self-perceived ability to interpret cats' behavioral expressions (p < .05), satisfaction with cat handling skills (p < .05), and perception of feline versus canine handling ability (p < .05).
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Attitudes Toward Physical Examination Skills among registered nurses in clinical settings in Jordan. INFORMATICS IN MEDICINE UNLOCKED 2022. [DOI: 10.1016/j.imu.2022.101027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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12
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Leidi A, Saudan A, Soret G, Rouyer F, Marti C, Stirnemann J, Reny JL, Grosgurin O. Confidence and use of physical examination and point-of-care ultrasonography for detection of abdominal or pleural free fluid. A cross-sectional survey. Intern Emerg Med 2022; 17:113-122. [PMID: 34148178 PMCID: PMC8214715 DOI: 10.1007/s11739-021-02781-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/27/2021] [Indexed: 12/02/2022]
Abstract
Physical examination (PE) has always been a corner stone of medical practice. The recent advances in imaging and fading of doctors' ability in performing it, however, raised doubts on PE usefulness. Point-of-care ultrasonography (POCUS) is gaining ground in medicine with the detection of free fluids being one of its main applications. To estimate physicians' confidence and use of PE and POCUS for the detection of abdominal or pleural free fluid, we conducted a cross-sectional survey. In all, 246 internal and emergency medicine physicians answered to the survey (197 in-hospital physicians and 49 general practitioners; response rate 28.5%). Almost all declared to perform PE in case of suspected ascites or pleural effusion (88% and 90%, respectively). The highest rates of confidence were observed in conventional PE signs (91% for diminished breath sounds, 80% for dullness to thorax percussion, and 66% for abdominal flank dullness). For the remaining signs, rates of confidence were less than 53%. Physicians with > 15 years of experience and POCUS-naïve doctors reported higher confidence in PE. Most of emergency and almost half of internal medicine physicians (78% and 44%, respectively) attended a structured POCUS course. POCUS use was higher among trained physicians for both ascites (84% vs 50%, p < 0.001) and pleural effusion (80% vs 34%, p < 0.001). Similarly, higher POCUS use was observed in younger physicians. In conclusion, PE is frequently performed and rates of confidence are low for most PE signs, especially among young doctors and POCUS users. This detailed inventory suggests an ongoing shift towards POCUS integration in clinical practice.
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Affiliation(s)
- Antonio Leidi
- grid.150338.c0000 0001 0721 9812General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Antoine Saudan
- grid.8591.50000 0001 2322 4988Faculty of Medicine, Geneva University, Geneva, Switzerland
| | - Guillaume Soret
- grid.150338.c0000 0001 0721 9812General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Frédéric Rouyer
- grid.150338.c0000 0001 0721 9812Emergency Medicine, Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Christophe Marti
- grid.150338.c0000 0001 0721 9812General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Jérôme Stirnemann
- grid.150338.c0000 0001 0721 9812General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Jean-Luc Reny
- grid.150338.c0000 0001 0721 9812General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Olivier Grosgurin
- grid.150338.c0000 0001 0721 9812General Internal Medicine, Department of Medicine, Geneva University Hospitals, Geneva, Switzerland
- grid.150338.c0000 0001 0721 9812Emergency Medicine, Department of Acute Medicine, Geneva University Hospitals, Geneva, Switzerland
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Mahmoud A, Abid F, Ezdini M, Lahdhiri ML, Ouanes I, Messaoud R. The contribution of simulation in training for funduscopic examination. LA TUNISIE MEDICALE 2021; 99:1141-1147. [PMID: 35288920 PMCID: PMC8974430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Simulation is emerging as an essential part of health sciences training programs as it provides safer patient care by reducing the risk of error. In the healthcare environment, simulation continues to spread in emergency specialties, but it is still underdeveloped in ophthalmology and there is a shortage of publications on this subject in Tunisia. OBJECTIVE To evaluate the effectiveness of procedural simulation as a teaching tool for funduscopic examination training. Methods and population studied: This was a prospective study including students who underwent procedural simulation training sessions during their ophthalmology internship. The included students were assessed at the initiation and end of each session by a pre-test and post-test. The procedure for performing the funduscopic examination was evaluated by a specific performance score. Student satisfaction was assessed at the end of each session. RESULTS During the study period, four groups of 12 students were included, for a total of 48 participants spread over 4 simulation sessions. Simulation training improved post-test. assessment scores with an overall median delta of +4.00. It also provided specific skills for performing the funduscopic examination, with an overall median specific performance score of 5.5/8 (5/8 to 7/8). The majority of students were satisfied upon completion of the simulation session. CONCLUSION The training of fundus examination using an ophthalmoscopic simulator can improve the skills and knowledge of ophthalmic learners. This type of training can be an innovative addition to traditional learning.
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Affiliation(s)
- Anis Mahmoud
- 1- Service d’ophtalmologie, Centre hospitalo-universitaire Taher Sfar, Mahdia / Université de Monastir, Tunisie / faculté de médecine de Monastir
| | - Fatma Abid
- 1- Service d’ophtalmologie, Centre hospitalo-universitaire Taher Sfar, Mahdia / Université de Monastir, Tunisie / faculté de médecine de Monastir
| | | | - Mohamed Lahbib Lahdhiri
- 1- Service d’ophtalmologie, Centre hospitalo-universitaire Taher Sfar, Mahdia / Université de Monastir, Tunisie / faculté de médecine de Monastir
| | - Islem Ouanes
- 3- Service de Réanimation Polyvalente, Centre Hospitalo-Universitaire Fattouma Bourguiba, Monastir / Université de Monastir, Tunisie / faculté de médecine de Monastir
| | - Riadh Messaoud
- 1- Service d’ophtalmologie, Centre hospitalo-universitaire Taher Sfar, Mahdia / Université de Monastir, Tunisie / faculté de médecine de Monastir
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Ayub G, Souza RB, de Albuquerque AM, de Vasconcellos JPC. Comparison of conventional and wide field direct ophthalmoscopy on medical students' self-confidence for fundus examination: a 1-year follow-up. BMC MEDICAL EDUCATION 2021; 21:507. [PMID: 34565378 PMCID: PMC8474948 DOI: 10.1186/s12909-021-02942-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/15/2021] [Indexed: 06/02/2023]
Abstract
BACKGROUND Fundus examination is an easy, quick and effective way to diagnose sight- and life-threatening diseases. However, medical students and physicians report lack of proficiency and self-confidence in perform fundoscopy. The aim of this study was to compare students' self-confidence in fundus examination, using two different direct ophthalmoscopes, 1 month and 1 year after practical training. METHODS In this prospective cohort, medical students (MS) of the same class were divided in small groups for PanOptic (PO) or conventional (CO) direct ophthalmoscope training. The intervention group encompassed MS of the 4th -year (class of 2019), and the control group encompassed MS of year behind (class of 2020). A questionnaire to measure self-confidence in fundoscopy technique assessing optic nerve, cup-to-disc ratio and macula was translated and validated to Portuguese, and applied 1-month and 1-year after practical training. RESULTS One-hundred and sixty-seven MS were enrolled (35 PO group, 38 CO group, and 94 control group). PO group had a significantly higher overall self-confidence comparing either control or CO groups, respectively (3.57 ± 0.65 vs. 2.97 ± 1.03 vs. 2.46 ± 0.87, p < 0.01) as well as in evaluate cup-to-disc ratio (3.09 ± 0.75 vs. 2.32 ± 0.87 vs. 1.46 ± 0.81, p < 0.01), optic disc margins (3.26 ± 0.85 vs. 2.71 ± 0.96 vs. 2.01 ± 0.97, p < 0.01) and macula (3.43 ± 1.12 vs. 2.89 ± 1.08 vs. 2.02 ± 0.89, p < 0.01) 1-month after practical training. One-year after intervention, CO group showed a significantly higher score compared to PO group in overall self-confidence (3.31 ± 0.69 vs. 3.18 ± 0.73, p = 0.03) and in optic disc margins assessing (3.16 ± 0.85 vs. 2.95 ± 0.78, p = 0.03), but not significant in the evaluation of cup-to-disc ratio (2.78 ± 0.97 vs. 2.68 ± 0.94, p = 0.08), and macula (3.34 ± 0.79 vs. 3.27 ± 0.98, p = 0.07). CONCLUSIONS Students were more confident in use PO as an instrument to perform direct ophthalmoscopy immediately after practical training, but confidence level of CO was higher compared to PO one year after practical training. These findings would help medical schools decide which ophthalmoscope to choose to teach fundus examination.
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Affiliation(s)
- Gabriel Ayub
- Department of Ophthalmology, Faculty of Medical Sciences, University of Campinas, 251 Vital Brazil St, SP, 13083-888, Campinas, Brazil.
| | - Rafael Boava Souza
- Department of Ophthalmology, Faculty of Medical Sciences, University of Campinas, 251 Vital Brazil St, SP, 13083-888, Campinas, Brazil
| | - Andrelisa Marina de Albuquerque
- Department of Ophthalmology, Faculty of Medical Sciences, University of Campinas, 251 Vital Brazil St, SP, 13083-888, Campinas, Brazil
| | - José Paulo Cabral de Vasconcellos
- Department of Ophthalmology, Faculty of Medical Sciences, University of Campinas, 251 Vital Brazil St, SP, 13083-888, Campinas, Brazil
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Shikino K, Rosu CA, Yokokawa D, Suzuki S, Hirota Y, Nishiya K, Ikusaka M. Flexible e-learning video approach to improve fundus examination skills for medical students: a mixed-methods study. BMC MEDICAL EDUCATION 2021; 21:428. [PMID: 34389012 PMCID: PMC8364022 DOI: 10.1186/s12909-021-02857-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 07/26/2021] [Indexed: 06/07/2023]
Abstract
BACKGROUND Training for the fundus examination using traditional teaching is challenging, resulting in low generalist physicians' confidence in performing the funduscopic examination. There is growing evidence suggesting a flexible e-learning video approach's value in teaching physical examination procedures. However, whether the flexible e-learning video approach is superior to the traditional, face-to-face (F2F) lecture-based teaching for the funduscopic exam and the cognitive processes supporting its effectiveness has not yet been determined. METHODS We conducted a sequential explanatory mixed-method study to compare the flexible e-learning video approach's effectiveness versus the F2F lecture-based approach for teaching the funduscopic exam to medical students at Chiba University in Japan. Medical students were randomly assigned to either a flexible e-learning video approach group or a F2F lecture approach group. We then quantitatively measured the diagnostic accuracy of funduscopic findings before and after attending the specific classrooms. Next, we conducted student focus groups to explore the students' thinking processes in the flexible e-learning video approach vs. the F2F lecture-based teaching of fundus examination. The qualitative data were analyzed using the qualitative content analysis method. RESULTS The mean diagnostic accuracy scores in the post-test significantly increased from pre-test in the intervention group (36.6 to 63.4%, p < 0.001). Post-post comparisons across the two groups revealed a significant difference (intervention group 63.4% vs. control group 34.6%, p < 0.001). Six semi-structured focused group interviews were conducted (n = 36). In the flexible e-learning video approach group, we identified ten categories corresponding to four levels of the revised Bloom's taxonomy: remember, understand, apply, analyze. Five categories were identified in the traditional F2F lecture approach group corresponding to three revised Bloom's taxonomy levels: understand, apply, analyze. Interrater reliability was substantial (Cohen's kappa = 0.81). CONCLUSIONS Teaching medical students funduscopic examination using the flexible e-learning video approach leads to improved diagnostic accuracy of funduscopic examinations. The flexible e-learning video teaching method enabled higher cognitive activity levels than the traditional, lecture-based classroom, as assessed using the revised Bloom's taxonomy. TRIAL REGISTRATION This study was registered with the University Hospital Medical Information Network Clinical Trials Registry on 08/02/2020 (Unique trial number: UMIN 000039434 ).
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Affiliation(s)
- Kiyoshi Shikino
- Department of General Medicine, Chiba University Hospital, Chiba, Japan.
- Health Professional Development Center, Chiba University Hospital, Chiba, Japan.
| | - Claudia A Rosu
- Health Professions Education Program, MGH Institute of Health Professions, Boston, MA, USA
| | - Daiki Yokokawa
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Shingo Suzuki
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
- Department of Internal Medicine, Chiba Medical Center, Chiba, Japan
| | - Yusuke Hirota
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
- Department of Diabetes, Endocrinology and Metabolism, Tokyo Medical University Hachioji Medical Center, Tokyo, Japan
| | - Katsumi Nishiya
- Center for Medical Education, Kansai Medical University, Hirakata, Japan
| | - Masatomi Ikusaka
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
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Garibaldi BT, Russell SW. Strategies to Improve Bedside Clinical Skills Teaching. Chest 2021; 160:2187-2195. [PMID: 34242633 DOI: 10.1016/j.chest.2021.06.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 06/27/2021] [Accepted: 06/30/2021] [Indexed: 11/18/2022] Open
Abstract
The bedside encounter between a patient and physician remains the cornerstone of the practice of medicine. However, physicians and trainees spend less time in direct contact with patients and families in the modern healthcare system. The current pandemic has further threatened time spent with patients. This lack of time has led to a decline in clinical skills, and a decrease in the number of faculty who are confident in teaching at the bedside. In this review we offer several strategies to get physicians and trainees back to the bedside to engage in clinical skills teaching and assessment. We recommend that providers pause before bedside encounters to be present with patients and learners and develop clear goals for a bedside teaching session. We suggest that clinical teachers practice an evidence-based approach, including a hypothesis-driven physical examination. We encourage the use of point-of-care technology to assist in diagnosis and allow learners to calibrate traditional physical exam skills with real-time visualization of pathology. Tools like point-of-care ultrasound can be powerful levers to get learners excited about bedside teaching, and to engage patients in their clinical care. We value telemedicine visits as unique opportunities to engage with patients in their home environment and to participate in patient-directed physical exam maneuvers. Finally, we recommend that educators provide feedback to learners on specific clinical exam skills, whether in the clinic, the wards, or during dedicated clinical skills assessments.
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Affiliation(s)
- Brian T Garibaldi
- Department of Medicine, Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD.
| | - Stephen W Russell
- University of Alabama at Birmingham School of Medicine, Birmingham, AL
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Dean R, Morrow D, Connelly S. A Multifaceted Resident-Led Physical Exam Course. MEDEDPUBLISH 2021; 10:109. [PMID: 38486536 PMCID: PMC10939526 DOI: 10.15694/mep.2021.000109.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
This article was migrated. The article was marked as recommended. BACKGROUND Physicians frequently report poor confidence applying the physical exam for medical decision making. We developed a novel, multifaceted, resident-led curriculum to teach medical students the physical exam for clinical practice. METHODS We created a two-week elective comprised of didactics, journal discussions, bedside ultrasound, and physical exam rounds for fourth year medical students at the University of South Carolina School of Medicine - Greenville. JAMA: The Rational Clinical Exam and Evidence-Based Physical Diagnoses, by Steven McGee, MD, were used to develop content. The curriculum focused on cardiac, pulmonary, abdominal, endocrine, and neurologic exams. Faculty and residents facilitated all portions of the course. Chi-squared testing was used to calculate confidence intervals on pre- and post-course assessments. RESULTS Twenty-two fourth year medical students enrolled in the elective over the course of three years. Seventeen faculty, three chief residents, and 13 residents provided instruction. Residents provided roughly half of the total instruction hours. Students demonstrated statistically significant improvement on multiple choice pre-course and post-course assessments (56.8% vs 77.1%, p < 0.001). 95.5% of students reported feeling "confident" in their physical exam skills after the course. CONCLUSION After participating in the course, students demonstrated improved skill and comfort using the physical exam for clinical decision making.
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Nishizaki Y, Nozawa K, Shinozaki T, Shimizu T, Okubo T, Yamamoto Y, Konishi R, Tokuda Y. Difference in the general medicine in-training examination score between community-based hospitals and university hospitals: a cross-sectional study based on 15,188 Japanese resident physicians. BMC MEDICAL EDUCATION 2021; 21:214. [PMID: 33858403 PMCID: PMC8050907 DOI: 10.1186/s12909-021-02649-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 04/05/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The general medicine in-training examination (GM-ITE) is designed to objectively evaluate the postgraduate clinical competencies (PGY) 1 and 2 residents in Japan. Although the total GM-ITE scores tended to be lower in PGY-1 and PGY-2 residents in university hospitals than those in community-based hospitals, the most divergent areas of essential clinical competencies have not yet been revealed. METHODS We conducted a nationwide, multicenter, cross-sectional study in Japan, using the GM-ITE to compare university and community-based hospitals in the four areas of basic clinical knowledge". Specifically, "medical interview and professionalism," "symptomatology and clinical reasoning," "physical examination and clinical procedures," and "disease knowledge" were assessed. RESULTS We found no significant difference in "medical interview and professionalism" scores between the community-based and university hospital residents. However, significant differences were found in the remaining three areas. A 1.28-point difference (95% confidence interval: 0.96-1.59) in "physical examination and clinical procedures" in PGY-1 residents was found; this area alone accounts for approximately half of the difference in total score. CONCLUSIONS The standardization of junior residency programs and the general clinical education programs in Japan should be promoted and will improve the overall training that our residents receive. This is especially needed in categories where university hospitals have low scores, such as "physical examination and clinical procedures."
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Affiliation(s)
- Yuji Nishizaki
- Medical Technology Innovation Center, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
- Department of Medical Education, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Keigo Nozawa
- Department of Information and Computer Technology, Faculty of Engineering, Tokyo University of Science, 6-3-1 Niijuku, Katsushika-ku, Tokyo, 125-8585, Japan
| | - Tomohiro Shinozaki
- Department of Information and Computer Technology, Faculty of Engineering, Tokyo University of Science, 6-3-1 Niijuku, Katsushika-ku, Tokyo, 125-8585, Japan
| | - Taro Shimizu
- Department of Diagnostic and Generalist Medicine, Dokkyo Medical University Hospital, 880 Kitakobayashi, Mibumachi, Shimotuga-gun, Tochigi, 321-0293, Japan
| | - Tomoya Okubo
- Research Division, National Center for University Entrance Examinations, 2-19-23 Komaba, Meguro-ku, Tokyo, 153-8501, Japan
| | - Yu Yamamoto
- Division of General Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan
| | - Ryota Konishi
- Education Adviser Japan Organization of Occupational Health and Safety, 1-1 Kiduki Sumiyoshi-cho, Nakahara-ku, Kawasaki-shi, Kanagawa, 211-0021, Japan
| | - Yasuharu Tokuda
- General Internal Medicine, Muribushi Okinawa for Teaching Hospitals, 3-42-8 Iso, Urasoe-shi, Okinawa, 901-2132, Japan
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Iragavarapu T, Sunkarapalli G, Vutukuru S, Kataria A. “Art at its Heart” “The Golden Art of History and Clinical Examination”. JOURNAL OF THE PRACTICE OF CARDIOVASCULAR SCIENCES 2021. [DOI: 10.4103/jpcs.jpcs_38_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Wilcox S, Okut H, Badgett R, Hassouneh S, Ablah E. Effectiveness of Flow Sheet Implementation on Diabetes Progression Screening at a Student-Run Free Clinic. Kans J Med 2020; 13:285-289. [PMID: 33312411 PMCID: PMC7725131 DOI: 10.17161/kjm.vol13.13423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 08/19/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction Diabetes mellitus (DM) disproportionately affects people with low socioeconomic status (SES). Student-run free clinics (SRFC) aim to care for low SES populations and experience high clinician turnover. Flow sheets have been used to improve care for those with diabetes, yet no research has assessed the use of such a flow sheet in a SRFC. The aim of this project was to determine if use of a flow sheet improved care for people with DM in an SRFC. Methods Charts from all patients receiving care for DM at one SRFC in the year before (n = 53) and after (n = 56) implementation of the flow sheet were reviewed. Pre- and post-group comparisons and post subgroup comparisons were made for glycosylated-hemoglobin (HgbA1c), microalbumin, and foot and eye exams. Results During a one-year period, a larger proportion of patients who received care post flow sheet introduction received at least two HgbA1c tests (53%), a microalbumin test (46%), and a foot-exam (46%) compared to those receiving care before the flow sheet (28%, 2%, and 25%, respectively). There was no difference in proportions of patients undergoing eye exams. In post subgroup analysis, flow sheets were used for 50% of patients, and patients who received care with the flow sheet were more likely to receive at least two HgbA1c tests and a foot exam per year. Conclusion Flow sheets may improve the process of care for patients with diabetes in a SRFC, but the effect must be studied further. Regardless, a systematic integration of the flow sheet is being implemented in the SRFC evaluated in this study.
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Affiliation(s)
- Samuel Wilcox
- Northwest Washington Family Medicine Residency, Bremerton, WA
| | - Hayrettin Okut
- Office of Research, University of Kansas School of Medicine-Wichita, Wichita, KS.,Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Robert Badgett
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, KS.,Department of Internal Medicine, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Stephanie Hassouneh
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, KS
| | - Elizabeth Ablah
- Department of Population Health, University of Kansas School of Medicine-Wichita, Wichita, KS
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Jacobsen AP, Khiew YC, Murphy SP, Lane CM, Garibaldi BT. The Modern Physical Exam - A Transatlantic Perspective from the Resident Level. TEACHING AND LEARNING IN MEDICINE 2020; 32:442-448. [PMID: 32090631 DOI: 10.1080/10401334.2020.1724792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Issue: The physical examination has been in decline for many years and poorer skills contribute to medical errors and adverse events. Diagnostic error is also increasing with the complexity of medicine. Comparing the physical examination in Ireland and the United States with a focus on education, assessment, culture, and health systems may provide insight into the decline of the physical exam in the United States, uncover possible strategies to improve clinical skills, and limit diagnostic error. Evidence: The physical exam is a core component of both undergraduate and postgraduate medical education in Ireland. This is reflected by the time and effort invested by medical schools and medical societies in Ireland in teaching and assessing skills. This high standard of skills results in the physical exam being a key component of the diagnostic process and a gatekeeper to expensive investigations essential in a resource-limited health system such as Ireland. Use of the physical exam in the United States is hindered by the high-tech transformation of healthcare and a more litigious society. Known strategies to highlight the role of the physical exam in clinical practice include creating an evidence base to show that better physical exam skills improve outcomes, identifying accurate physical exam maneuvers, stressing the therapeutic alliance the physical exam brings to the patient encounter, and the incorporation of technology into the bedside exam. Implications: Contrasting the education and clinical use of the physical examination in the United States with Ireland allowed us to identify a number of strategies which could be used to promote the physical exam among learners in both countries. Highlighting simple and pragmatic physical exam maneuvers combined with evidence-based physical exam diagnostic data may renew confidence in the physical exam as a core diagnostic tool. Use of the hypothesis-driven approach may streamline a clinician's physical exam during a patient encounter, focusing on the key examination components and avoiding unnecessary and low yield maneuvers. The absence of assessment of physical exam skills using real patients in United States licensing exams communicates to learners that these skills are not important. However, steps to introduce a culture of assessment to drive learning are being introduced. One area Ireland could learn from the United States is incorporating more technology into the bedside exam. Enhanced physical examination skills in both countries could reduce reliance on expensive investigations and improve diagnostic accuracy.
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Affiliation(s)
- Alan P Jacobsen
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Yii Chun Khiew
- Department of Medicine, Pennsylvania Hospital, Philadelphia, Pennsylvania, USA
| | - Sean P Murphy
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Conor M Lane
- Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian T Garibaldi
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Calleja R, Kabashneh S. Acute Myeloid Leukemia: A "Head to Toe" Examination. Cureus 2020; 12:e8526. [PMID: 32656039 PMCID: PMC7346315 DOI: 10.7759/cureus.8526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Acute myeloid leukemia (AML) is a hematologic malignancy that can affect all blood cell lineages, the presentation varies, and infection is a common complication. This case involves a patient initially presenting with a necrotic foot ulcer and leukocytosis, ultimately leading to a diagnosis of osteomyelitis. After establishing adequate source control with serial debridements and intravenous antibiotics, the patient developed some knee swelling. On repeat assessment, he was discovered to have lymphadenopathy, and workup revealed AML. As indicated by this case, though it appeared a clear-cut diagnosis of osteomyelitis, there was an underlying malignancy that would have potentially gone unnoticed due to incomplete clinical examination.
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Affiliation(s)
- Robert Calleja
- Emergency Medicine, Wayne State University, Detroit, USA
| | - Sohaip Kabashneh
- Internal Medicine, Wayne State University/Detroit Medical Center, Detroit, USA
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Sharma D, Sohn JK, Zillioux JM, Herndon CDA, Corbett ST, Kern NG. Identifying and addressing training deficiencies in the examination of cryptorchidism-a quality improvement study. J Pediatr Urol 2020; 16:61.e1-61.e8. [PMID: 31848108 DOI: 10.1016/j.jpurol.2019.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 11/05/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Accurate and timely diagnosis of cryptorchidism by primary care providers (PCPs) is critical to oncologic and fertility outcomes. Physical exam is the mainstay of diagnosis, but little is known about PCPs' skills in examining cryptorchid patients. Patients referred to surgeons for cryptorchidism often have normal or retractile testes on exam, and delayed or missed diagnosis of cryptorchidism may contribute to advanced age at surgical intervention. Previous studies on cryptorchidism have not investigated the baseline training, confidence, and/or exam skills of providers. OBJECTIVE The authors aimed to define baseline training and provider confidence in the exam of cryptorchid patients and to improve examiner confidence using bedside teaching with a pediatric urologist. Secondarily, baseline training and confidence were correlated to skill. STUDY DESIGN Medical students, family medicine, pediatrics, and urology residents, and pediatric attendings completed surveys on baseline training and self-reported confidence in the examination of cryptorchid patients at an academic institution from 2017 to 2018. N.G.K. (pediatric urologist) proctored examinations of cryptorchid patients and provided standardized grades and individualized feedback. Surveys were readministered after 3 months. Non-parametric comparison tests were performed to determine intervention effect and compare subgroups. RESULTS Ninety-two respondents participated. 62% reported little to no formal training on the scrotal exam, 50% were self-taught, and 20% defined undescended testis incorrectly. Confidence increased with level of training, comparing attendings to residents to students (P < 0.001). Those who learned from a mentor had higher baseline confidence than those who did not (P < 0.01). Baseline confidence and amount of formal training positively correlated with exam skill as graded during proctored sessions (n = 59, P < 0.01). Provider confidence was higher after proctored exams (Fig. 2, n = 32, P < 0.0001). DISCUSSION Significant training deficiencies exist in the examination of cryptorchid patients. A single proctored exam with a pediatric urologist can improve provider confidence and may improve exam skills. A rotation with pediatric urology, including proctored exams of cryptorchid patients, has become standard practice for pediatric trainees at the authors institution as a result of this study. CONCLUSIONS While further studies are required to assess the effectiveness of bedside teaching and its impact on accurate and timely diagnosis of cryptorchidism, implementation of the authors quality improvement recommendations at other teaching institutions would help address training deficiencies in the examination of cryptorchid patients.
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Affiliation(s)
- Devang Sharma
- University of Virginia School of Medicine, Department of Urology, PO Box 800422, Charlottesville, VA, 22908, USA
| | - Julia K Sohn
- University of Virginia School of Medicine, Department of Pediatrics, PO Box 801355, Charlottesville, VA, 22908, USA
| | - Jacqueline M Zillioux
- University of Virginia School of Medicine, Department of Urology, PO Box 800422, Charlottesville, VA, 22908, USA
| | - C D Anthony Herndon
- Children's Hospital of Richmond at Virginia Commonwealth University, Department of Urology, 8700 Stony Point Parkway, Richmond, VA, 23235, USA
| | - Sean T Corbett
- University of Virginia School of Medicine, Department of Urology, PO Box 800422, Charlottesville, VA, 22908, USA
| | - Nora G Kern
- University of Virginia School of Medicine, Department of Urology, PO Box 800422, Charlottesville, VA, 22908, USA.
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Frank MG, Pierce C, Northcutt N, Keach JW, Salame G, Allyn R. The Master Clinician's Elective: Integrating Evidence-Based Physical Examination and Point of Care Ultrasonography in Modern Clinical Medicine. POCUS JOURNAL 2020; 5:13-19. [PMID: 36895859 PMCID: PMC9979949 DOI: 10.24908/pocus.v5i1.14225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Many internal medicine residency programs have incorporated ultrasonography into their curriculum; however, its integration with physical examination skills teaching at a graduate medical level is scarce. The program's aim is to create a reproducible elective that combines physical exam and bedside ultrasound as a method for augmenting residents' knowledge and competence in these techniques with the ultimate goal of improving patient care. Methods: We designed and implemented a two-week elective rotation for senior internal medicine residents, combining evidence-based physical examination with diagnostic bedside ultrasonography. The rotation took place in an inpatient setting at Denver Health Hospital. Program evaluation data was collected data between February 2016 to March 2019. IRB approval was waived. Results: Since its inception in 2016, 19 residents completed the rotation. Residents performed a pre-test and a post-test under direct observation by course faculty. Each resident was measured on the ability to perform pre-determined physical exam and point-of-care ultrasound (POCUS) skills. In the pre-test, participants correctly performed an average of 40% of expected physical exam maneuvers and 32% of expected POCUS skills. At elective conclusion, all participants were effectively able to demonstrate the highest yield physical exam and ultrasound maneuvers. Discussion and Conclusion: An elective designed specifically to integrate POCUS and physical exam modalities improves the ability of resident physicians to utilize both diagnostic modalities.
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Affiliation(s)
- Maria Gabriela Frank
- Division of Hospital Medicine, Department of Medicine, Denver Health Hospital Authority Denver, CO.,University of Colorado School of Medicine Aurora, CO
| | - Cason Pierce
- Division of Hospital Medicine, Department of Medicine, Denver Health Hospital Authority Denver, CO.,University of Colorado School of Medicine Aurora, CO
| | - Noelle Northcutt
- Division of Hospital Medicine, Department of Medicine, Denver Health Hospital Authority Denver, CO.,University of Colorado School of Medicine Aurora, CO
| | - Joseph Walker Keach
- Division of Hospital Medicine, Department of Medicine, Denver Health Hospital Authority Denver, CO.,University of Colorado School of Medicine Aurora, CO
| | - Gerard Salame
- Division of Hospital Medicine, Department of Medicine, Denver Health Hospital Authority Denver, CO.,University of Colorado School of Medicine Aurora, CO
| | - Rebecca Allyn
- Division of Hospital Medicine, Department of Medicine, Denver Health Hospital Authority Denver, CO.,University of Colorado School of Medicine Aurora, CO
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Ragsdale JW, Habashy C, Warrier S. Developing Physical Exam Skills in Residency: Comparing the Perspectives of Residents and Faculty About Values, Barriers, and Teaching Methods. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2020; 7:2382120520972675. [PMID: 33294620 PMCID: PMC7705809 DOI: 10.1177/2382120520972675] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 10/15/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND The physical examination (PE) skills of residents are often not improved since medical school. Unfortunately, how residents learn PE is not well understood. There is a paucity of research on the factors involved and the differences between resident and faculty perspectives. The authors sought to determine resident and faculty perceptions about the value of PE, the major barriers to learning PE, and the most effective teaching methods. METHODS Based on a rigorous process of literature review and semi-structured interviews, the authors developed an online survey which was sent to 406 internal medicine residents and 93 faculty at 3 institutions. Residents and faculty answered questions about both their own opinions and about their perception of the other group's opinions. RESULTS About 283 residents (70%) and 61 faculty (66%) completed the survey. Both residents and faculty rated the importance of PE similarly. Residents rated being too busy, followed by a lack of feedback, as the most significant barriers to learning PE. Faculty rated a lack of feedback, followed by a lack of resident accountability, as the most significant barriers. Both groups rated the availability of abnormal findings as the least significant barrier. Both groups agreed that faculty demonstration at the bedside was the most effective teaching method. CONCLUSION This survey can serve as a needs assessment for educational interventions to improve the PE skills of residents by focusing on areas of agreement between residents and faculty, specifically faculty demonstration at the bedside combined with feedback about residents' skills.
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Affiliation(s)
| | | | - Sarita Warrier
- Warren Alpert Medical School of Brown University, Providence, RI, USA
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National survey of the management of eye emergencies in the accident and emergency department by foundation doctors: has anything changed over the past 15 years? Eye (Lond) 2019; 34:1094-1099. [PMID: 31649348 DOI: 10.1038/s41433-019-0645-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 09/20/2019] [Accepted: 09/30/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Ophthalmic emergencies comprise a significant portion of junior doctors' workload in accident and emergency (A&E). However, previous studies have demonstrated a lack of training and confidence in the management of such emergencies. This study assessed changes in basic ophthalmic training that A&E junior doctors received in dealing with eye emergencies, their perceived level of confidence and the availability of appropriate ophthalmic equipment in A&E over the last 15 years. METHODS A prospective, national, combined online and telephone survey using a previously published questionnaire was performed. Foundation year two doctors (FY2s) from each A&E department in the UK listed on the official NHS directory were contacted for participation. RESULTS Two hundred and ten A&E departments were contacted and 202 responded (response rate of 96.2%). There was no significant change in the number of A&E departments equipped with slit lamps (82.5% in 2003 vs 79.7% in 2018; p = 0.26). However, the prevalence of training in its use has decreased significantly (68.4% in 2003 vs 52% in 2018; p = 0.005). There was also a significant reduction in the prevalence of training in the management of eye emergencies (77.4% in 2003 vs 45.5% in 2018; p < 0.001) and the proportion of FY2s who felt confident in dealing with such cases (36.1% in 2003 vs 6% in 2018; p < 0.001). CONCLUSION There is a concerning decline in basic ophthalmic training for A&E FY2s, reflected by the alarmingly low level of confidence in the management of eye emergencies. This highlights an urgent need to improve ophthalmic training for junior doctors in A&E.
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Shikino K, Suzuki S, Hirota Y, Kikukawa M, Ikusaka M. Effect of the iExaminer Teaching Method on Fundus Examination Skills: A Randomized Clinical Trial. JAMA Netw Open 2019; 2:e1911891. [PMID: 31539072 PMCID: PMC6755710 DOI: 10.1001/jamanetworkopen.2019.11891] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This randomized clinical trial compares the effect of the iExaminer teaching method on fundus examination skills with the traditional teaching method.
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Affiliation(s)
- Kiyoshi Shikino
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Shingo Suzuki
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Yusuke Hirota
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Makoto Kikukawa
- Department of Medical Education, Kyushu University, Fukuoka, Japan
| | - Masatomi Ikusaka
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
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Emergency department point-of-care ultrasound diagnosis of submacular hemorrhage presenting as painless loss of vision. CAN J EMERG MED 2019. [DOI: 10.1017/cem.2019.375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
ABSTRACTOcular complaints prompt a significant number of emergency department (ED) visits, and they can range from benign to sight-threatening. Detailed fundoscopic examination is difficult, even for experienced providers. Point-of-care ultrasound (POCUS) is increasingly utilized in the ED for numerous applications, including ocular evaluation. We present a case in which ocular POCUS was used to diagnose a submacular hemorrhage in a patient who presented with acute painless loss of vision. Ocular POCUS can be readily employed to assess for myriad clinically significant pathologies.
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Kelly MA, Freeman LK, Dornan T. Family Physicians' Experiences of Physical Examination. Ann Fam Med 2019; 17:304-310. [PMID: 31285207 PMCID: PMC6827637 DOI: 10.1370/afm.2420] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 02/21/2019] [Accepted: 03/10/2019] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The increased availability of reliable diagnostic technologies has stimulated debate about the utility of physical examination in contemporary clinical practice. To reappraise its utility, we explored family physicians' experiences. METHODS Guided by principles of phenomenology, we conducted in-depth qualitative interviews exploring 16 family physicians' experiences of conducting physical examination: 7 (44%) men and 9 women (56%) whose clinical experience varied widely, from 11 (69%) urban and 5 (31%) rural locations. We recorded the interviews, transcribed them verbatim, and identified initial themes using template analysis. We worked reflexively, critiquing our own and other team members' interpretations, in order to synthesize and write a final interpretation. RESULTS Participants described 2 facets of physical examination: making diagnoses and estimating prognoses rationally and objectively; and responding subjectively and intuitively to patients' illnesses, which formed relationships between doctor and patient that enacted medical care in the moment. Physical examination allowed physicians to use their own bodies to experience patients' illnesses. Performing physical examination was integral to being a family doctor because it promoted rapport and developed trust. CONCLUSIONS Physical examination is part of the identity of family physicians. It not only contributes diagnostic information but is a therapeutic intervention in and of itself. Physical examination contributes to relationship-centered care in family practice.
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Affiliation(s)
- Martina Ann Kelly
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Lisa Kathryn Freeman
- Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, Alberta, Canada
| | - Tim Dornan
- Centre for Medical Education, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
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Rousseau M, Könings KD, Touchie C. Overcoming the barriers of teaching physical examination at the bedside: more than just curriculum design. BMC MEDICAL EDUCATION 2018; 18:302. [PMID: 30537960 PMCID: PMC6288852 DOI: 10.1186/s12909-018-1403-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 11/23/2018] [Indexed: 05/21/2023]
Abstract
BACKGROUND Physicians in training must achieve a high degree of proficiency in performing physical examinations and must strive to become experts in the field. Concerns are emerging about physicians' abilities to perform these basic skills, essential for clinical decision making. Learning at the bedside has the potential to support skill acquisition through deliberate practice. Previous skills improvement programs, targeted at teaching physical examinations, have been successful at increasing the frequency of performing and teaching physical examinations. It remains unclear what barriers might persist after such program implementation. This study explores residents' and physicians' perceptions of physical examinations teaching at the bedside following the implementation of a new structured bedside curriculum: What are the potentially persisting barriers and proposed solutions for improvement? METHODS The study used a constructivist approach using a qualitative inductive thematic analysis that was oriented to construct an understanding of the barriers and facilitators of physical examination teaching in the context of a new bedside curriculum. Participants took part in individual interviews and subsequently focus groups. Transcripts were coded and themes were identified. RESULTS Data analyses yielded three main themes: (1) the culture of teaching physical examination at the bedside is shaped and threatened by the lack of hospital support, physicians' motivation and expertise, residents' attitudes and dependence on technology, (2) the hospital environment makes bedside teaching difficult because of its chaotic nature, time constraints and conflicting responsibilities, and finally (3) structured physical examination curricula create missed opportunities in being restrictive and pose difficulties in identifying patients with findings. CONCLUSIONS Despite the implementation of a structured bedside curriculum for physical examination teaching, our study suggests that cultural, environmental and curriculum-related barriers remain important issues to be addressed. Institutions wishing to develop and implement similar bedside curricula should prioritize recruitment of expert clinical teachers, recognizing their time and efforts. Teaching should be delivered in a protected environment, away from clinical duties, and with patients with real findings. Physicians must value teaching and learning of physical examination skills, with multiple hands-on opportunities for direct role modeling, coaching, observation and deliberate practice. Ideally, clinical teachers should master the art of combining both patient care and educational activities.
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Affiliation(s)
- Melissa Rousseau
- Department of Medicine, The Ottawa Hospital, University of Ottawa, 501 Smyth Road CPCR L2135, Box 209, Ontario, Ottawa K1H 8L6 Canada
| | - Karen D. Könings
- Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, the Netherlands, Universiteitssingel 60, Room M 5.08, 6229 ER Maastricht, The Netherlands
| | - Claire Touchie
- Department of Medicine, The Ottawa Hospital, University of Ottawa and the Ottawa Hospital Research Institute, 501 Smyth Road CPCR L2135, Box 209, Ontario, Ottawa K1H 8L6 Canada
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Evaluation of an Ophthalmoscopy Simulator to Teach Funduscopy Skills to Pediatric Residents. Can J Neurol Sci 2018; 45:320-324. [DOI: 10.1017/cjn.2017.291] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackground: Medical school and residency training in ophthalmoscopic evaluation is limited, reducing diagnostic accuracy. We sought to evaluate the efficacy of self-study using an ophthalmoscopy simulator to improve the technical motor skills involved in direct funduscopy in postgraduate pediatric residents. Methods: In this randomized-controlled study, 17 pediatric residents (postgraduate years 1-3) were randomized to control (n=8) or intervention (n=9) groups. Participants were asked to correctly identify the funduscopic findings presented to them on an ophthalmoscopy simulator after being trained on its use. Each participant was asked to review 20 images of the fundus, and then record their multiple-choice response on a scantron sheet listing all possible funduscopic pathologies. Pre- and post-intervention testing was performed. Survey data assessing exposure to funduscopy skills during undergraduate and postgraduate training and overall experience with the simulator were collected. Results: Most (65% [11/17]) participants reported minimal or no formal teaching in ophthalmology during their undergraduate medical studies. Average pre-intervention score (of 20) was 10.24±1.75 (51%) for the entire group, with no statistically significant difference between average pre-score in the control (10.63±1.77) versus intervention (9.89±1.76, p=0.405) groups. Intervention subjects experienced a statistically significant improvement in scores (9.89±1.76 vs. 12.78±2.05, p=0.006 [95% confidence interval 4.80-0.98]), but control subjects did not. Conclusions: A single session with an ophthalmoscopy simulator can improve diagnostic accuracy in postgraduate pediatric trainees. Use of ophthalmoscopy simulation represents a novel addition to traditional learning methods for postgraduate pediatric residents that can help trainees to improve their confidence and accuracy in performing this challenging examination.
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Biousse V, Bruce BB, Newman NJ. Ophthalmoscopy in the 21st century: The 2017 H. Houston Merritt Lecture. Neurology 2017; 90:167-175. [PMID: 29273687 DOI: 10.1212/wnl.0000000000004868] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 10/05/2017] [Indexed: 11/15/2022] Open
Abstract
Although the usefulness of viewing the ocular fundus is well-recognized, ophthalmoscopy is infrequently and poorly performed by most nonophthalmologist physicians, including neurologists. Barriers to the practice of ophthalmoscopy by nonophthalmologists include not only the technical difficulty related to direct ophthalmoscopy, but also lack of adequate training and discouragement by preceptors. Recent studies have shown that digital retinal fundus photographs with electronic transmission and remote interpretation of images by an ophthalmologist are an efficient and reliable way to allow examination of the ocular fundus in patients with systemic disorders such as diabetes mellitus. Ocular fundus photographs obtained without pharmacologic dilation of the pupil using nonmydriatic fundus cameras could be of great value in emergency departments (EDs) and neurologic settings. The Fundus Photography vs Ophthalmoscopy Trial Outcomes in the Emergency Department (FOTO-ED) study showed that ED providers consistently failed to correctly identify relevant ocular funduscopic findings using the direct ophthalmoscope, and that nonmydriatic fundus photography was an effective alternate way of providing access to the ocular fundus in the ED. Extrapolating these results to headache clinics, outpatient neurology clinics, and adult and pediatric primary care settings seems self-evident. As technology advances, nonmydriatic ocular fundus imaging systems will be of higher quality and more portable and affordable, thereby circumventing the need to master the use of the ophthalmoscope. Visualizing the ocular fundus is more important than the method used. Ocular fundus photography facilitates nonophthalmologists' performance of this essential part of the physical examination, thus helping to reestablish the value of doing so.
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Affiliation(s)
- Valérie Biousse
- From the Departments of Ophthalmology (V.B., B.B.B., N.J.N.), Neurology (V.B., B.B.B., N.J.N.), Epidemiology (B.B.B.), and Neurological Surgery (N.J.N.), Emory University School of Medicine, Atlanta, GA
| | - Beau B Bruce
- From the Departments of Ophthalmology (V.B., B.B.B., N.J.N.), Neurology (V.B., B.B.B., N.J.N.), Epidemiology (B.B.B.), and Neurological Surgery (N.J.N.), Emory University School of Medicine, Atlanta, GA
| | - Nancy J Newman
- From the Departments of Ophthalmology (V.B., B.B.B., N.J.N.), Neurology (V.B., B.B.B., N.J.N.), Epidemiology (B.B.B.), and Neurological Surgery (N.J.N.), Emory University School of Medicine, Atlanta, GA.
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Bursztyn L, Woodward MA, Cornblath WT, Grabe HM, Trobe JD, Niziol L, De Lott LB. Accuracy and Reliability of a Handheld, Nonmydriatic Fundus Camera for the Remote Detection of Optic Disc Edema. Telemed J E Health 2017; 24:344-350. [PMID: 29027884 DOI: 10.1089/tmj.2017.0120] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Optic disc edema can be an important indicator of serious neurological disease, but is poorly detected using the direct ophthalmoscope. Portable fundus photography may overcome this difficulty. INTRODUCTION The purpose of this study was to determine the sensitivity and specificity of a handheld, nonmydriatic fundus camera for the detection of optic disc edema. MATERIALS AND METHODS Retrospective review of nonmydriatic optic disc photographs taken with a portable fundus camera (Pictor Plus; Volk Optical, Mentor, OH) from the University of Michigan Neuro-Ophthalmology Clinics. We included 103 consecutive eyes with optic disc edema and 103 consecutive eyes without optic disc edema of 109 patients. Four masked neuro-ophthalmologists graded a single photograph of each optic disc presented in randomized order and documented the presence of optic disc edema. Sensitivity and specificity of graders' photographic interpretation was compared with clinical examinations. Reliability of assessments within and between graders was determined using kappa statistics. RESULTS The sensitivity and specificity for detection of optic disc edema were 71.8-92.2% and 81.6-95.2%, respectively. Photos were found to be ungradable in 0-8.3% of cases. The intergrader reliabilities ranged from 0.60 [95% confidence interval (CI): 0.52-0.67] to 0.72 (95% CI: 0.66-0.77). Intragrader reliability ranged from 0.76 (95% CI: 0.63-0.92) to 0.82 (95% CI: 0.69-0.95). DISCUSSION Photographs taken with portable, nonmydriatic technology met threshold sensitivity and specificity for remote screening for optic disc edema when performed by most, but not all graders. Reliability between graders was moderate-strong and strong within individual providers. CONCLUSIONS Portable photography holds promise for use in remote screening of optic disc edema.
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Affiliation(s)
- Lulu Bursztyn
- 1 Department of Ophthalmology, Western University , London, Ontario, Canada
| | - Maria A Woodward
- 2 Department of Ophthalmology & Visual Sciences, University of Michigan , Ann Arbor, Michigan
| | - Wayne T Cornblath
- 2 Department of Ophthalmology & Visual Sciences, University of Michigan , Ann Arbor, Michigan
| | - Hilary M Grabe
- 3 Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern , Bern, Switzerland
| | - Jonathan D Trobe
- 2 Department of Ophthalmology & Visual Sciences, University of Michigan , Ann Arbor, Michigan
| | - Leslie Niziol
- 2 Department of Ophthalmology & Visual Sciences, University of Michigan , Ann Arbor, Michigan
| | - Lindsey B De Lott
- 2 Department of Ophthalmology & Visual Sciences, University of Michigan , Ann Arbor, Michigan
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Ricci LH, Ferraz CA. Ophthalmoscopy simulation: advances in training and practice for medical students and young ophthalmologists. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2017; 8:435-439. [PMID: 28721118 PMCID: PMC5498681 DOI: 10.2147/amep.s108041] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To describe and appraise the latest simulation models for direct and indirect ophthalmoscopy as a learning tool in the medical field. METHODS The present review was conducted using four national and international databases - PubMed, Scielo, Medline and Cochrane. Initial set of articles was screened based on title and abstracts, followed by full text analysis. It comprises of articles that were published in the past fifteen years (2002-2017). RESULTS Eighty-three articles concerning simulation models for medical education were found in national and international databases, with only a few describing important aspects of ophthalmoscopy training and current application of simulation in medical education. After secondary analysis, 38 articles were included. CONCLUSION Different ophthalmoscopy simulation models have been described, but only very few studies appraise the effectiveness of each individual model. Comparison studies are still required to determine best approaches for medical education and skill enhancement through simulation models, applied to both medical students as well as young ophthalmologists in training.
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Affiliation(s)
- Lucas Holderegger Ricci
- Department of Ophthalmology, School of Medicine, Laureate International Universities, São Paulo (SP), Brazil
| | - Caroline Amaral Ferraz
- Department of Ophthalmology, Federal University of São Paulo (UNIFESP), São Paulo (SP), Brazil
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Gottlieb M, Bailitz J. Can Ocular Ultrasonography Be Used to Assess Intracranial Pressure? Ann Emerg Med 2016; 68:349-51. [DOI: 10.1016/j.annemergmed.2016.04.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Indexed: 11/24/2022]
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Ting DSW, Sim SSKP, Yau CWL, Rosman M, Aw AT, Yeo IYS. Ophthalmology simulation for undergraduate and postgraduate clinical education. Int J Ophthalmol 2016; 9:920-4. [PMID: 27366698 DOI: 10.18240/ijo.2016.06.22] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Accepted: 09/06/2015] [Indexed: 11/23/2022] Open
Abstract
This is a review education paper on the current ophthalmology simulators utilized worldwide for undergraduate and postgraduate training. At present, various simulators such as the EYE Exam Simulator (Kyoto Kagaku Co. Ltd., Kyoto, Japan), Eyesi direct ophthalmoscope simulator (VRmagic, GmbH, Mannheim, Germany), Eyesi indirect ophthalmoscope simulator (VRmagic, GmbH, Mannheim, Germany) and Eyesi cataract simulators (VRmagic, GmbH, Mannheim, Germany). These simulators are thought to be able to reduce the initial learning curve for the ophthalmology training but further research will need to be conducted to assess the effectiveness of the simulation-assisted Ophthalmology training. Future research will be of great value to assess the medical students and residents' responses and performance regarding the usefulness of the individual eye simulator.
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Affiliation(s)
- Daniel Shu Wei Ting
- Third Hospital Avenue, Singapore National Eye Centre, 168751, Singapore; College Road, DUKE-NUS Medical School Singapore, 169857, Singapore
| | | | | | - Mohamad Rosman
- Third Hospital Avenue, Singapore National Eye Centre, 168751, Singapore; College Road, DUKE-NUS Medical School Singapore, 169857, Singapore
| | - Ai Tee Aw
- Third Hospital Avenue, Singapore National Eye Centre, 168751, Singapore
| | - Ian Yew San Yeo
- Third Hospital Avenue, Singapore National Eye Centre, 168751, Singapore; College Road, DUKE-NUS Medical School Singapore, 169857, Singapore
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Williams DE, Thornton JW. Flipping the Physical Examination: Web-Based Instruction and Live Assessment of Bedside Technique. Ochsner J 2016; 16:70-72. [PMID: 27046409 PMCID: PMC4795508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND The skill of physicians teaching the physical examination skill has decreased, with newer faculty underperforming compared to their seniors. Improved methods of instruction with an emphasis on physical examinations are necessary to both improve the quality of medical education and alleviate the teaching burden of faculty physicians. METHODS We developed a curriculum that combines web-based instruction with real-life practice and features individualized feedback. RESULTS This innovative medical education model should allow the physical examination to be taught and assessed in an effective manner. The model is under study at Baton Rouge General Medical Center. CONCLUSION Our goals are to limit faculty burden, maximize student involvement as learners and evaluators, and effectively develop students' critical skills in performing bedside assessments.
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Affiliation(s)
- Dustyn E. Williams
- Department of Internal Medicine, Baton Rouge General Medical Center, Baton Rouge, LA
| | - John W. Thornton
- Department of Internal Medicine, Tulane University School of Medicine, New Orleans, LA
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Addressing Ophthalmology Education for Newly Matriculated Emergency Medicine Residents Using Innovative Models. Simul Healthc 2015; 10:381-385. [PMID: 26650704 DOI: 10.1097/sih.0000000000000112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION A majority of newly matriculated emergency medicine residents begin their residencies without any formal ophthalmology training received in medical school. Research on available eye models for procedural education and an eye emergencies curriculum is limited. METHODS We developed an eye emergencies curriculum that incorporated a series of lectures and case presentations over the academic year with a biannual "ophthalmology day", which included an intense skills laboratory with novel models. RESULTS From July 2012 to July 2013, 24 newly matriculated interns and 20 upper-level residents participated in the curriculum. The simulations were successfully implemented during multiple sessions. Reasonable material, faculty, and facility resources allowed for continuation of the curriculum. CONCLUSIONS The eye emergencies curriculum provides a well-received and practical model for residents to gain ophthalmology experience. Novel eye simulation models may be useful for other programs to implement to enhance postgraduate education.
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Addressing the 'forgotten art of fundoscopy': evaluation of a novel teaching ophthalmoscope. Eye (Lond) 2015; 30:375-84. [PMID: 26563657 DOI: 10.1038/eye.2015.238] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 09/30/2015] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Direct ophthalmoscopy is an essential skill that students struggle to learn. A novel 'teaching ophthalmoscope' has been developed that allows a third person to observe the user's view of the fundus. OBJECTIVES To evaluate the potential use of this device as an aid to learning, and as a tool for objective assessment of competence. METHODS Participants were randomised to be taught fundoscopy either with a conventional direct ophthalmoscope (control) or with the teaching device (intervention). Following this teaching session, participant competence was assessed within two separate objective structured clinical examination (OSCE) stations: the first with the conventional ophthalmoscope and the second with the teaching device. Each station was marked by two independent masked examiners. Students were also asked to rate their own confidence in fundoscopy on a scale of 1-10. Scores of competence and confidence were compared between groups. The agreement between examiners was used as a marker for inter-rater reliability and compared between the two OSCE stations. RESULTS Fifty-five medical students participated. The intervention group scored significantly better than controls on station 2 (19.8 vs 17.6; P=0.01). They reported significantly greater levels of confidence in fundoscopy (7.3 vs 4.9; P<0.001). Independent examiner scores showed significantly improved agreement when using the teaching device during assessment of competence, compared to the conventional ophthalmoscope (r=0.90 vs 0.67; P<0.001). CONCLUSION The teaching ophthalmoscope is associated with improved confidence and objective measures of competence, when compared with a conventional direct ophthalmoscope. Used to assess competence, the device offers greater reliability than the current standard.
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Golombievski E, Doerrler MW, Ruland SD, McCoyd MA, Biller J. Frequency of Direct Funduscopy Upon Initial Encounters for Patients with Headaches, Altered Mental Status, and Visual Changes: A Pilot Study. Front Neurol 2015; 6:233. [PMID: 26617565 PMCID: PMC4638141 DOI: 10.3389/fneur.2015.00233] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 10/21/2015] [Indexed: 11/25/2022] Open
Abstract
Objective To determine the performance of direct funduscopy (DF) as part of the initial clinical assessment among different faculty physicians and residents from internal medicine, emergency medicine, and neurology (N). Methods Retrospective study of 163 randomly reviewed charts of patients (>18 years) presenting either to the ED, inpatient units, or outpatient clinics from January 2001 to July 2013, with corresponding ICD-9 codes for headaches, altered mental status, and visual changes. Results Although the Neurology Service was the one who performed most DF upon initial evaluation, DF is infrequently done throughout services independent of inpatient or outpatient location. Two thirds of the patients (66%) presenting with visual symptoms had evaluation done by Ophthalmology, which in some instances contributed to the final diagnosis. Conclusion A more robust teaching of DF should be included among the basic clinical competencies during Medical School and Neurology Residency training.
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Affiliation(s)
- Esteban Golombievski
- Department of Neurology, Stritch School of Medicine, Loyola University Chicago , Maywood, IL , USA
| | - Michael W Doerrler
- Department of Neurology, Stritch School of Medicine, Loyola University Chicago , Maywood, IL , USA
| | - Sean D Ruland
- Department of Neurology, Stritch School of Medicine, Loyola University Chicago , Maywood, IL , USA
| | - Matthew A McCoyd
- Department of Neurology, Stritch School of Medicine, Loyola University Chicago , Maywood, IL , USA
| | - José Biller
- Department of Neurology, Stritch School of Medicine, Loyola University Chicago , Maywood, IL , USA
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Douglas C, Windsor C, Lewis P. Too much knowledge for a nurse? Use of physical assessment by final-semester nursing students. Nurs Health Sci 2015; 17:492-9. [PMID: 26138523 DOI: 10.1111/nhs.12223] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Accepted: 03/31/2015] [Indexed: 12/19/2022]
Abstract
There is debate around the scope of physical assessment skills that should be taught in undergraduate nursing programs. Yet this debate is largely uninformed by evidence on what is learned and practiced by nursing students. This study examined the pattern and correlates of physical assessment skill utilization by 208 graduating nursing students at an Australian university, including measures of knowledge, frequency of use, and perceived barriers to physical assessment skills during clinical practice. Of the 126 skills surveyed, on average, only five were used every time students practiced. Core skills reflected inspection or general observation of the patient; none involved complex palpation, percussion, or auscultation. Skill utilization was also shaped by specialty area. Most skills (70%) were, on average, never performed or learned and students perceived nursing physical assessment was marginalized in both university and workplace contexts. Lack of confidence was, thus, a significant barrier to use of skills. Based on these findings, we argue that the current debate must shift to how we might best support students to integrate comprehensive physical assessment into nursing practice.
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Affiliation(s)
- Clint Douglas
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Carol Windsor
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Peter Lewis
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
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Ojeda JC, Colbert JA, Lin X, McMahon GT, Doubilet PM, Benson CB, Wu J, Katz JT, Yialamas MA. Pocket-sized ultrasound as an aid to physical diagnosis for internal medicine residents: a randomized trial. J Gen Intern Med 2015; 30:199-206. [PMID: 25387438 PMCID: PMC4314490 DOI: 10.1007/s11606-014-3086-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 06/17/2014] [Accepted: 10/21/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Proficiency and self-confidence in the physical examination is poor among internal medicine residents and interest in ultrasound technology has expanded. OBJECTIVE We aimed to determine whether a pocket-sized ultrasound improves the diagnostic accuracy and confidence of residents after a 3-h training session and 1 month of independent practice. DESIGN This was a randomized parallel group controlled trial. PARTICIPANTS Forty internal medicine residents in a single program at an academic medical center participated in the study. INTERVENTION Three hours of training on use of pocket-sized ultrasound was followed by 1 month of independent practice. MAIN MEASURES The primary outcome was a comparison of the diagnostic accuracy of a physical exam alone versus a physical examination augmented with a pocket-sized ultrasound. Other outcomes included confidence in exam findings and a survey of attitudes towards the physical exam and the role of ultrasound. KEY RESULTS Residents in the intervention group using a pocket-sized ultrasound correctly identified an average of 7.6 of the 17 abnormal findings (accuracy rate of 44.9 %). Those in the control group correctly identified an average of 6.4 abnormal findings (accuracy rate of 37.6 %, p = 0.11). Residents in the intervention group identified on average 15.9 findings as abnormal when no abnormality existed (false positive rate of 16.8 %). Those in the control group incorrectly identified an average of 15.5 positive findings (false positive rate of 16.3 %). There was no difference between groups regarding self-assessed confidence in physical examination. Residents in the intervention group identified 6.1 of 13 abnormal cardiac findings versus the control group's 4.5 of 13, an accuracy rate of 47.0 % versus 34.6 % (p = 0.023). CONCLUSIONS The diagnostic ability of internal medicine residents did not significantly improve with use of a pocket-sized ultrasound device after a 3-h training session and 1 month of independent practice. TRIAL REGISTRATION clinicaltrials.gov: number NCT01948076; URL http://clinicaltrials.gov/ct2/show/study/NCT01948076?term=ultrasound+physical+exam&rank=2.
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Affiliation(s)
- Jason C Ojeda
- Department of Medicine, Jefferson University, Philadelphia, PA, USA
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Mookherjee S, Hunt S, Chou CL. Twelve tips for teaching evidence-based physical examination. MEDICAL TEACHER 2014; 37:543-550. [PMID: 25270026 DOI: 10.3109/0142159x.2014.959908] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Practicing evidence-based physical examination (EBPE) requires clinicians to apply the diagnostic accuracy of PE findings in relation to a suspected disease. Though it is important to effectively teach EBPE, clinicians often find the topic challenging. AIMS There are few resources available to guide clinicians on strategies to teach EBPE. We seek to fill that need by presenting tips for effectively teaching EBPE in the clinical context. METHODS This report is based primarily on the authors' experience and is supported by the available literature. RESULTS We present 12 practical tips targeting the clinician educator. The first six tips condense key preparatory steps for the teacher, including basic statistics underpinning EBPE. The final six tips provide specific guidance on how to teach EBPE in the clinical environment. CONCLUSIONS By practicing the 12 tips provided, clinicians will develop the confidence needed to effectively teach EBPE in inpatient or outpatient settings.
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Krohn J, Kjersem B, Høvding G. Matching fundus photographs of classmates. An informal competition to promote learning and practice of direct ophthalmoscopy among medical students. J Vis Commun Med 2014; 37:13-8. [PMID: 24694281 DOI: 10.3109/17453054.2014.884551] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To present a new approach for teaching direct ophthalmoscopy to medical students. METHODS At the University of Bergen, four consecutive classes of fourth-year medical students complete a required 9-week ophthalmology course every year. In the present project, one fundus photograph was taken of each student. The photographs were randomly numbered, printed on A4 glossy photo paper, and displayed on the classroom wall. Each student was given a form to fill in the fellow students' names matching the number of the fundus photographs. They were encouraged to practise direct ophthalmoscopy on their classmates outside formal teaching hours. At the end of the course, they returned the filled-in forms, and those with the highest number of correct matches between the fundus photographs and fellow students received a reward. RESULTS Between 2011 and 2013, 239 students completed their ophthalmology course. Of these, 220 students (92%) voluntarily participated in the project. The mean score was 70% correct matches between fundus photographs and fellow students (range 7 - 100%). The students' course evaluations were overall positive. CONCLUSIONS We recommend the use of peer fundus photographs in the context of a learning competition as a simple, inexpensive, and effective way to improve teaching of direct ophthalmoscopy.
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Affiliation(s)
- Jørgen Krohn
- Department of Clinical Medicine, Section of Ophthalmology, University of Bergen , Bergen , Norway
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Coker J, Castiglioni A, Stanford Massie F, Russell SW, Shaneyfelt T, Willett LL, Estrada CA, Kraemer RR, Morris JL, Rodriguez M. Evaluation of an Advanced Physical Diagnosis Course Using Consumer Preferences Methods: The Nominal Group Technique. Am J Med Sci 2014; 347:199-205. [DOI: 10.1097/maj.0b013e3182831798] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gowda D, Blatt B, Fink MJ, Kosowicz LY, Baecker A, Silvestri RC. A core physical exam for medical students: results of a national survey. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2014; 89:436-42. [PMID: 24448049 DOI: 10.1097/acm.0000000000000137] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE Medical students are traditionally taught the physical exam as a comprehensive battery of maneuvers, yet they express uncertainty about which maneuvers are "core" and should be performed routinely on patients and which ones should be performed only when clinically indicated. The authors sought to determine whether educator consensus existed on the concept and the specifics of a core physical exam for students. METHOD The authors developed a 45-maneuver core physical exam to be performed by a medicine clerkship student on every newly admitted patient, with the expectation that it would be supplemented by clinically indicated additional maneuvers. From 2011 to 2012 they sent surveys to physical diagnosis course directors (PDCDs) and internal medicine clerkship directors (IMCDs) from all 132 U.S. allopathic medical schools to determine the extent of their agreement with the proposed 45 maneuvers and their opinions about the concept of a core exam. RESULTS Seventy-one percent (94/132) of PDCDs and 63% (83/132) of IMCDs responded to the survey. In total, 84% (111/132) of all schools surveyed were represented by either their PDCD or IMCD. Of the 45 proposed maneuvers, 37 were deemed "core" by a majority of respondents. The majority of IMCDs preferred a slightly leaner 37-maneuver core exam than the majority of PDCDs, who voted for 41 maneuvers. CONCLUSIONS Among PDCDs and IMCDs, there was openness to teaching medical students a streamlined core physical exam to which other maneuvers are added as clinically indicated. These educators closely agreed on the maneuvers this core exam should include.
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Affiliation(s)
- Deepthiman Gowda
- Dr. Gowda is assistant professor of medicine, Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, New York. Dr. Blatt is professor of medicine, Department of Medicine, George Washington University School of Medicine, Washington, DC. Dr. Fink is assistant professor of medicine, Program in Family Medicine, Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, New York. Dr. Kosowicz is associate professor of medicine, Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut. Ms. Baecker is a PhD candidate in epidemiology, University of California at Los Angeles, Los Angeles, California. At the time of this study, Ms. Baecker was an MPH candidate, Columbia University Mailman School of Public Health, New York, New York. Dr. Silvestri is assistant professor of medicine, Department of Medicine, Harvard Medical School, and physician, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Development of an Instrument to Evaluate Residents’ Confidence in Quality Improvement. Jt Comm J Qual Patient Saf 2013; 39:502-10. [DOI: 10.1016/s1553-7250(13)39066-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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AlMutar S, AlTourah L, Sadeq H, Karim J, Marwan Y. Medical and surgical ward rounds in teaching hospitals of Kuwait University: students' perceptions. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2013; 4:189-93. [PMID: 24101889 PMCID: PMC3791545 DOI: 10.2147/amep.s52096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
BACKGROUND Teaching sessions for medical students during ward rounds are an essential component of bedside teaching, providing students with the opportunity to regard patients as actual people, and to observe their physical conditions directly, allowing a better understanding of illnesses to be developed. We aim to explore medical students' perceptions regarding medical and surgical ward rounds within the Faculty of Medicine at Kuwait University, and to evaluate whether this teaching activity is meeting the expectation of learners. METHODS A pretested questionnaire was used to collect data from 141 medical students during the 2012-2013 academic year. They were asked to provide their current and expected ratings about competencies that were supposed to be gained during ward rounds, on a scale from 1 (lowest) to 5 (highest). Mean scores were calculated, and the Student t-test was used to compare results. P < 0.05 was the cut-off level for significance. RESULTS Only 17 students (12.1%) declined to participate in the study. The students' current competency scores (for competencies taught within both disciplines - medical and surgical) were significantly lower than the scores indicating students' expectations (P < 0.001). The best-taught competency was bedside examination, in both medical (mean: 3.45) and surgical (mean: 3.05) ward rounds. However, medical ward rounds were better than surgical rounds in covering some competencies, especially the teaching of professional attitude and approach towards patients (P < 0.001). CONCLUSION Both medical and surgical ward rounds were deficient in meeting the students' expectations. Medical educators should utilize the available literature to improve the bedside teaching experience for their students.
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Affiliation(s)
| | | | - Hussain Sadeq
- Department of Pediatrics, Mubarak Al-Kabeer Hospital, Kuwait City, Kuwait
| | - Jumanah Karim
- Department of Pediatrics, Mubarak Al-Kabeer Hospital, Kuwait City, Kuwait
| | - Yousef Marwan
- Department of Orthopedic Surgery, Al-Razi Orthopedic Hospital, Kuwait City, Kuwait
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