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Liao J, Wright RR, Vora GK. The Decline of Basic Ophthalmology in General Medical Education: A Scoping Review and Recommended Potential Solutions. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205241245635. [PMID: 38596233 PMCID: PMC11003344 DOI: 10.1177/23821205241245635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/20/2024] [Indexed: 04/11/2024]
Abstract
OBJECTIVE This literature review aims to explore research and conceptual pieces on the state of ophthalmology education and suggest potential ways to address current challenges. METHODS A search was conducted in PubMed, ERIC, Web of Science, and Google Scholar with combinations of the following search terms: "ophthalmology education," "undergraduate medical education," "medical student," "United States," and "Canada." Eliminating irrelevant articles yielded 47 articles. Three were excluded because of region and focus, leaving 44. After examining the citations, we generated an additional 22 texts for review, totaling 66 articles. RESULTS Four primary themes were identified: (1) challenges to ophthalmological education in the U.S. and Canada, (2) potential remedies for optimizing ophthalmology curriculum, (3) technology in ophthalmology education, and (4) innovative ophthalmology teaching approaches. Major challenges included the lack of a standardized curriculum and inadequate clinical exposure and skills training. A number of remedies were proposed, such as standardizing curriculum and furthering faculty involvement, utilizing technology as time-effective learning aids, and employing innovative teaching approaches such as service learning. CONCLUSION In light of challenges in ophthalmology education, curriculum designers should consider Cognitive Load Theory (CLT) to assist students to remember meaningful exposures to ophthalmology knowledge and techniques. Based on CLT, we suggest two potential approaches to incorporating ophthalmology curriculum. The first is to embrace interdisciplinary collaborations and place ophthalmology knowledge in varied contexts to facilitate schema construction. The second is to incorporate ophthalmology diagnostics requirements into OSCEs and utilize simulation models for students to gradually increase the fidelity of tasks and devote cognitive resources fully to learning.
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Affiliation(s)
- Jennifer Liao
- Department of Ophthalmology, The Robert Larner, M.D. College of Medicine, University of Vermont, Burlington, VT, USA
| | - Robin Redmon Wright
- Department of Behavioral Sciences and Education, Pennslyvania State University Harrisburg, Middletown, PA, USA
| | - Gargi K Vora
- Department of Ophthalmology, Yale School of Medicine, New Haven, CT, USA
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Optimising fundoscopy practices across the medical spectrum: A focus group study. PLoS One 2023; 18:e0280937. [PMID: 36706098 PMCID: PMC9882965 DOI: 10.1371/journal.pone.0280937] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/11/2023] [Indexed: 01/28/2023] Open
Abstract
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.
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Ahmed Y, Pereira A, Rai AS, Leung VC, Ahmed A, Rai AS. Prospective evaluation of medical student accuracy conducting direct ophthalmoscopy with an unmodified iPhone X. Int Ophthalmol 2022; 42:3933-3940. [PMID: 35871237 PMCID: PMC9308475 DOI: 10.1007/s10792-022-02377-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 06/14/2022] [Indexed: 11/27/2022]
Abstract
Purpose To evaluate fundus examination accuracy of medical students when using an unmodified iPhone X or a direct ophthalmoscope in comparison to a staff ophthalmologist’s retinal examination. Methods In this prospective comparative analysis, patients underwent dilated fundus examination by novice medical trainees using either an unmodified iPhone X or standard direct ophthalmoscope. The primary outcome was the mean difference and degree of agreement in cup-to-disc ratio between student examination and the staff ophthalmologist’s cup-to-disc observation. Results A total of 18 medical students conducted 230 retinal examinations, 117 with the iPhone X and 113 with the direct ophthalmoscope. A greater proportion of students were unable to report cup-to-disc ratio using the iPhone X (81.2%) vs direct ophthalmoscope (30.1%). Student examination of cup-to-disc ratio led to a systematic bias (95% limits of agreement) of + 0.16 (−0.22 to + 0.54) and + 0.10 (−0.36 to + 0.56) with the iPhone X and direct ophthalmoscope, respectively. iPhone X and direct ophthalmoscope student observation concordance for optic disc colour (88.7 and 82.4%, respectively) and contour (68.3 and 74.2%, respectively) demonstrated low agreement with staff ophthalmologist findings. Student iPhone X observations demonstrated lower agreement with staff findings compared to direct ophthalmoscope observations for spontaneous venous pulsations (Cohen’s Kappa = −0.044 vs 0.099). Conclusion Amongst medical trainees, optic disc visualization using an unmodified iPhone X was inferior to the direct ophthalmoscope. When able to visualize the optic nerve head, there was no significant difference in reported cup-to-disc ratio between modalities. However, both modalities demonstrated poor reliability in comparison to staff ophthalmologist findings. Supplementary Information The online version contains supplementary material available at 10.1007/s10792-022-02377-4.
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Affiliation(s)
- Yusuf Ahmed
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Austin Pereira
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Amrit S Rai
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | - Victoria C Leung
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada
| | | | - Amandeep S Rai
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada.
- Kensington Eye Institute, University of Toronto, Toronto, ON, Canada.
- Kensington Vision and Research Centre, Suite 600, 340 College Street, Toronto, ON, M5T 3A9, Canada.
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Burton E, Assi L, Vongsachang H, Swenor BK, Srikumaran D, Woreta FA, Johnson TV. Demographics, clinical interests, and ophthalmology skills confidence of medical student volunteers and non-volunteers in an extracurricular community vision screening service-learning program. BMC MEDICAL EDUCATION 2022; 22:143. [PMID: 35246114 PMCID: PMC8894556 DOI: 10.1186/s12909-022-03194-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 02/22/2022] [Indexed: 05/29/2023]
Abstract
BACKGROUND Medical school curricular hours dedicated to ophthalmology are low and declining. Extracurricular ophthalmology activities, such as participation in community vision screenings, may serve an important adjunctive role in medical school curricula. The Johns Hopkins University (JHU) Vision Screening In Our Neighborhoods (ViSION) Program is an example of a voluntary medical student-directed community service-learning program. METHODS We used a mixed-methods cross-sectional approach, including an online survey and semi-structured interviews. JHU School of Medicine students enrolled in MD or MD/PhD programs during the 2019-2020 academic year were surveyed regarding demographics, career and service interests, involvement in ophthalmology-related activities, and confidence in their ophthalmology-related skills. Survey responses were compared between ViSION volunteers and non-volunteers using Fisher's exact chi-square tests. Semi-structured interviews were conducted via webconference with 8 prior or current ViSION volunteers and responses analyzed using inductive thematic analysis. Data were collected when ViSION volunteers were in variable stages of their medical education and involvement with the ViSION program. RESULTS A total of 118 medical students were included, representing an overall response rate of 24.6% of JHU medical students. ViSION volunteers reported greater involvement in ophthalmology-related research (42% vs. 4%, p < 0.001), intent to apply to ophthalmology residency programs (35% vs. 1%, p = 0.001), and confidence with multiple ophthalmology knowledge and clinical skill domains. In particular, ViSION volunteers were more likely to feel confident estimating cup-to-disc ratio using direct ophthalmoscopy (20% vs. 0%, p < 0.001). In open-ended survey and interview questions, most volunteers attributed at least some degree of their ophthalmology skill development and desire to pursue ophthalmology and public health careers to their ViSION experience. CONCLUSIONS Medical students who volunteered with a student-led community vision screening program were more likely to have a prior interest in ophthalmology than those who did not volunteer, but only 1/3 of volunteers planned to pursue a career in ophthalmology. Overall, volunteers reported higher confidence performing ophthalmology-related clinical skills, suggesting that student-led community vision screening programs may provide an important avenue for medical students to explore public health aspects of ophthalmology, while practicing ophthalmology exam skills and learning about common ophthalmic pathologies, regardless of their career intentions.
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Affiliation(s)
- Eleanor Burton
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lama Assi
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Maumenee B-110, Baltimore, MD, 21287, USA
| | | | - Bonnielin K Swenor
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Maumenee B-110, Baltimore, MD, 21287, USA
| | - Divya Srikumaran
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Maumenee B-110, Baltimore, MD, 21287, USA
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Maumenee B-110, Baltimore, MD, 21287, USA
| | - Thomas V Johnson
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, 600 N Wolfe Street, Maumenee B-110, Baltimore, MD, 21287, USA.
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Developing, conducting and evaluating the internship preparatory program (Ipp). Ann Med Surg (Lond) 2022; 73:103215. [PMID: 35079360 PMCID: PMC8767267 DOI: 10.1016/j.amsu.2021.103215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/23/2021] [Accepted: 12/23/2021] [Indexed: 12/03/2022] Open
Abstract
Background Medical schools worldwide have employed different practices to facilitate a smooth transition from medical school into the internship phase to promote success in graduates’ future professional life. The College of Medicine at Princess Nourah University (PNU) has developed a unique internship preparatory program focusing on soft and clinical skills. Objective The aim of this study was to describe the internship preparatory program (IPP) and evaluate its effectiveness in improving medical students’ transition to internship. Materials and methods The IPP for fifth-year medical students at PNU was planned and designed based on students’ needs, the Saudi-Med framework, and similar national/international programs. The one-year longitudinal IPP in 2016–2017 covered four modules conducted as ten workshops focusing on soft skills, clinical skills, and professional development for the future. All data were analyzed by using SPSS version 20. Results The IPP was attended and evaluated by 48 participants; 70% of them attended 80% of the IPP workshops. The satisfaction rate for workshop participants was 6.8–8.8 out of 10. Most participants were either satisfied or strongly satisfied with respect to each item on the IPP satisfaction scale; the median satisfaction score was 4 out of 5. A positive significant correlation between the satisfaction score and the number of workshops attended was detected. Conclusion The IPP was a satisfying initiative for most participants. It refines their clinical and soft skills, facilitates future planning, and provides a smooth transition from medical school to internship. Internship preparatory program (IPP) refines the graduate's clinical skills. Internship preparatory program (IPP) refines the graduate's soft skills like communication and collaboration. IPP may facilitates future planning for future career. IPP provides a smooth transition from medical school to internship.
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Kohler J, Tran TM, Sun S, Montezuma SR. Teaching Smartphone Funduscopy with 20 Diopter Lens in Undergraduate Medical Education. Clin Ophthalmol 2021; 15:2013-2023. [PMID: 34012252 PMCID: PMC8128496 DOI: 10.2147/opth.s266123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 03/15/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess attitudes of pre-clinical undergraduate medical students toward learning smartphone funduscopy (SF) and its appropriateness as a teaching tool. Patients and Methods Second year medical students received instruction on direct ophthalmoscopy (DO) and SF; they were then paired with a peer and randomly assigned to perform DO or SF first. The SF technique involved freehand alignment of the axes of the smartphone camera with a condenser lens. Both techniques were done through a maximally dilated pupil. A questionnaire was completed to acquire data on baseline experience, performance of both examination techniques, attitudes, and appropriateness. Statistical significance testing and Bland-Altman analysis were used to determine differences between DO and SF, and a multivariable mixed regression model was fitted to identify any predictors for positive attitudes toward DO or SF. Results One hundred thirty-seven (137) individuals completed the study. A similar proportion of students could identify the optic nerve, macula, and vessels using DO and SF. However, self-reported quality scores were higher for DO for the optic nerve (p = 0.006) and macula (p = 0.08). The mean (standard deviation) attempts to identify these major structures were 2.7 (SD 2.3) for DO and 4.5 (SD 2.9) for SF (p < 0.001). Attitudes of students were consistently more positive toward DO across the five questions assessed. A small subset of students had equally positive attitudes toward DO and SF. Improved quality scores were predictive of positive attitudes for both DO and SF. Ultimately, 24% of students preferred SF over DO. Conclusion Among inexperienced examiners of the fundus through a dilated pupil, SF is a non-inferior technique to DO in identifying structures. Despite overall favorable attitudes towards the more familiar DO, those students who quickly learned the SF technique had similar satisfaction scores. Teaching SF should be considered in undergraduate medical education.
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Affiliation(s)
- James Kohler
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN, USA
| | - Tu M Tran
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN, USA
| | - Susan Sun
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN, USA
| | - Sandra R Montezuma
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN, USA
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Dunn HP, Kang CJ, Marks S, Witherow JL, Dunn SM, Healey PR, White AJ. Perceived usefulness and ease of use of fundoscopy by medical students: a randomised crossover trial of six technologies (eFOCUS 1). BMC MEDICAL EDUCATION 2021; 21:41. [PMID: 33419444 PMCID: PMC7793394 DOI: 10.1186/s12909-020-02469-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 12/21/2020] [Indexed: 06/02/2023]
Abstract
BACKGROUND Fundoscopy outside ophthalmology is in decline, and the technical demands of the traditional direct ophthalmoscope examination are likely contributing. Alternative fundoscopy technologies are increasingly available, yet valid comparisons between fundoscopy technologies are lacking. We aimed to assess medical students' perceptions of usefulness and ease of use of traditional and contemporary fundus-viewing technologies including smartphone fundoscopy. METHODS One hundred forty-six second-year medical students participated in a cross-sectional, randomised, cross-over study of fundoscopy methods. Medical students completed small group training sessions using six current fundoscopy technologies including: a non-mydriatic fundus camera; two types of direct fundoscopy; and three types of smartphone fundoscopy. A novel survey of perceived usefulness and ease of use was then completed by students. RESULTS Repeated-measures ANOVA found students rated both the perceived usefulness (p< 0.001) and ease of use (p< 0.001) of smartphone fundoscopy significantly higher than both the non-mydriatic camera and direct fundoscopy. CONCLUSIONS Smartphone fundoscopy was found to be significantly more useful and easier to use than other modalities. Educators should optimise student access to novel fundoscopy technologies such as smartphone fundoscopy which may mitigate the technical challenges of fundoscopy and reinvigorate use of this valuable clinical examination.
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Affiliation(s)
- H P Dunn
- Faculty of Medicine & Health, University of Sydney, Sydney, Australia.
- Department of Ophthalmology, Westmead Hospital, Sydney, Australia.
| | - C J Kang
- Faculty of Medicine & Health, University of Sydney, Sydney, Australia
| | - S Marks
- Faculty of Medicine & Health, University of Sydney, Sydney, Australia
| | - J L Witherow
- Discipline of Physiotherapy, Faculty of Medicine & Health Services, Macquarie University, Sydney, Australia
| | - S M Dunn
- Faculty of Medicine & Health, University of Sydney, Sydney, Australia
| | - P R Healey
- Faculty of Medicine & Health, University of Sydney, Sydney, Australia
- Department of Ophthalmology, Westmead Hospital, Sydney, Australia
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Sydney, Australia
| | - A J White
- Faculty of Medicine & Health, University of Sydney, Sydney, Australia
- Department of Ophthalmology, Westmead Hospital, Sydney, Australia
- Centre for Vision Research, Westmead Institute for Medical Research, University of Sydney, Sydney, Australia
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Moxon NR, Goyal A, Giaconi JA, Rosenberg JB, Graubart EB, Waxman EL, Knoch D, Forster SH, Sankar PS, Mirza RG. The State of Ophthalmology Medical Student Education in the United States: An Update. Ophthalmology 2020; 127:1451-1453. [PMID: 32437862 PMCID: PMC7211606 DOI: 10.1016/j.ophtha.2020.05.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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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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10
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Shipman E, Burford JH, Bowen M, Duz M. Use of smartphones to aid the teaching of equine ocular fundus examination. Vet Rec 2020; 186:532. [PMID: 32169945 DOI: 10.1136/vr.105544] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 12/09/2019] [Accepted: 02/25/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Teaching and learning how to perform examination of the ocular fundus is challenging. Smartphones can support to enhance students' confidence and experience. METHODS Following an optional year-4 ophthalmoscopy practical using hand-held ophthalmoscopes, students completed a questionnaire using a visual analogue scale (VAS) investigating if students felt smartphone use aided learning and if student's self-assessed confidence in visualising the ocular fundus had improved. VAS scores were compared using the Wilcoxon signed rank test (significance: P<0.05). RESULTS All 30 year-4 students attending the practical participated to the study. Confidence in performing direct ophthalmoscopy significantly increased after the practical. Confidence after the practical was 65.3 (±19.8) per cent compared with before the practical when confidence was 20.1 (±15.6) per cent (P<0.001). The perceived usefulness of traditional teaching was 62.3 (±23.8) per cent. The perceived usefulness of the teaching with the smartphone was 91.1 (±8.6) per cent. While students found both methods useful, they perceived the use of the smartphone to be significantly more useful (P<0.001). Free-text comments on the use of the smartphone were all positive and included 'useful', 'fun' and 'good teaching tool'. CONCLUSIONS This study shows that students positively received the use of the smartphone, which can be a useful tool to teach the equine ocular examination to undergraduate veterinary students.
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Affiliation(s)
- Emma Shipman
- School of Veterinary Medicine and Science, The University of Nottingham, Sutton Bonington, UK.,Oakham Veterinary Hospital, Oakham, UK
| | - John H Burford
- School of Veterinary Medicine and Science, The University of Nottingham, Sutton Bonington, UK
| | - Mark Bowen
- School of Veterinary Medicine and Science, The University of Nottingham, Sutton Bonington, UK.,Oakham Veterinary Hospital, Oakham, UK
| | - Marco Duz
- School of Veterinary Medicine and Science, The University of Nottingham, Sutton Bonington, UK
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Graubart EB, Waxman EL, Forster SH, Giaconi JA, Rosenberg JB, Sankar PS, Goyal A, Mirza RG. Ophthalmology Objectives for Medical Students: Revisiting What Every Graduating Medical Student Should Know. Ophthalmology 2019; 125:1842-1843. [PMID: 30454712 DOI: 10.1016/j.ophtha.2018.08.032] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 07/31/2018] [Accepted: 08/28/2018] [Indexed: 10/27/2022] Open
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12
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Uchida T, Achike FI, Blood AD, Boyle M, Farnan JM, Gowda D, Hojsak J, Ovitsh RK, Park YS, Silvestri R. Resources Used to Teach the Physical Exam to Preclerkship Medical Students: Results of a National Survey. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2018; 93:736-741. [PMID: 29116985 DOI: 10.1097/acm.0000000000002051] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE To examine resources used in teaching the physical exam to preclerkship students at U.S. medical schools. METHOD The Directors of Clinical Skills Courses developed a 49-question survey addressing resources and pedagogical methods employed in preclerkship physical exam curricula. The survey was sent to all 141 Liaison Committee on Medical Education-accredited medical schools in October 2015. Results were averaged across schools, and data were weighted by class size. RESULTS Results from 106 medical schools (75% response rate) identified a median of 59 hours devoted to teaching the physical exam. Thirty-eight percent of time spent teaching the physical exam involved the use of standardized patients, 30% used peer-to-peer practice, and 25% involved examining actual patients. Approximately half of practice time with actual patients was observed by faculty. At 48% of schools (51), less than 15% of practice time was with actual patients, and at 20% of schools (21) faculty never observed students practicing with actual patients. Forty-eight percent of schools (51) did not provide compensation for their outpatient clinical preceptors. CONCLUSIONS There is wide variation in the resources used to teach the physical examination to preclerkship medical students. At some schools, the amount of faculty observation of students examining actual patients may not be enough for students to achieve competency. A significant percentage of faculty teaching the physical exam remain uncompensated for their effort. Improving faculty compensation and increasing use of senior students as teachers might allow for greater observation and feedback and improved physical exam skills among students.
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Affiliation(s)
- Toshiko Uchida
- T. Uchida is associate professor of medicine and medical education and director, Clinical Skills Education, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ORCID: http://orcid.org/0000-0002-3251-5872. F.I. Achike is professor of pharmacology, clinical skills, and anesthesiology; director, Clinical Skills and Simulation Program; and associate dean, Interprofessional Education, California University of Science and Medicine School of Medicine, Colton, California. A.D. Blood is director of curriculum and education management, Rush Medical College, Rush University, Chicago, Illinois, and a doctoral candidate in health professions education, University of Illinois at Chicago, Chicago, Illinois; ORCID: http://orcid.org/0000-0003-2275-923X. M. Boyle is clinical associate professor of emergency medicine, assistant dean, Clinical Formation, and course director, Patient Centered Medicine 2, Loyola Stritch School of Medicine, Maywood, Illinois. J.M. Farnan is associate professor of medicine, assistant dean, Curricular Innovation and Evaluation, and director, Clinical Skills Education, University of Chicago Pritzker School of Medicine, Chicago, Illinois. D. Gowda is associate professor of medicine and course director, Foundations of Clinical Medicine Tutorials, Columbia University College of Physicians and Surgeons, New York, New York; ORCID: http://orcid.org/0000-0001-7124-7615. J. Hojsak is associate professor of pediatrics and medical education and course codirector, The Art and Science of Medicine, Years 1 and 2, Icahn School of Medicine at Mount Sinai, New York, New York. R.K. Ovitsh is assistant professor of pediatrics and assistant dean, Clinical Competencies, SUNY Downstate College of Medicine, Brooklyn, New York. Y.S. Park is assistant professor of medical education, University of Illinois at Chicago College of Medicine, Chicago, Illinois; ORCID: http://orcid.org/0000-0001-8583-4335. R. Silvestri is assistant professor of medicine and site director, Practice of Medicine, Harvard Medical School, Boston, Massachusetts; ORCID: http://orcid.org/0000-0001-7706-2208
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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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Selvendran SS, Biswas SK, Aggarwal N. Improving medical students' proficiency in ophthalmoscopy. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2017; 8:219-220. [PMID: 28331384 PMCID: PMC5356919 DOI: 10.2147/amep.s133314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
| | - Sudeep Kumar Biswas
- Department of Undergraduate Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Nikhil Aggarwal
- Department of Undergraduate Medicine, Faculty of Medicine, Imperial College London, London, UK
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