Enhancing Medical Student Education by Implementing a Competency-Based Ophthalmology Curriculum

Ophthalmology teaching in Australian medical schools: A national survey

PURPOSE

To survey the current educational trends and methods of ophthalmology teaching in Australian undergraduate and postgraduate medical schools.

MATERIALS AND METHODS

Cross-sectional survey; National online survey distributed to Australian university undergraduate and post-graduate medical schools from November 2020 to March 2021. The survey encompassed 35 questions on student demographics, teaching methods, core theoretical topics, clinical skills, and assessment methods in ophthalmology. One survey per institution completed by the relevant individual responsible for curriculum.

RESULTS

Total response rate of 90.48% (19 of 21 medical schools) was received with good representation across Australia. Ophthalmology rotations were required in 63.3% (n = 12), while 36.7% (n = 7) did not have mandatory terms. This compares favourably to the USA (16%), Canada (35.7%) and equivalent to UK (65%). 74% (n = 14) state ophthalmology is not a priority in the curriculum. All respondents reported student exposure to at least one clinical day in ophthalmology, with total teaching time ranging from less than six hours (36.9%), up to greater than two weeks (10.5%). Overall, only 31.6% reported utilisation of the International Council of Ophthalmology (ICO) curriculum in curricular development.

CONCLUSIONS

Ophthalmology medical school teaching in Australia remains reasonable when compared internationally, but there is significant variation amongst universities. Incorporation of the ICO curriculum and development of shared resources would enhance medical graduates' competence.

Outcomes of a Short Course in Improving Eye Healthcare Knowledge and Skills Among Final-Year Medical Students

BACKGROUND

Globally, at least, more than 2 billion people are either blind or visually impaired, the majority of whom live in low-income settings. Visually impaired people experience limitations in their daily activities in addition to the negative psychological impact. Ophthalmology is not a major focus in medical curricula, including in Sudan. The purpose of this study was to evaluate the effects of a short course in improving eye healthcare knowledge and skills among final-year medical students in a public university in Khartoum State, Sudan.

METHODS

A mixed-methods interventional study was conducted among 25 final-year medical students in Sudan. A short ophthalmology course was designed and conducted aiming to strengthen the knowledge and ability of the medical students to deal with common eye disorders, eye emergencies, prevention of blindness, and promotion for eye health. Data were collected using a closed-ended questionnaire at the start and 1 month after completion of the course. The quantitative data were analyzed using Excel, and the Fisher exact test was performed using Statistical Package for the Social Sciences (version 21.0) to examine any association between variables of interest. A p value of less than 0.05 was considered statistically significant. The quantitative data was supplemented by one focus group discussion that was conducted at the end of the course.

RESULTS

The average ophthalmology knowledge of participants improved from 52.6 to 86.6% (p < 0.001). Diagnostic skills improved from 57.3 to 93.6% (p < 0.001), and knowledge regarding the needed interventional actions improved from 58.6% to 94% (p < 0.001). Participants both enjoyed and learnt from this short course. Participants felt more confident and able to distinguish between simple, complicated, and urgent conditions. The majority of course content was new to them, but they suggested replacing some content with actual clinical work.

CONCLUSION

A well-designed short ophthalmology course significantly improves the levels of medical students' knowledge and skills towards eye health. Implementing such a course as a standard component in the national medical curriculum has the potential to contribute towards the reduction of blindness in the long term.

Demographics, clinical interests, and ophthalmology skills confidence of medical student volunteers and non-volunteers in an extracurricular community vision screening service-learning program

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.

Evaluation and Analysis of Fellow Learning and Education Curriculum in a Regional Anesthesiology and Acute Pain Medicine Fellowship: A Prospective, Observational Pilot Study

BACKGROUND

Since 2017, several regional anesthesiology and acute pain medicine fellowship programs throughout the country have developed various educational didactic curriculums to address the core medical knowledge requirements as set by the Accreditation Council for Graduate Medical Education. Given the paucity of existing literature regarding the medical knowledge acquisition of regional anesthesiology and acute pain medicine fellows, this study aimed to determine how quickly these fellows learn during their fellowship year, with a secondary aim of analyzing a new educational didactic curriculum in its goal of delivering the required medical knowledge.

METHODS

An 89-question, multiple-choice examination was administered to the 2020-2021 regional anesthesiology and acute pain medicine fellows at the University of Pittsburgh Medical Center during orientation and again at 4 months and 8 months into the fellowship. A secondary analysis of anonymous deidentified answers was completed.

RESULTS

Fellows averaged 64%, 74%, and 79% correct responses on the orientation, 4-month, and 8-month exams, respectively. An analysis of the orientation exam revealed that the most commonly incorrect answers stemmed from topics including lower extremity nerve blocks, truncal blocks, and neuraxial anesthesia. The 4-month exam showed overall marked improvement; however, truncal blocks remained the most missed topic. Topics with 100% correct response rates in all examinations were local anesthetic pharmacology and systemic opioids.

CONCLUSIONS

The results of this study indicate that a large portion of learning occurs during the first 4 months of the fellowship and slows thereafter. Using this simple form of fellowship evaluation, changes to an educational didactic curriculum can be implemented to reach medical knowledge goals more effectively and efficiently as required by the Accreditation Council for Graduate Medical Education.

Twelve tips for teaching ophthalmology in the undergraduate curriculum

Ophthalmology education in the undergraduate medical curriculum has declined, and graduating healthcare professionals express discomfort with basic evaluation and management of ophthalmic complaints. With the growing aging population, ophthalmic needs will continue to rise, underscoring the need for increased eye care. This article offers 12 tips for increasing undergraduate ophthalmic education, which can be implemented strategically within limited established curricular time, or in novel ways outside the traditional curriculum. Within the curriculum, existing ophthalmology sessions can be enhanced through use of simulation technology and partnership with ophthalmology faculty. Additional curricular time can be justified through needs assessments and alignment of content with other disciplines, and ophthalmology content on licensing examinations. Finally, ophthalmology can be reinforced in service-based initiatives and through use of online resources and social media.