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Abuallut I, Hurissi E, Abuageelah BM, Alfaifi M, Hakami A, Qadri A, Hakami A, Ghulaysi S. Assessment of Ophthalmology Teaching and its Impact on the Choice of Future Specialties Among Medical Students of Jazan University. Cureus 2023; 15:e49134. [PMID: 38130548 PMCID: PMC10733128 DOI: 10.7759/cureus.49134] [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] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Ophthalmology is essential for primary and specialty care physicians, as eye complaints are common, accounting for a sizable proportion of general practice consultations and emergency department visits. Fundamental ophthalmology knowledge is also relevant to other specialty fields. Thus, medical schools must provide effective undergraduate curricula to teach students about salient points, visual examination skills, emergency recognition, and referral indications. The International Council of Ophthalmology (ICO) has set guidelines that medical students should imbibe to become proficient in ophthalmology. However, there have been no recent investigations evaluating undergraduate ophthalmology education at Jazan University's Faculty of Medicine. Therefore, this study aimed to compare the curriculum at Jazan University to the ICO's requirements for undergraduate medical education. METHODS An observational cross-sectional study was conducted with both male and female student participants enrolled in an ophthalmology course at Jazan University's Faculty of Medicine. Following IRB approval, the questionnaire was distributed on social media to assess if Jazan University's undergraduate ophthalmology curriculum complies with ICO standards. RESULTS The study included a diverse sample of 322 participants, predominantly consisting of female students (n=178, 55.3%). The participants' ages ranged from 22 to 36 years, with the majority falling within the 24-25 year age range (n=173, 53.7%). Regarding academic performance, (n=117, 36.3%) of participants had a GPA of less than 4, while 66 (20.5%) had a GPA between 4.76 and 5.00. Among the respondents, 31 (9.6%) indicated having no exposure to ophthalmology, while 117 (36.3%) felt they had insufficient exposure. A considerable percentage of participants expressed competence in various areas, such as obtaining ocular history (n=113, 35.1%), testing visual acuity (n=201, 62.4%), and examining extraocular motility (n=201, 62.4%). In total, 98 participants (30.4%) expressed an interest in ophthalmology, while the majority (n=224, 69.6%) were not interested. CONCLUSION Essential improvements include increasing hands-on clinical experience, small-group learning, exposure across academic years, and early mentorship. Developing competency-based curricula aligned with ICO guidelines could significantly strengthen education. Better training quality and exposure will equip students with the necessary skills, boost confidence, and potentially expand the ophthalmology workforce.
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Affiliation(s)
- Ismail Abuallut
- Department of Surgery, Ophthalmology Division, Jazan University, Jazan, SAU
| | - Eman Hurissi
- Department of Surgery, Ophthalmology Division, Prince Mohammed Bin Naser Hospital, Jazan, SAU
| | | | - Mona Alfaifi
- Department of Medicine and Surgery, Batterjee Medical College, Aseer, SAU
| | - Alshomokh Hakami
- Department of Medicine, Emergency Division, General Jazan Hospital, Jazan, SAU
| | - Alanoud Qadri
- Department of Pediatrics, General Jazan Hospital, Jazan, SAU
| | - Afnan Hakami
- Department of Pharmacy, Maternity & Children's Hospital Bisha, Bisha, SAU
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Hartley MJ, Bartley GB. Ophthalmology and Direct Ophthalmoscopy in Contemporary Medical Education. Am J Ophthalmol 2022; 238:xv-xvi. [PMID: 35192792 DOI: 10.1016/j.ajo.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 11/01/2022]
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Scantling-Birch Y, Naveed H, Tollemache N, Gounder P, Rajak S. Is undergraduate ophthalmology teaching in the United Kingdom still fit for purpose? Eye (Lond) 2022; 36:343-345. [PMID: 34462584 PMCID: PMC8807702 DOI: 10.1038/s41433-021-01756-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/04/2021] [Accepted: 08/18/2021] [Indexed: 02/03/2023] Open
Affiliation(s)
- Y Scantling-Birch
- Department of Medicine, Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK.
| | - H Naveed
- Ophthalmology Unit, Royal Surrey County Hospital, Royal Surrey NHS Foundation Trust, Surrey, UK.,Brighton and Sussex Medical School, Falmer Campus, Brighton, UK
| | - N Tollemache
- Department of Medicine, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - P Gounder
- Department of Oculoplastics, Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK.,Ophthalmology Unit, Royal Perth Hospital, The University of Western Australia, Perth, WA, Australia
| | - S Rajak
- Brighton and Sussex Medical School, Falmer Campus, Brighton, UK.,Department of Oculoplastics, Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, UK
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Al-Najmi YA, Subki AH, Alzaidi NS, Butt NS, Alsammahi AA, Madani FM, Alsallum MS, Al-Harbi RS, Alhibshi NM. Medical Schools' Ophthalmology Course: An Appraisal by Ophthalmology Residents. Int J Gen Med 2021; 14:8365-8372. [PMID: 34819744 PMCID: PMC8607127 DOI: 10.2147/ijgm.s330044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 10/18/2021] [Indexed: 11/25/2022] Open
Abstract
Objective To investigate the perception and satisfaction of ophthalmology residents with the currently provided ophthalmology curricula to medical students. Methods A cross-sectional survey involving first to fourth year ophthalmology residents (N = 106) from all regions of Saudi Arabia was conducted between December 2018 and February 2019. An online questionnaire explored opinions about the ophthalmology course regarding three dimensions. Firstly, adequacy in covering essential parts of the specialty; secondly, improvements required; and thirdly, effectiveness. A score (0–21) was calculated, indicating the overall suitability of the ophthalmology course. In addition, factors of good overall suitability (score ≥10) were analyzed. Results Regarding adequacy, respondents opined that the ophthalmology course did not reasonably cover the basic part (35.8%), clinical part (61.3%), common disease (26.4%), and emergencies (39.6%). Concerning improvements required, more than 80% of the participants expressed that the course required to be improved for all its features, including duration (80.2%), objectives (85.8%), content (82.1%), organization (83.0%), and supervision (81.1%). As to effectiveness, half of them deemed the course unhelpful in familiarizing general practitioners with common ophthalmic diseases and emergencies. Overall, the ophthalmology course was generally deemed suitable (score ≥10) for only 27.4% of the participants, with no differences across gender, level, or region. Conclusion Ophthalmology residents perceived multiple deficits in the current Saudi ophthalmology teaching course. Significant improvements in ophthalmologic curricula are required, besides coping with unprecedented technological advancement in the ophthalmological field.
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Affiliation(s)
| | - Ahmed Hussein Subki
- Department of Internal Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | | | - Nadeem Shafique Butt
- Department of Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Firas Mohamed Madani
- Department of Ophthalmology, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | | | - Rakan Salah Al-Harbi
- Department of Family Medicine, King Fahd Armed Forces Hospital, Jeddah, Saudi Arabia
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Pujari A. Smartphone Ophthalmoscopy: is there a place for it? Clin Ophthalmol 2021; 15:4333-4337. [PMID: 34737548 PMCID: PMC8560125 DOI: 10.2147/opth.s243103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 10/20/2021] [Indexed: 12/12/2022] Open
Abstract
Smartphone technology is advancing at a rapid pace. Their role in day-to-day life is becoming more and more intricate and irreplaceable. Of late, they have gained immense importance in different medical specialities where they possess an active ability to guide the clinician. This is particularly evident in ophthalmology, where the constantly evolving camera-illumination systems and the artificial intelligence integrated technology have unravelled many novel observations for non-contact posterior segment imaging. The scope of this review is to highlight the role of smartphones as ophthalmoscopes (direct as well as indirect). Nevertheless, their limitations and future directions are also stated here with the intention of making progress in the field of smartphone fundus imaging.
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Affiliation(s)
- Amar Pujari
- Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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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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Hytiris ML, Fioratou E, Gillan SN. The Arclight vs. traditional ophthalmoscope: a cross-over trial. Eye (Lond) 2021; 35:831-837. [PMID: 32461568 PMCID: PMC8027786 DOI: 10.1038/s41433-020-0972-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 05/05/2020] [Accepted: 05/13/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND/OBJECTIVES To compare skill acquisition of the new, cost-effective Arclight ophthalmoscope, with the traditional ophthalmoscope (TO), in medical students with no prior experience of ophthalmoscopy. SUBJECTS/METHODS University of Dundee medical students took part in a cross-over trial. Students were divided into two groups and were alternately taught each device using a video tutorial. In period one, Group A was taught the TO first; Group B was taught the Arclight. They were then assessed using simulated objective, structured, clinical, examinations, examining four model heads with lettered fundal photographs of varying sizes of font. Groups crossed over following a 2-week washout period and were taught the second device and reassessed. A questionnaire was distributed to ascertain students' opinions and preferences. RESULTS Forty medical students participated. Overall, 92.5% of students performed better with the Arclight, irrespective of cross-over trial period. The mean difference in score in period one of the cross-over trial was 16.77 (95% CI: 11.63-21.93), with students performing better with the Arclight (p < 0.0001). The mean difference in score in period two was 8.02 (95% CI: 4.52-11.52), with students performing better with the Arclight (p < 0.0001). In addition, performance with the TO improved by 52.9% following initial exposure to the Arclight. The Arclight was the preferred device by 82.5% of students, and 82.5% of students would choose this device for future practice. CONCLUSION Students performed better with and preferred the Arclight ophthalmoscope. The Arclight could be considered as a suitable alternative to the TO used for training medical students.
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Samaranayake UMJE, Mathangasinghe Y, Samaranayake UMNP, Wijayatunga M. Non-simulator-based techniques in teaching direct ophthalmoscopy for medical students: a systematic review. Int J Ophthalmol 2020; 13:660-666. [PMID: 32399420 DOI: 10.18240/ijo.2020.04.20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 12/16/2019] [Indexed: 11/23/2022] Open
Abstract
Non-simulator-based examination methods of the fundal examination have shown to be cost-effective. We reviewed different non-simulator-based direct fundoscopy examination methods used in undergraduate curricula and their outcomes. PubMed (MEDLINE) and Cochrane Database of Systematic Reviews were searched using standard Medical Subject Heading (MeSH) terms ophthalmoscopy, medical education, undergraduate medical education, medical student, educational assessment and learning. The search included publications until 28th February 2019. We obtained 34 articles after screening abstracts; of them, 12 articles were included in the qualitative synthesis. The studies were comprised of diverse teaching methods which included fundal photograph matching with corresponding eye, continuous education using community-based eye clinics, formal instructions and demonstrations prior to skills training, ophthalmoscopy skills practice using eye pathologies, teaching versus conventional ophthalmoscopy and group-based teaching. We concluded that non-simulator-based techniques such as use of fundal photograph matching of an eye of a volunteer, introduction to eye pathologies, smaller student groups and formal instructions with video demonstrations prior to skills training were highly effective in teaching direct ophthalmoscopy for undergraduate medical students.
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Affiliation(s)
| | - Yasith Mathangasinghe
- Department of Anatomy, Faculty of Medicine, University of Colombo, Colombo 00800, Sri Lanka
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Jørgensen M, Savran MM, Christakopoulos C, Bek T, Grauslund J, Toft PB, Ziemssen F, Konge L, Sørensen TL, Subhi Y. Development and validation of a multiple-choice questionnaire-based theoretical test in direct ophthalmoscopy. Acta Ophthalmol 2019; 97:700-706. [PMID: 30816642 DOI: 10.1111/aos.14065] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 02/02/2019] [Indexed: 12/17/2022]
Abstract
PURPOSE Direct ophthalmoscopy can reveal systemic, neurologic and ophthalmic conditions, but is poorly mastered among young physicians. A theoretical test is needed to measure effect of educational interventions. We developed and gathered validity evidence for a multiple-choice questionnaire (MCQ)-based theoretical test in direct ophthalmoscopy. METHODS The MCQ was developed by interviewing experts. Then, validity evidence was evaluated using Messick's validity framework. Content was ensured by inviting the experts to contribute in a Delphi-like process. Response process was ensured by piloting and by streamlining all instructions. Then, the test was taken by ophthalmologists and by medical students without experience in direct ophthalmoscopy. Results were used to evaluate internal structure (item quality analysis and internal consistency), relations to other variables (correlation of test scores to experience level) and consequences (establishment of pass-fail score and the consequences of its use). RESULTS The first phase of the study yielded 100 MCQs. In second phase, we identified that 60 items fulfilled predefined relevance and item quality requirements. These items demonstrated very high internal consistency (Cronbach's alpha = 0.95), significantly discriminated medical students from specialists (p < 0.001, independent samples t-test) and the established pass-fail score of 50 (83%) correct answers resulted in no false positives (students passing) and no false negatives (specialists failing). A Decision study identified that sampling 15 items suffice for certification. CONCLUSION We developed and validated an MCQ-based theoretical test in direct ophthalmoscopy that enables an evidence-based approach to measuring, evaluating and certifying the theoretical knowledge necessary for direct ophthalmoscopy.
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Affiliation(s)
- Morten Jørgensen
- Department of Ophthalmology Zealand University Hospital Roskilde Denmark
- CAMES – Copenhagen Academy for Medical Education and Simulation Capital Region of Denmark Copenhagen Denmark
- Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Mona Meral Savran
- CAMES – Copenhagen Academy for Medical Education and Simulation Capital Region of Denmark Copenhagen Denmark
- Department of Obstetrics and Gynaecology Copenhagen University Hospital Amager and Hvidovre Hvidovre Denmark
| | | | - Toke Bek
- Department of Ophthalmology Aarhus University Hospital Aarhus Denmark
| | - Jakob Grauslund
- Department of Ophthalmology Odense University Hospital Odense Denmark
- Department of Clinical Research Faculty of Healthy Science University of Southern Denmark Odense Denmark
| | - Peter Bjerre Toft
- Department of Ophthalmology, Rigshospitalet Copenhagen University Hospital Copenhagen Denmark
| | - Focke Ziemssen
- Center for Ophthalmology Eberhard‐Karl University Tübingen Tübingen Germany
| | - Lars Konge
- CAMES – Copenhagen Academy for Medical Education and Simulation Capital Region of Denmark Copenhagen Denmark
- Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Torben Lykke Sørensen
- Department of Ophthalmology Zealand University Hospital Roskilde Denmark
- Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
| | - Yousif Subhi
- Department of Ophthalmology Zealand University Hospital Roskilde Denmark
- Faculty of Health and Medical Sciences University of Copenhagen Copenhagen Denmark
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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: 8] [Impact Index Per Article: 1.6] [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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Gilmour-White JA, Picton A, Blaikie A, Denniston AK, Blanch R, Coleman J, Murray PI. Does access to a portable ophthalmoscope improve skill acquisition in direct ophthalmoscopy? A method comparison study in undergraduate medical education. BMC MEDICAL EDUCATION 2019; 19:201. [PMID: 31196068 PMCID: PMC6567496 DOI: 10.1186/s12909-019-1644-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 05/31/2019] [Indexed: 06/02/2023]
Abstract
BACKGROUND Direct ophthalmoscopy (DO) is an essential skill for medical graduates but there are multiple barriers to learning this. Medical students and junior doctors typically lack confidence in DO. Most students do not own an ophthalmoscope and learn via ward devices that vary in design and usability. The Arclight ophthalmoscope (AO) is an easy to use, low-cost and portable device that could help address device access. This study aimed to assess the impact of personal ownership of an AO on DO skill acquisition and competency amongst medical students in the clinical environment. METHODS Method comparison study with 42 medical students randomised to either traditional device ophthalmoscope (TDO) control or AO intervention group during an 18-week medical placement. Three objective assessments of DO competency were performed at the beginning and end of the placement: vertical cup to disc ratio (VCDR) measurement, fundus photo multiple-choice questions (F-MCQ) and model slide examination (MSE). DO examinations performed during the placement were recorded via an electronic logbook. RESULTS Students in both groups recorded a median number of six examinations each during an eighteen-week placement. There was no statistically significant difference between the groups in any of the objective assessment measures (VCDR p = 0.561, MCQ p = 0.872, Model p = 0.772). Both groups demonstrated a minor improvement in VCDR measurement but a negative performance change in F-MCQ and MSE assessments. CONCLUSIONS Students do not practice ophthalmoscopy often, even with constant access to their own portable device. The lack of significant difference between the groups suggests that device access alone is not the major factor affecting frequency of DO performance and consequent skill acquisition. Improving student engagement with ophthalmoscopy will require a more wide-ranging approach.
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Affiliation(s)
| | - A. Picton
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - A. Blaikie
- Global Health Implementation Team, School of Medicine, University of St Andrews, Scotland, UK
| | - A. K. Denniston
- University Hospitals Birmingham NHSFT, Birmingham, UK
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - R. Blanch
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
| | - J. Coleman
- Institute of Clinical Sciences, University of Birmingham, Birmingham, UK
| | - P. I. Murray
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
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12
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Kim Y, Chao DL. Comparison of smartphone ophthalmoscopy vs conventional direct ophthalmoscopy as a teaching tool for medical students: the COSMOS study. Clin Ophthalmol 2019; 13:391-401. [PMID: 30858689 PMCID: PMC6387606 DOI: 10.2147/opth.s190922] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the utility of smartphone ophthalmology for medical students for learning fundoscopy compared with direct ophthalmoscopy. Methods After 1 hour of didactic instruction on ophthalmoscopy, second-year medical students in a small group setting were randomized to start training with the direct ophthalmoscope vs smartphone ophthalmoscope and crossed over to the other instrument through the session. Main outcome measures Ability to visualize the optic nerve and retinal blood vessels in an undilated pupil as well as a survey evaluating ease of use, confidence, and ability to visualize the optic nerve with the two instruments. Results One hundred and one medical students participated. Significantly more medical students were able to visualize the optic nerve with the smartphone ophthalmoscope vs the direct ophthalmoscope in an undilated pupil (82.3% vs 48.5%, P<0.0001). Students reported a more positive experience with the smartphone ophthalmoscope, specifically regarding ease of use (median of 4 vs 3; P<0.0001), their confidence in performing ophthalmoscopy (median of 4 vs 3; P<0.0001), and their ability to visualize features of the optic nerve (median 4 vs 3; P<0.0001). A significant number of participants preferred the smartphone ophthalmoscope over the traditional direct ophthalmoscope for learning how to identify the optic disc and for evaluating patients (78.2% and 77.2%, respectively; P<0.0001). Conclusion Smartphone ophthalmoscopy may serve as a useful adjunctive tool to teach direct ophthalmoscopy as well as being an alternative for examining the fundus for noneye care physicians.
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Affiliation(s)
- Yeji Kim
- Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego, CA, USA,
| | - Daniel L Chao
- Department of Ophthalmology, Shiley Eye Institute, University of California, San Diego, CA, USA,
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Gunasekera CD, Thomas P. High-Resolution Direct Ophthalmoscopy With an Unmodified iPhone X. JAMA Ophthalmol 2019; 137:212-213. [PMID: 30489602 DOI: 10.1001/jamaophthalmol.2018.5806] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Chrishan D. Gunasekera
- Department of Ophthalmology, Ipswich Hospital, University College London, Ipswich, United Kingdom
- Now with Department of Ophthalmology, West Suffolk Hospital, Hardwick Lane, Bury St Edmunds, United Kingdom
| | - Peter Thomas
- National Institute of Health Research Biomedical Research Centre, Moorfields Eye Hospital, UCL Institute of Ophthalmology, London, United Kingdom
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Mamtora S, Sandinha MT, Ajith A, Song A, Steel DHW. Smart phone ophthalmoscopy: a potential replacement for the direct ophthalmoscope. Eye (Lond) 2018; 32:1766-1771. [PMID: 30042410 PMCID: PMC6224494 DOI: 10.1038/s41433-018-0177-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 05/29/2018] [Accepted: 06/18/2018] [Indexed: 11/08/2022] Open
Abstract
PURPOSE The purpose of this study is to evaluate a commercially available smartphone ophthalmoscope, D-EYE, as compared with the direct ophthalmoscope when used by a cohort of final-year medical students in a prospective study. METHODS Two-hundred fundal examinations were performed on the eyes of 10 mannequins featuring 5 unique fundal images by 20 final-year medical students from Newcastle University. Each student examined the five fundal images twice, once each with a direct ophthalmoscope and D-EYE in a random order. Students recorded their findings at the optic nerve, macula, and retina in an objective questionnaire, and the findings were analysed by an observer masked to the examination technique. RESULTS Students provided more accurate clinical descriptions of their findings when using D-EYE as opposed to using the direct ophthalmoscope (p < 0.05). In addition, we found that students were overall more likely to make a correct diagnosis based on their findings when using D- EYE compared with the direct ophthalmoscope. CONCLUSION Our study suggests that the use of a smartphone-based alternative to the direct ophthalmoscope may improve the accuracy and quality of fundal examinations by non-ophthalmologists.
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Affiliation(s)
| | | | | | - Anna Song
- Newcastle University, Newcastle upon Tyne, UK
| | - David H W Steel
- Institute of Genetic Medicine, Newcastle University, Newcastle upon Tyne, UK
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15
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Dhillon B, Dhillon N. Reading the retina. CLINICAL TEACHER 2018; 15:272. [DOI: 10.1111/tct.12770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Baljean Dhillon
- Clinical Ophthalmology Department; University of Edinburgh; Division of Health Services; Edinburgh UK
- NHS Lothian; Ophthalmology Department; Princess Alexandra Eye Pavilion; Edinburgh UK
| | - Niku Dhillon
- NHS Tayside; Obstetrics and Gynaecology Department; Ninewells Hospital; Dundee UK
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16
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Williams DL, Wager C, Brearley J. Student attitudes regarding the educational value and welfare implications in the use of model eyes and live dogs in teaching practical fundus examination: evaluation of responses from 40 students. Open Vet J 2016; 6:172-177. [PMID: 27822453 PMCID: PMC5095501 DOI: 10.4314/ovj.v6i3.5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 09/26/2016] [Indexed: 12/02/2022] Open
Abstract
This study sought to document student opinions on the educational value and welfare implications of use of artificial model eyes and live dogs in the training of veterinary students in examination of the canine fundus. Forty students who had undertaken a practical class on canine fundoscopy involving both use of artificial model eyes and live dogs were asked to complete a short questionnaire using a Likert scale to gauge their opinion on whether the use of live dogs and artificial eyes was very valuable (scoring 2), valuable (1), a neutral response (0), not particularly valuable (-1) or not at all valuable (-2) and to write a free text response on their views of the educational value and welfare implications of using artificial model eyes or live dogs in training for ophthalmic examination of the canine ocular fundus. Likert responses were 1.84±0.37 for using live greyhounds and 0.58±0.79 for using simulator eyes (p<0.0001). Thematic analysis of the written responses showed that while the artificial eyes were considered somewhat valuable in initial training, the live dogs were significantly preferred for their realism and the opportunity to examine the eye while handling a live animal. In conclusion, while model eyes are valuable initial training in use of the ophthalmoscope for funduscopic examination, students consider that examining the eye in the live dog is significantly more valuable and that the welfare of dogs thus used is not in their view unduly compromised.
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Affiliation(s)
- D L Williams
- Queen's Veterinary School Hospital, Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK
| | - C Wager
- Clinical Skills Center, Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK
| | - J Brearley
- Clinical Skills Center, Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge CB3 0ES, UK
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17
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Borgersen NJ, Henriksen MJV, Konge L, Sørensen TL, Thomsen ASS, Subhi Y. Direct ophthalmoscopy on YouTube: analysis of instructional YouTube videos' content and approach to visualization. Clin Ophthalmol 2016; 10:1535-41. [PMID: 27574393 PMCID: PMC4993418 DOI: 10.2147/opth.s111648] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Direct ophthalmoscopy is well-suited for video-based instruction, particularly if the videos enable the student to see what the examiner sees when performing direct ophthalmoscopy. We evaluated the pedagogical effectiveness of instructional YouTube videos on direct ophthalmoscopy by evaluating their content and approach to visualization. Methods In order to synthesize main themes and points for direct ophthalmoscopy, we formed a broad panel consisting of a medical student, junior and senior physicians, and took into consideration book chapters targeting medical students and physicians in general. We then systematically searched YouTube. Two authors reviewed eligible videos to assess eligibility and extract data on video statistics, content, and approach to visualization. Correlations between video statistics and contents were investigated using two-tailed Spearman’s correlation. Results We screened 7,640 videos, of which 27 were found eligible for this study. Overall, a median of 12 out of 18 points (interquartile range: 8–14 key points) were covered; no videos covered all of the 18 points assessed. We found the most difficulties in the approach to visualization of how to approach the patient and how to examine the fundus. Time spent on fundus examination correlated with the number of views per week (Spearman’s ρ=0.53; P=0.029). Conclusion Videos may help overcome the pedagogical issues in teaching direct ophthalmoscopy; however, the few available videos on YouTube fail to address this particular issue adequately. There is a need for high-quality videos that include relevant points, provide realistic visualization of the examiner’s view, and give particular emphasis on fundus examination.
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Affiliation(s)
- Nanna Jo Borgersen
- Department of Ophthalmology, Zealand University Hospital, Roskilde; Copenhagen Academy for Medical Education and Simulation, the Capital Region of Denmark; Faculty of Health and Medical Sciences, University of Copenhagen
| | - Mikael Johannes Vuokko Henriksen
- Copenhagen Academy for Medical Education and Simulation, the Capital Region of Denmark; Faculty of Health and Medical Sciences, University of Copenhagen
| | - Lars Konge
- Copenhagen Academy for Medical Education and Simulation, the Capital Region of Denmark; Faculty of Health and Medical Sciences, University of Copenhagen
| | - Torben Lykke Sørensen
- Department of Ophthalmology, Zealand University Hospital, Roskilde; Faculty of Health and Medical Sciences, University of Copenhagen
| | - Ann Sofia Skou Thomsen
- Copenhagen Academy for Medical Education and Simulation, the Capital Region of Denmark; Faculty of Health and Medical Sciences, University of Copenhagen; Department of Ophthalmology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Yousif Subhi
- Department of Ophthalmology, Zealand University Hospital, Roskilde; Faculty of Health and Medical Sciences, University of Copenhagen
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18
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19
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Orlans HO. Direct ophthalmoscopy should be taught within the context of its limitations. Eye (Lond) 2015; 30:326-7. [PMID: 26611850 DOI: 10.1038/eye.2015.225] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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20
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Appleton JP, Nicholl DJ. Comment on: 'Direct ophthalmoscopy should be taught to undergraduate medical students'. Eye (Lond) 2015; 30:327. [PMID: 26611843 DOI: 10.1038/eye.2015.226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- J P Appleton
- Department of Neurology, Sandwell and West Birmingham Hospitals NHS Trust, City Hospital, Dudley Road, Birmingham, UK
| | - D J Nicholl
- Department of Neurology, Sandwell and West Birmingham Hospitals NHS Trust, City Hospital, Dudley Road, Birmingham, UK
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21
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Hill SCL, Jawaid I, Amoaku W. Response to: 'Direct ophthalmoscopy should be taught to undergraduate medical students'. Eye (Lond) 2015; 30:327-8. [PMID: 26611847 DOI: 10.1038/eye.2015.227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- S C L Hill
- Division of Clinical Neurosciences, Ophthalmology and Vision Sciences, EENT Centre, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - I Jawaid
- Division of Clinical Neurosciences, Ophthalmology and Vision Sciences, EENT Centre, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - W Amoaku
- Division of Clinical Neurosciences, Ophthalmology and Vision Sciences, EENT Centre, Queen's Medical Centre, University of Nottingham, Nottingham, UK
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22
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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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