Prospective, Randomized Trial Comparing Simulator-based versus Traditional Teaching of Direct Ophthalmoscopy for Medical Students

Simulator-Based Versus Traditional Training of Fundus Biomicroscopy for Medical Students: A Prospective Randomized Trial

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.

Efficacy of Simulator-Based Slit Lamp Training for Medical Students: A Prospective, Randomized Trial

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.

Optimising fundoscopy practices across the medical spectrum: A focus group study

INTRODUCTION

Fundoscopy can be of great clinical value, yet remains underutilised. Educational attempts to improve fundoscopy utilisation have had limited success. We aimed to explore the barriers and facilitators underlying the uptake of clinical direct ophthalmoscopy across a spectrum of medical specialties and training levels.

METHODS

Ten focus groups were conducted with medical students (n = 42), emergency department doctors (n = 24), basic physician trainees (n = 7), hospital physicians (n = 6) and general practitioners (n = 7). Independent thematic analysis of transcripts was conducted by three investigators. A consensus thematic framework was developed, and transcripts were reanalysed using this framework.

RESULTS

Thematic analysis identified seven main themes: (1) technical barriers to performing fundoscopy examinations; (2) clinical culture and expectations regarding fundoscopy; (3) the influence of fundoscopy on clinical management; (4) motivation to perform the examination; (5) novel technology including smartphone fundoscopy, and the value of a digital fundus image; (6) training requirements, and; (7) use of limited resources.

CONCLUSION

Our results build a more nuanced picture of the factors which determine fundoscopy utilisation. As current barriers limit practice by clinicians and medical students, expertise and confidence performing and interpreting fundoscopy are lost. This shifts the balance of perceived clinical utility to futility in changing patient management, and reinforces a cycle of reducing fundoscopy utilisation. We identified important cultural barriers such as accepted incompetence, and misperceptions of senior discouragement. Emerging technologies reduce the technical barriers to fundoscopy. Therefore education should: focus on detecting pathology from digital images; clarify the role of fundoscopy in patient management, and; be targeted at key career progression points.