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Spencer SKR, Ireland PA, Braden J, Hepschke JL, Lin M, Zhang H, Channell J, Razavi H, Turner AW, Coroneo MT, Shulruf B, Agar A. A Systematic Review of Ophthalmology Education in Medical Schools: The Global Decline. Ophthalmology 2024; 131:855-863. [PMID: 38185285 DOI: 10.1016/j.ophtha.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 12/15/2023] [Accepted: 01/02/2024] [Indexed: 01/09/2024] Open
Abstract
TOPIC This systematic review examined geographical and temporal trends in medical school ophthalmology education in relationship to course and student outcomes. CLINICAL RELEVANCE Evidence suggesting a decline in ophthalmology teaching in medical schools is increasing, raising concern for the adequacy of eye knowledge across the rest of the medical profession. METHODS Systematic review of Embase and SCOPUS, with inclusion of studies containing data on medical school ophthalmic course length; 1 or more outcome measures on student ophthalmology knowledge, skills, self-evaluation of knowledge or skills, or student course appraisal; or both. The systematic review was registered prospectively on the International Prospective Register of Systematic Reviews (identifier, CRD42022323865). Results were aggregated with outcome subgroup analysis and description in relationship to geographical and temporal trends. Descriptive statistics, including nonparametric correlations, were used to analyze data and trends. RESULTS Systematic review yielded 4596 publication titles, of which 52 were included in the analysis, with data from 19 countries. Average course length ranged from 12.5 to 208.7 hours, with significant continental disparity among mean course lengths. Africa reported the longest average course length at 103.3 hours, and North America reported the shortest at 36.4 hours. On average, course lengths have been declining over the last 2 decades, from an average overall course length of 92.9 hours in the 2000s to 52.9 hours in the 2020s. Mean student self-evaluation of skills was 51.3%, and mean student self-evaluation of knowledge was 55.4%. Objective mean assessment mark of skills was 57.5% and that of knowledge was 71.7%, compared with an average pass mark of 66.7%. On average, 26.4% of students felt confident in their ophthalmology knowledge and 34.5% felt confident in their skills. DISCUSSION Most evidence describes declining length of courses devoted to ophthalmology in the last 20 years, significant student dissatisfaction with courses and content, and suboptimal knowledge and confidence. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
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Affiliation(s)
- Sascha K R Spencer
- The University of New South Wales, Sydney, Australia; Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Patrick A Ireland
- The University of New South Wales, Sydney, Australia; Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Jorja Braden
- The University of Sydney, Sydney, New South Wales, Australia; Melanoma Institute of Australia, Sydney, New South Wales, Australia
| | - Jenny L Hepschke
- The University of New South Wales, Sydney, Australia; Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Michael Lin
- The University of New South Wales, Sydney, Australia
| | - Helen Zhang
- The University of New South Wales, Sydney, Australia
| | - Jessie Channell
- University of Western Australia, Perth, Western Australia, Australia; Lions Eye Institute, Perth, Western Australia, Australia
| | - Hessom Razavi
- University of Western Australia, Perth, Western Australia, Australia; Lions Eye Institute, Perth, Western Australia, Australia
| | - Angus W Turner
- University of Western Australia, Perth, Western Australia, Australia; Lions Eye Institute, Perth, Western Australia, Australia
| | - Minas T Coroneo
- The University of New South Wales, Sydney, Australia; Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Boaz Shulruf
- The University of New South Wales, Sydney, Australia
| | - Ashish Agar
- The University of New South Wales, Sydney, Australia; Prince of Wales Hospital, Sydney, New South Wales, Australia.
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Reynolds GL, Plant G, Epps S, Sebastian R, Bennetto L. Glaucoma: what the neurologist needs to know. Pract Neurol 2024:pn-2023-003905. [PMID: 38906698 DOI: 10.1136/pn-2023-003905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2024] [Indexed: 06/23/2024]
Abstract
Glaucoma is a progressive optic neuropathy resulting from pathological changes at the optic disc due to elevated intraocular pressure. Its diagnosis, treatment and follow-up are almost entirely conducted in ophthalmology clinics, with screening conducted by community optometrists. Despite this, neurologists may encounter glaucoma in both its acute presentation (as angle closure, presenting as acute headache) and its chronic forms (often as optic neuropathy of unknown cause). An awareness of the underlying pathological process, and the key distinguishing signs and symptoms, will allow neurologists to identify the glaucomatous process rapidly. Timely referral is essential as glaucoma invariably results in progressive visual loss without treatment. This review therefore condenses the wide field of glaucoma into a practical summary, aimed at practitioners with limited clinical experience of this ophthalmic condition.
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Affiliation(s)
- Gavin L Reynolds
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Eye Hospital, Bristol, UK
| | - Gordon Plant
- National Hospital for Neurology and Neurosurgery, London, UK
| | - Simon Epps
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Eye Hospital, Bristol, UK
| | - Rani Sebastian
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Eye Hospital, Bristol, UK
| | - Luke Bennetto
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol Eye Hospital, Bristol, UK
- Department of Neuroscience, North Bristol NHS Trust Southmead Hospital, Bristol, UK
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Dutt DDCS, Carr SE, Scott TM, Petsoglou C, Grigg J, Razavi H. Educators' consideration of learner motivation in ophthalmology education in medical school: Influences on teaching practice and course design. MEDICAL TEACHER 2024; 46:387-398. [PMID: 37703439 DOI: 10.1080/0142159x.2023.2256956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
BACKGROUND Ophthalmology education in medical school has historically neglected the impact of autonomous motivation on student learning and wellbeing. This study aimed to understand ophthalmology educators' consideration and application of student motivation in ophthalmology medical education. MATERIAL AND METHODS Lead ophthalmology educators from Australian and New Zealand medical schools participated in an online semi-structured in-depth interview. Interview transcripts were analysed using thematic analysis. Codes were generated and aligned into overarching themes. FINDINGS Six educators participated in the study. Five main themes arose from the transcripts: the lack of explicit consideration of student motivation, implicit consideration of motivation in curriculum design and in teaching practices, the impact of innovation on motivation and the relationship between teacher and student motivation. Participants also commented on trends in ophthalmology education including generalists' confidence in managing ophthalmic disease, the role of fundoscopy in medical education and time pressure on ophthalmology in medical schools. CONCLUSION There has only been an implicit instead of explicit consideration of motivation in ophthalmology education in medical school, which leaves an unfulfilled potential for teaching practices to impact the affective along with cognitive and metacognitive aspects of learning. This study highlights the need for motivation to be explicitly incorporated into the development of teaching practices and curriculum reform.
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Affiliation(s)
- Deepaysh D C S Dutt
- Health Professions Education, The University of Western Australia, Perth, Western Australia, Australia
| | - Sandra E Carr
- Health Professions Education, The University of Western Australia, Perth, Western Australia, Australia
| | - Tabitha M Scott
- Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
| | | | - John Grigg
- Save Sight Institute, University of Sydney, Sydney, New South Wales, Australia
- The Children's Hospital at Westmead, Eye Genetics Research Group, Children's Medical Research Institute, Sydney, New South Wales, Australia
- Genetic Medicine and Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Hessom Razavi
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Western Australia, Australia
- Department of Ophthalmology, Lions Eye Institute, Perth, Western Australia, Australia
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Dutt DD, Razavi H, Carr SE. Self-determination theory in ophthalmology education: factors influencing autonomy, competence and relatedness in medical students. MEDICAL EDUCATION ONLINE 2023; 28:2258633. [PMID: 37729582 PMCID: PMC10512850 DOI: 10.1080/10872981.2023.2258633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/08/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND The affective components of learning, including student motivation, has yet to be thoroughly investigated in undergraduate ophthalmology education. This study aims to use Self-Determination Theory (SDT) as a framework to describe the variations in student perceptions of motivation in studying ophthalmology through their satisfactions of autonomy, competence and relatedness, and to highlight factors that stimulate or hinder this. METHODS Penultimate year medical students from a single tertiary educational institution undertaking a clinical placement in ophthalmology participated in in-depth interviews to explore factors affecting their perceptions of motivation in studying ophthalmology. Interviews were transcribed and analysed according to the principles of interpretive phenomenography through the theoretical framework of SDT. RESULTS Of the 39 students invited, 10 agreed to participate. Variations in perceptions of experiences generated the outcome space. Participants experienced either amotivation, external locus extrinsic motivation, internal locus extrinsic motivation and intrinsic motivation (conceptions of the outcome space). This was described with respect to their satisfaction of autonomy, competence and relatedness (dimensions of the outcome space). Additionally, 21 factors that impacted on motivation were identified, of which five over-arching factors impacted all three basic psychological needs - guidance, growth mindset, assessment, curricular pressure and extracurricular pressure. CONCLUSIONS The findings of this study provide a unique insight into the motivation of medical students studying ophthalmology. This provides an exciting opportunity for medical educators to address the affective aspect of learning.
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Affiliation(s)
- Deepaysh D.C.S. Dutt
- Health Professions Education, The University of Western Australia, Perth, Western Australia, Australia
| | - Hessom Razavi
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Western Australia, Australia
- Lions Eye Institute, Department of Ophthalmology, Perth, Western Australia, Australia
| | - Sandra E. Carr
- Health Professions Education, The University of Western Australia, Perth, Western Australia, Australia
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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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Chan PP, Lee VWY, Yam JCS, Brelén ME, Chu WK, Wan KH, Chen LJ, Tham CC, Pang CP. Flipped Classroom Case Learning vs Traditional Lecture-Based Learning in Medical School Ophthalmology Education: A Randomized Trial. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:1053-1061. [PMID: 37067959 DOI: 10.1097/acm.0000000000005238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
PURPOSE To address the problem of teaching noncore specialties, for which there is often limited teaching time and low student engagement, a flipped classroom case learning (FCCL) module was designed and implemented in a compulsory 5-day ophthalmology rotation for undergraduate medical students. The module consisted of a flipped classroom, online gamified clinical cases, and case-based learning. METHOD Final-year medical students in a 5-day ophthalmology rotation were randomized to the FCCL or a traditional lecture-based (TLB) module. The outcomes of subjective assessments (student-rated anonymous Likert scale questionnaire, scale 1 to 5, and course and teaching evaluation, scale 1 to 6) and objective assessments (end-of-rotation and post-MBChB multiple-choice questions, scale 0 to 60) were compared between the 2 groups. RESULTS Between May 2021 and June 2022, 216 students (108 in each group) completed the study. Compared with the TLB students, the students in the FCCL group rated various aspects of the course statistically significantly higher, including feeling more enthusiastic and engaged by the course and more encouraged to ask questions and participate in discussions (all P < .001). They also gave higher ratings for the instructional methods, course assignments, course outcomes, and course workload ( P < .001). They gave higher course and teaching evaluation scores to the tutors (5.7 ± 0.6 vs 5.0 ± 1.0, P < .001). The FCCL group scored higher than the TLB group on the end-of-rotation multiple-choice questions (53.6 ± 3.1 vs 51.8 ± 2.8, P < .001). When 32 FCCL students and 36 TLB students were reassessed approximately 20 weeks after the rotation, the FCCL group scored higher (40.3 ± 9.1) than the TLB group (34.3 ± 10.9, P = .018). CONCLUSIONS Applying the FCCL module in ophthalmology teaching enhanced medical students' satisfaction, examination performance, and knowledge retention. A similar model may be suitable for other specialties.
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Affiliation(s)
- Poemen P Chan
- P.P. Chan is assistant professor, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Vivian W Y Lee
- V.W.Y. Lee is associate professor, Centre for Learning Enhancement And Research, The Chinese University of Hong Kong, Hong Kong, China
| | - Jason C S Yam
- J.C.S. Yam is associate professor, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Marten E Brelén
- M.E. Brelén is associate professor, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Wai Kit Chu
- W.K. Chu is research assistant professor, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Kelvin H Wan
- K.H. Wan was assistant professor, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China, at the time of writing
| | - Li J Chen
- L.J. Chen is professor, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Clement C Tham
- C.C. Tham is S.H. Ho Professor of Ophthalmology and Visual Sciences and chairman, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi P Pang
- C.P. Pang is S.H. Ho Research Professor of Visual Science, Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
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Scott TM, Succar T, Petsoglou C. Ophthalmology teaching in Australian medical schools: A national survey. MEDICAL TEACHER 2022; 44:1173-1178. [PMID: 36202774 DOI: 10.1080/0142159x.2022.2072283] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
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.
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Affiliation(s)
- Tabitha M Scott
- Save Sight Institute, University of Sydney, Sydney, Australia
| | - Tony Succar
- Save Sight Institute, University of Sydney, Sydney, Australia
- Massachusetts Eye and Ear, Harvard Medical School, Boston, USA
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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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Succar T, Beaver HA, Lee AG. Impact of COVID-19 pandemic on ophthalmology medical student teaching: educational innovations, challenges, and future directions. Surv Ophthalmol 2022; 67:217-225. [PMID: 33838164 PMCID: PMC9757816 DOI: 10.1016/j.survophthal.2021.03.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/26/2021] [Accepted: 03/29/2021] [Indexed: 01/17/2023]
Abstract
Graduate medical education (GME) in ophthalmology has faced and overcome many challenges over the past years, and 2020 has been a game-changer. Although the severe acute respiratory syndrome coronavirus pandemic disrupted medical education globally, ophthalmic educators rapidly transformed their curricula to novel and effective virtual learning formats. Thus, while the COVID-19 outbreak has been one of the most significant challenges faced in the history of medical education, it has also provided an impetus to develop innovative teaching practices, bringing with it unprecedented success in allowing medical students to continue their education in ophthalmology despite these challenges. We review and appraise novel educational interventions implemented by various institutions in response to the COVID-19 pandemic, highlighting their effectiveness, challenges and proposing future directions beyond the pandemic. Many of these innovations will persist even after the end of the pandemic because they have proven that face-to-face learning is not required for all aspects of the ophthalmic GME curriculum. As ophthalmic educators harness the power of educational technology it is critical that their novel educational initiatives are incorporated into competency-based curricula with assessments mapped to the competencies. Future research should focus on evaluating the impact of this transformation to virtual learning environments on student performances as well as implementing longitudinal assessment strategies for clinical competence in workplace-based practice.
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Affiliation(s)
- Tony Succar
- Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA; University of Sydney, Discipline of Ophthalmology, Save Sight Institute, Sydney, Australia.
| | - Hilary A Beaver
- Blanton Eye Institute, Houston Methodist Hospital, Department of Ophthalmology, Houston, Texas, USA; Department of Ophthalmology, University of Texas Medical Branch, Galveston, Texas, USA; University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA; Departments of Neurology and Neurological Surgery, Weill Cornell Medical College, New York, New York, USA; Department of Ophthalmology, Baylor College of Medicine (Adjunct Professor), Houston, Texas, USA; The UT MD Anderson Cancer Center, Houston, Texas, USA; The University of Iowa Hospitals and Clinics (Adjunct Professor), Iowa City, Iowa, USA
| | - Andrew G Lee
- Blanton Eye Institute, Houston Methodist Hospital, Department of Ophthalmology, Houston, Texas, USA; Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, New York, USA; Department of Ophthalmology, University of Texas Medical Branch, Galveston, Texas, USA; University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA; Departments of Neurology and Neurological Surgery, Weill Cornell Medical College, New York, New York, USA; Department of Ophthalmology, Baylor College of Medicine (Adjunct Professor), Houston, Texas, USA; The UT MD Anderson Cancer Center, Houston, Texas, USA; The University of Iowa Hospitals and Clinics (Adjunct Professor), Iowa City, Iowa, USA
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Curtis R, Xu M, Liu D, Kwok J, Hopman W, Irrcher I, Baxter S. Smartphone Compatible versus Conventional Ophthalmoscope: A Randomized Crossover Educational Trial. JOURNAL OF ACADEMIC OPHTHALMOLOGY 2021. [DOI: 10.1055/s-0041-1736438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Objective The aim of the study is to compare performance and ease-of-use (EOU) of optic disk assessment using a smartphone direct ophthalmoscope attachment (D-EYE) to the gold standard direct ophthalmoscope (DO).
Design The type of study involved is prospective, randomized, crossover, and educational trial.
Participants The participants involved were first year medical students inexperienced in ophthalmoscopy.
Methods Optic disks of standardized and volunteer patients were examined using the D-EYE and a conventional DO. Optic disk identification, EOU ratings of the devices, self-reported confidence level in their examination with the devices, and estimation of vertical cup-to-disk ratio (VCDR) were compared. Analyses included Chi-square tests, independent samples t-tests, correlations, and multivariable linear regression.
Results Forty-four medical students voluntarily participated in the study. Students using the DO required more attempts (3.57 vs. 2.69, p = 0.010) and time (197.00 vs. 168.02 seconds, p = 0.043) to match the patient's fundus to the correct photograph. Overall EOU between the devices (6.40 vs. 4.79, p < 0.001) and overall confidence in examination (5.65 vs. 4.49, p = 0.003) were greater when using the D-EYE. There were no statistically significant differences in accuracy of VCDR estimations between the two ophthalmoscopes.
Conclusion Smartphone ophthalmoscopy could offer additional learning opportunities in medical education and may be considered in clinical practice by non-specialist physicians given its greater EOU and increased success in visualizing the optic disk.
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Affiliation(s)
- Rachel Curtis
- Kingston Health Sciences Centre-Kingston General Hospital Research Institute, Kingston, Ontario, Canada
| | - Mark Xu
- Kingston Health Sciences Centre-Kingston General Hospital Research Institute, Kingston, Ontario, Canada
| | - Daisy Liu
- Kingston Health Sciences Centre-Kingston General Hospital Research Institute, Kingston, Ontario, Canada
| | - Jason Kwok
- Kingston Health Sciences Centre-Kingston General Hospital Research Institute, Kingston, Ontario, Canada
| | - Wilma Hopman
- Kingston Health Sciences Centre-Kingston General Hospital Research Institute, Kingston, Ontario, Canada
| | - Isabella Irrcher
- Kingston Health Sciences Centre-Kingston General Hospital Research Institute, Kingston, Ontario, Canada
| | - Stephanie Baxter
- Kingston Health Sciences Centre-Kingston General Hospital Research Institute, Kingston, Ontario, Canada
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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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Waters M, Clarke R, England L, O'Connor A. The Accuracy of GP Referrals into Manchester Royal Eye Hospital Orthoptic Department. Br Ir Orthopt J 2021; 17:91-96. [PMID: 34278224 PMCID: PMC8269771 DOI: 10.22599/bioj.168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 04/07/2021] [Indexed: 11/30/2022] Open
Abstract
Background: There is little research that examines the accuracy of paediatric referrals into secondary and tertiary care, particularly those from general practicioners (GPs) to ophthalmology and orthoptic departments. Inaccurate referrals could have a detrimental effect on service delivery and NHS funding as well as patient experience. Available evidence shows GP referral accuracy to range between 39% and 90% across different areas of medicine with accuracy of GP referral to ophthalmology between 56% and 66%. Methods: A retrospective case note analysis was carried out on 99 case notes to examine the accuracy of paediatric GP referrals (including those via the community optometrist) into the Orthoptic Department at Manchester Royal Eye Hospital (MREH). Results: GP referral accuracy was found to be 63% for strabismus cases, 50% for reduced vision/amblyopia cases, 45% for NAD cases, 100% of nystagmus cases and 92% of “other” cases. GPs were significantly less accurate than community optometrists (p = 0.01). Referrals from GPs alone had an accuracy rate of 65% compared to 87% of GP referral via community optometrist. Accuracy of referral appeared to improve with age, however this was not found to be statistically significant (p = 0.06). Conclusion: This study found orthoptic referral accuracy for GPs in Manchester to be similar to other areas of medicine. While acceptable compared to other areas of medicine, improving referral accuracy is essential to improve NHS spending, service delivery, and patient experience. To aid with this the aim is to design and implement a virtual training package that focuses on detection of strabismus to improve referral accuracy.
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Chadha N, Gooding H. Twelve tips for teaching ophthalmology in the undergraduate curriculum. MEDICAL TEACHER 2021; 43:80-85. [PMID: 32400234 DOI: 10.1080/0142159x.2020.1758649] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
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.
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Affiliation(s)
- Nisha Chadha
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai/New York Eye and Ear Infirmary, Eye and Vision Research Institute, New York, NY, USA
| | - Holly Gooding
- Division of Pediatrics and Adolescent Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Nour R, Jobling K, Mayer A, Babikir S. How does participation in a voluntary prize exam affect medical students' knowledge and interest in ENT, plastic surgery, ophthalmology and dermatology? BMC MEDICAL EDUCATION 2020; 20:387. [PMID: 33109199 PMCID: PMC7592581 DOI: 10.1186/s12909-020-02314-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/16/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Otolaryngology (ENT), plastic surgery, ophthalmology and dermatology are medical specialties which tend to receive less coverage in UK medical school curricula compared to larger, generalist specialties. As a result, there are fewer opportunities for medical students to learn and to cultivate an interest. There are numerous papers that report concerns about junior doctors' ability to manage conditions within these specialties, which may jeopardise patient safety. The aim of our pilot project was to increase medical students' interest and knowledge of ENT, plastic surgery, ophthalmology and dermatology. In addition to describing our project, we present and discuss literature on UK undergraduate education in these specialties and its impact on preparedness of junior doctors and future career choices. METHODS One hundred twelve final year medical students at Newcastle University were invited to take part in a voluntary two-part (written and clinical) exam, in which prizes could be won and all participants would receive a certificate of participation. We distributed two online surveys to the students, one administered before the exam and one afterwards. Data was collected regarding the students' motivation for entering the prize exam and the students' baseline interest and knowledge in these specialties before and after the prize exam. Free-text responses were collected about the students' opinion of the project and whether participation was beneficial. RESULTS Sixteen students participated in the exam. There was a statistically significant increase in the students' knowledge in ENT (p < 0.000), plastic surgery (p < 0.000), ophthalmology (p < 0.028) and dermatology (p < 0.012) after participation in the exam, but not in their interest levels. ENT was the preferred specialty of our cohort. The students reported that they found participation beneficial to their learning, particularly receiving exam feedback and explanations to exam questions. CONCLUSIONS This pilot project was a useful intervention in increasing medical students' knowledge in these specialties, but not in their levels of interest. It also demonstrates that medical students are willing to participate in voluntary initiatives (in their spare time) to gain more learning opportunities and that medical students value timely exam feedback to guide their revision.
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Affiliation(s)
- Razan Nour
- Renal Unit, Ulster Hospital, Upper Newtownards Road, Dundonald, Belfast, UK.
- Department of Ophthalmology, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK.
| | - Kerry Jobling
- Department of Dermatology, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK
| | - Alasdair Mayer
- Department of ENT, Freeman Hospital, Newcastle-upon-Tyne, UK
| | - Salma Babikir
- Department of Vascular Surgery, Freeman Hospital, Newcastle-upon-Tyne, UK
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Mah JM, Bellan L, Baxter SA. Undergraduate ophthalmology education in Canadian medical schools: a cross-sectional survey. Can J Ophthalmol 2020; 56:139-141. [PMID: 33007223 DOI: 10.1016/j.jcjo.2020.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 08/06/2020] [Accepted: 08/25/2020] [Indexed: 10/23/2022]
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Lin J, Chua MT. A low cost surrogate eye model for corneal foreign body removal. BMC Ophthalmol 2020; 20:48. [PMID: 32028904 PMCID: PMC7006147 DOI: 10.1186/s12886-020-1310-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 01/07/2020] [Indexed: 11/17/2022] Open
Abstract
Background Patients commonly present to the Emergency Department with a corneal foreign body (FB). There is currently a lack of adequate training for junior doctors in the management of this condition. Our self-made surrogate eye model aims to address this void in our junior doctors’ knowledge. Methods Participants were guided through a hands-on session with a slit-lamp using our eye model, which is made of a hemispherical agar embedded with pencil lead fragments simulating as FBs. Using a 7-point Likert scale, all participants completed a questionnaire both before and after training, for: (1) knowledge in corneal FB removal, (2) confidence in corneal FB removal, and (3) effectiveness of the model. Results Out of 73 participants, 82.2% (60/73) had no prior experience in corneal FBs removal. After the training session, their knowledge improved from a median score of 2 (interquartile range [IQR] 1 to 3) to 5 (IQR 5 to 6), with improvement in confidence levels from 2 (IQR 1 to 2) to 5 (IQR 4 to 6). The effectiveness of our eye model scored a median of 6 (IQR 5 to 7). Conclusions Our surrogate eye model is low-cost, quick and easy to reproduce. After use, our learners expressed greater confidence in managing the removal of corneal FBs and use of slit lamp. With a recent focus in patient safety and quality, teaching this procedure via simulation is a safe way of bridging the gap between traditional didactic teaching and the clinical environment.
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Affiliation(s)
- Jingping Lin
- Emergency Medicine Department, National University Hospital, Level 4, National University Centre for Oral Health, 9 Lower Kent Ridge Road, Singapore, 119085, Singapore. .,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Mui Teng Chua
- Emergency Medicine Department, National University Hospital, Level 4, National University Centre for Oral Health, 9 Lower Kent Ridge Road, Singapore, 119085, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Hogg HDJ, Pereira M, Purdy J, Frearson RJR, Lau GB. A non-randomised trial of video and written educational adjuncts in undergraduate ophthalmology. BMC MEDICAL EDUCATION 2020; 20:10. [PMID: 31918692 PMCID: PMC6953281 DOI: 10.1186/s12909-019-1923-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 12/30/2019] [Indexed: 05/28/2023]
Abstract
BACKGROUND Provision of relevant pre-learning materials has been shown to increase student engagement and improve outcomes in medical education. This non-randomised study attempts to quantify the educational gains, and relative efficacy of video and written pre-learning materials, in ophthalmology undergraduate teaching. METHODS Ninety-eight final year medical students were contacted prior to their three-day ophthalmology placements at a British tertiary ophthalmology unit. All participants were sent welcome packs prior to arrival requesting they undertake 90 min of work focusing on a list of specified ophthalmic conditions. One cohort (N = 33) were sent written materials, another (N = 32) was provided with video materials and a third cohort (N = 33) were not sent any materials. On arrival participants completed a simple knowledge test, a questionnaire estimating the time they spent preparing for the placement and a self-reported knowledge score. The teaching on placement was the same for all cohorts. At the conclusion of each placement participants completed a challenging knowledge test, a clinical skills test and repeated self-reported knowledge scores. RESULTS Eighty seven percent of students receiving specified materials claimed to complete pre-placement work compared to 70% of those receiving learning outcomes alone (p = 0.05). Students receiving learning materials scored higher in the post-placement tests of knowledge (p < 0.001), 74.8% (72.4-77.2%) vs 63.6% (95%CI 59.3-67.9%) and skills (p = 0.04), 86.9% (83.9-89.9%) vs 81.3% (77.2-85.4%). Students using video resources outperformed students using written materials in their visual acuity assessment test (p = 0.03), 90.4% (86.6-94.2%) vs 83.6% (80.1-87.1%) whilst those receiving written rather than video material performed better in the end of placement knowledge test (p = 0.03), 77.7% (74.3-81.1%) vs 72.0% (68.9-75.1%). CONCLUSION This study showed that providing pre-placement learning materials improves undergraduates' commitment and achievement. Written materials better facilitate knowledge acquisition while video materials preferentially promote skill acquisition. This is a novel demonstration within ophthalmology and can help address the imbalance between the expectations placed on undergraduates and the resources committed to ensuring they are met.
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Affiliation(s)
- H D Jeffry Hogg
- The University of Newcastle upon Tyne, Newcastle upon Tyne, Tyne and Wear, NE1 7RU, UK.
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Tyne and Wear, NE1 7RU, UK.
| | - Michael Pereira
- The University of Newcastle upon Tyne, Newcastle upon Tyne, Tyne and Wear, NE1 7RU, UK
| | - Julian Purdy
- The University of Newcastle upon Tyne, Newcastle upon Tyne, Tyne and Wear, NE1 7RU, UK
| | - Richard J R Frearson
- The University of Newcastle upon Tyne, Newcastle upon Tyne, Tyne and Wear, NE1 7RU, UK
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Tyne and Wear, NE1 7RU, UK
| | - Gordon B Lau
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Tyne and Wear, NE1 7RU, UK
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Smartphone ophthalmoscopy: patient and student practitioner perceptions. J Med Syst 2019; 44:10. [PMID: 31797206 PMCID: PMC6890584 DOI: 10.1007/s10916-019-1477-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/11/2019] [Indexed: 10/26/2022]
Abstract
It can take several years to become proficient at direct ophthalmoscopy; the instrument's single eyepiece allows only one individual to view the image at a time, which is considered disadvantageous during teaching. The introduction of smartphone ophthalmoscopes enables groups of teachers and students to view images together which could encourage peer-to-peer learning. In addition, the technology is significantly cheaper than the direct ophthalmoscope. User acceptability and engagement is essential to the success of any (medical) technological innovation. We sought to understand student opinions of a new commercially-available smartphone device for fundus examination, and compare usability to the traditional ophthalmoscope, from the perspective of both student practitioners and patients. Fifty-four undergraduate optometry students with prior experience of the traditional direct ophthalmoscope were asked to examine at least one eye with the D-EYE smartphone ophthalmoscope and also given an opportunity to experience the D-EYE from a patient's perspective. Minimal instructions were provided and all examinations conducted through undilated pupils. Participants completed an opinion survey to feedback on aspects such as the ease of handling and working distance. Compared to the direct ophthalmoscope, 92% of students preferred the (longer) working distance of the D-EYE; 77% felt it was easier to handle; and 92% preferred the patient experience with the D-EYE. Despite the positive feedback, only 43% of students preferred the D-EYE when assuming the role of the practitioner. Free text responses indicated that students felt the D-EYE may be most useful as a teaching tool. Student opinions indicated that smartphone ophthalmoscopes are an effective training tool for students as an accompaniment to learning the traditional ophthalmoscope method.
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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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Swystun AG, Davey CJ. A needs assessment for a minor eye condition service within Leeds, Bradford and Airedale, UK. BMC Health Serv Res 2019; 19:609. [PMID: 31464616 PMCID: PMC6716842 DOI: 10.1186/s12913-019-4448-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 08/20/2019] [Indexed: 11/22/2022] Open
Abstract
Background There are a number of limitations to the present primary eye care system in the UK. Patients with minor eye conditions typically either have to present to their local hospital or GP, or face a charge when visiting eye care professionals (optometrists). Some areas of the UK have commissioned enhanced community services to alleviate this problem; however, many areas have not. The present study is a needs assessment of three areas (Leeds, Airedale and Bradford) without a Minor Eye Conditions Service (MECS), with the aim of determining whether such a service is clinically or economically viable. Method A pro forma was developed for optometrists and practice staff to complete when a patient presented whose reason for attending was due to symptoms indicative of a problem that could not be optically corrected. This form captured the reason for visit, whether the patient was seen, the consultation funding, the outcome and where the patient would have presented to if the optometrists could not have seen them. Optometrists were invited to participate via Local Optical Committees. Results were submitted via a Google form or a Microsoft Excel document and were analysed in Microsoft Excel. Results Seventy-five percent of patients were managed in optometric practice. Nine and 16% of patients required subsequent referral to their General Practitioner or hospital ophthalmology department, respectively. Should they not have been seen, 34% of patients would have presented to accident and emergency departments and 59% to their general practitioner. 53% of patients paid privately for the optometrist appointment, 28% of patients received a free examination either through use of General Ophthalmic Service sight tests (9%) or optometrist good will (19%) and 19% of patients did not receive a consultation and were redirected to other providers (e.g. pharmacy, accident and emergency or General Practitioner). 88% of patients were satisfied with the level of service. Cost-analyses revealed a theoretical cost saving of £3198 to the NHS across our sample for the study period, indicating cost effectiveness. Conclusions This assessment demonstrates that a minor eye condition service in the local areas would be economically and clinically viable and well received by patients.
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Affiliation(s)
- Alexander G Swystun
- School of Optometry and Vision Science, University of Bradford, Richmond Road, Bradford, BD7 1DP, UK
| | - Christopher J Davey
- School of Optometry and Vision Science, University of Bradford, Richmond Road, Bradford, BD7 1DP, UK.
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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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Walkden A, Young JF, Spencer AF, Ashworth J. Determining the needs of ophthalmic trainees entering into specialist training and how they can be met. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2019; 10:201-206. [PMID: 31114420 PMCID: PMC6489662 DOI: 10.2147/amep.s189723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 03/11/2019] [Indexed: 06/09/2023]
Abstract
Problem: Starting ophthalmic specialty training can be daunting as new basic clinical examination and surgical skills must be acquired before meaningful assessment of patients can begin. No formal clinical induction currently exists with the aim to teach clinical and practical skills to new starters. Aim and objectives: To determine the experience and needs of ophthalmic trainees entering into specialist training. Using this information we developed and implemented a clinical skills training programme for Ophthalmology ST1s. Intervention: Using SMART objectives, PDSA cycles and Chartered Institute of Personnel Development guidance we implemented a clinical skills induction week. Pre-course skills evaluation took place in the form of a questionnaire in order to tailor the course content to the skill level of the group. Course material was made and simulation techniques devised for teaching practical skills. Qualitative data was collected via a pre- and post-course questionnaire. Outcome: All 9 participants rated the course as "extremely useful" it increased their confidence in terms of commencing clinical ophthalmology. 100% of participants felt that this course should be delivered to new ST1s. All participants reported improved confidence in managing ophthalmic emergencies and their clinical skills technique. Lessons learned: A sustainable induction programme was implemented tailored to the prior experience and skills of ST1 trainees. All participants felt it improved their confidence and clinical skills prior to commencing clinical activities. Basic clinical skills can be taught in a cost effective manner early on in postgraduate training.
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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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Status of Canadian undergraduate medical education in ophthalmology. Can J Ophthalmol 2018; 53:474-479. [DOI: 10.1016/j.jcjo.2017.11.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 11/08/2017] [Accepted: 11/20/2017] [Indexed: 11/19/2022]
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Zhang HH, Hepschke JL, Shulruf B, Francis IC, Spencer SKR, Coroneo M, Agar A. Sharpening the focus on ophthalmology teaching: perceptions of medical students and junior medical officers. Clin Exp Ophthalmol 2018; 46:984-993. [DOI: 10.1111/ceo.13342] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/26/2018] [Accepted: 05/28/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Helen H Zhang
- Faculty of MedicineUniversity of New South Wales Sydney New South Wales Australia
- Department of OphthalmologyPrince of Wales Hospital Sydney New South Wales Australia
| | - Jenny L Hepschke
- Faculty of MedicineUniversity of New South Wales Sydney New South Wales Australia
- Department of OphthalmologyPrince of Wales Hospital Sydney New South Wales Australia
| | - Boaz Shulruf
- Faculty of MedicineUniversity of New South Wales Sydney New South Wales Australia
| | - Ian C Francis
- Faculty of MedicineUniversity of New South Wales Sydney New South Wales Australia
- Department of OphthalmologyPrince of Wales Hospital Sydney New South Wales Australia
| | - Sascha KR Spencer
- Faculty of MedicineUniversity of New South Wales Sydney New South Wales Australia
- Department of OphthalmologyPrince of Wales Hospital Sydney New South Wales Australia
| | - Minas Coroneo
- Faculty of MedicineUniversity of New South Wales Sydney New South Wales Australia
- Department of OphthalmologyPrince of Wales Hospital Sydney New South Wales Australia
| | - Ashish Agar
- Faculty of MedicineUniversity of New South Wales Sydney New South Wales Australia
- Department of OphthalmologyPrince of Wales Hospital Sydney New South Wales Australia
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Evaluation of eLearning for the teaching of undergraduate ophthalmology at medical school: a randomised controlled crossover study. Eye (Lond) 2018; 32:1498-1503. [PMID: 29802293 DOI: 10.1038/s41433-018-0096-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 02/01/2018] [Accepted: 02/03/2018] [Indexed: 11/09/2022] Open
Abstract
AIM To compare ophthalmology teaching delivered by eLearning with traditional lectures, in terms of undergraduate performance and satisfaction. METHODS Randomised controlled crossover study at King's College London Medical School with 245 third year medical students. The ophthalmology syllabus was divided into ten topics. Five topics were randomised to be taught by traditional lectures and five by electronic learning (eLearning). For the second rotation of students the topics were crossed over, so that those topics taught by traditional lectures were taught by eLearning and vice versa. At the end of each rotation the students sat an optional online mock examination containing 100 questions (ten on each topic). Students' examination performance was compared between the two teaching methods. Student satisfaction was assessed using an online satisfaction survey. Outcome measures were the mean percentage of correct answers across all ten topics, student satisfaction and self-assessed knowledge. RESULTS The mean examination score for questions taught by eLearning was 58% (95% CI, 55.7-59.6), versus 55% (95% CI 53.1-56.8) for traditional lectures (P = 0.047). Across all topics students were more satisfied with eLearning than traditional lectures, with 87% (95% CI 84.5-88.4) rating eLearning as 'excellent' or 'good' versus 65% (95% CI 62.0-67.4) for lectures (p < 0.0001). Overall 180 (75.6%) preferred eLearning compared to traditional lectures, with 166 (69.7%) rating eLearning 'much better' or 'better,' 61 (25.6%) 'neutral' and 11 (4.6%) 'worse' or 'much worse.' CONCLUSIONS Student satisfaction and examination performance are both enhanced by ophthalmology eLearning. Similar eLearning modules may be suitable for other specialties and postgraduate learning.
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Hill S, Dennick R, Amoaku W. Present and future of the undergraduate ophthalmology curriculum: a survey of UK medical schools. INTERNATIONAL JOURNAL OF MEDICAL EDUCATION 2017; 8:389-395. [PMID: 29103017 PMCID: PMC5694697 DOI: 10.5116/ijme.59ac.f69b] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 09/04/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To investigate the current undergraduate ophthalmology curricula provided by the UK medical schools, evaluate how they compare with the guidelines of the Royal College of Ophthalmologists (RCOphth) and International Council for Ophthalmology (ICO), and determine the views of the UK ophthalmology teaching leads on the future direction of the curriculum. METHODS A cross-sectional questionnaire was sent to teaching leads in 31 medical schools across the UK. The questionnaire evaluated eight themes of the curriculum: content and learning outcomes, communication of learning outcomes, organisation of the curriculum, assessment, educational resources, teaching methods used, and the educational environment. The ophthalmology teaching leads were also asked their opinion on the current and future management of the curriculum. These were compared with RCOphth and ICO guidelines and descriptive statistical analysis performed. RESULTS A response rate of 93% (n=29/31) was achieved. The knowledge and clinical skills taught by the UK medical schools match the RCOphth guidelines, but fail to meet the ICO recommendations. A diverse range of assessment methods are used by UK medical schools during ophthalmology rotations. Variation was also observed in the organisation and methods of ophthalmology teaching. However, a significant consensus about the future direction of the curriculum was reported by teaching leads. CONCLUSIONS Comprehensive RCOphth guidance, and resource sharing between medical schools could help to ensure ophthalmology's continuing presence in the medical curriculum and improve the effectiveness of undergraduate ophthalmology teaching, while reducing the workload of local teaching departments and medical schools.
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Affiliation(s)
- Sophie Hill
- Ophthalmology Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Reg Dennick
- Medical Education Unit, University of Nottingham, Nottingham, UK
| | - Winfried Amoaku
- Academic Ophthalmology, Division of Clinical Neurosciences, University of Nottingham, UK
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Evaluation of an online peer fundus photograph matching program in teaching direct ophthalmoscopy to medical students. Can J Ophthalmol 2017; 52:441-446. [PMID: 28985801 DOI: 10.1016/j.jcjo.2017.02.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 02/22/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Direct ophthalmoscopy is an important clinical skill that is often poorly performed by medical professionals and students. This is attributable to a declining emphasis on ophthalmology in medical school. We present and evaluate a self-directed approach of teaching ophthalmoscopy to medical students that is suitable for the current medical curriculum. DESIGN Prospective medical education trial. PARTICIPANTS Ninety-five second-year medical students at Queen's University: 32 in the experimental group and 63 in the control group. METHODS The experimental group consisted of medical students who practised ophthalmoscopy with one another using an online peer fundus photograph matching exercise created by the Department of Ophthalmology at Queen's University. To use the program, students first examined a peer with an ophthalmoscope and then selected an online photograph of a fundus corresponding to that of the examinee. The program notifies students if a correct selection is made. To encourage use of the program, students participated in a 2-week ophthalmoscopy competition during their ophthalmology rotation. The control group consisted of students who did not participate in the learning exercise. RESULTS On assessment at the end of the ophthalmology rotation, the experimental group (n = 32) was more accurate in matching fundus photographs compared with the control group (n = 63) (p = 0.02). Participants were faster at performing ophthalmoscopy at the end of the learning exercise (p < 0.01). All students in the experimental group reported increased confidence levels in ophthalmoscopy after participation in the learning exercise. CONCLUSIONS Matching online peer fundus photographs in a self-directed manner appeared to increase the skill and confidence of medical students in ophthalmoscopy.
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Yusuf IH, Ridyard E, Fung THM, Sipkova Z, Patel CK. Integrating retinal simulation with a peer-assessed group OSCE format to teach direct ophthalmoscopy. Can J Ophthalmol 2017; 52:392-397. [PMID: 28774522 DOI: 10.1016/j.jcjo.2016.11.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 08/16/2016] [Accepted: 11/14/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe the conception and evaluation of a novel educational intervention to teach direct ophthalmoscopy with retinal simulators using a peer-assessed group objective structured clinical examination (OSCE) format. DESIGN Prospective, single-centre educational trial at Oxford University Medical School, Oxford, U.K. PARTICIPANTS A total of 160 consecutive undergraduate fifth-year medical students participated in the study. METHODS Students identified prior experience, teaching, examination, and feedback relevant to direct ophthalmoscopy. Students self-evaluated their perceived confidence across 6 domains of direct ophthalmoscopy examination before and after the educational intervention using a Likert-type psychometric scale. Wilcoxon matched pair testing was used to determine statistical significance for each domain. RESULTS The group OSCE intervention increased confidence in direct ophthalmoscopy overall from 2.5% to 63.8% (p < 0.001). Confidence improved in all 6 domains, most significantly in controls of ophthalmoscope (p < 0.001) and sequence of examination (p < 0.001) but also in the identification and interpretation of retinal signs (p < 0.001). Students rated the tutorial as very effective or effective across all 6 domains, and 96.29% rated the tutorial as effective overall. CONCLUSIONS Retinal simulation, integrated with a peer-assessed group OSCE format, is effective in increasing confidence in all aspects of direct ophthalmoscopy. It may be insufficient alone for training in the identification and interpretation of posterior segment clinical signs. Diminishing ophthalmology clerkships worldwide require ophthalmologists to identify innovative teaching methods, using modern technology and pedagogy to deliver high-quality, yet high-throughput, training in direct ophthalmoscopy. This novel teaching strategy may be considered by ophthalmologists responsible for direct ophthalmoscopy training in a teaching hospital context.
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Affiliation(s)
- Imran H Yusuf
- The Oxford Eye Hospital, John Radcliffe Hospital, Oxford, U.K..
| | - Edward Ridyard
- The Oxford Eye Hospital, John Radcliffe Hospital, Oxford, U.K
| | | | - Zuzana Sipkova
- The Oxford Eye Hospital, John Radcliffe Hospital, Oxford, U.K
| | - Chetan K Patel
- The Oxford Eye Hospital, John Radcliffe Hospital, Oxford, U.K
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Succar T, McCluskey P, Grigg J. Enhancing Medical Student Education by Implementing a Competency-Based Ophthalmology Curriculum. Asia Pac J Ophthalmol (Phila) 2017; 6:59-63. [PMID: 28161917 DOI: 10.22608/apo.2016102] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 08/26/2016] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To evaluate innovative educational strategies that help optimize ophthalmology teaching in a crowded medical curriculum. The knowledge acquisition and perceptions of medical students undertaking the revised competency-based curriculum were compared with the prior content-based curriculum within the Sydney Medical Program. DESIGN A mixed-methods research design was employed to include both quantitative and qualitative dimensions in evaluating the revised curriculum with medical students (n = 328) undergoing their ophthalmology rotation. METHODS Quantitative evaluation was performed with a 20-item multiple choice pre- and post-test of ophthalmic knowledge. A 12-month follow-up test was readministered to compare the long-term retention rate of graduates. Qualitative evaluation was measured with student satisfaction questionnaires. RESULTS In the original curriculum there was an improvement of 19.9% from pre- to post-test scores [2.15; 95% confidence interval (CI), 1.35-2.94; P < 0.001] and a greater improvement of 31.6% from pre- to post-test (3.50; 95% CI, 3.03-3.97; P < 0.001) in the revised curriculum. When assessing retained knowledge at 12 months, students from the revised curriculum scored 11.5% higher than students from the original curriculum (1.56; 95% CI, 0.42-2.71; P = 0.008). In addition, qualitative feedback also improved, with the rotation being highly valued. CONCLUSIONS The revised ophthalmic curriculum resulted in an increase in academic performance and a higher degree of student satisfaction. Given the gradual decline of ophthalmic education in the standard medical school curriculum, our results are timely in providing guidance for minimum ophthalmic curriculum exposure and strategies to improve ophthalmic education in medical schools.
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Affiliation(s)
- Tony Succar
- Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Peter McCluskey
- Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - John Grigg
- Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
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An Evaluation of Educational Neurological Eye Movement Disorder Videos Posted on Internet Video Sharing Sites: Comment. J Neuroophthalmol 2016; 36:352. [DOI: 10.1097/wno.0000000000000418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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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Kilduff C, Lois C. Red eyes and red-flags: improving ophthalmic assessment and referral in primary care. BMJ QUALITY IMPROVEMENT REPORTS 2016; 5:bmjquality_uu211608.w4680. [PMID: 27493748 PMCID: PMC4964165 DOI: 10.1136/bmjquality.u211608.w4680] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 04/28/2016] [Indexed: 11/03/2022]
Abstract
Up to five percent of primary care consultations are eye-related, yet 96% of General Practitioners (GPs) do not undergo postgraduate ophthalmology training. Most do not feel assured performing eye assessments. Some red eye conditions can become sight threatening, and often exhibit red-flag features. These features include moderate pain, photophobia, reduced visual acuity (VA), eye-trauma, or unilateral marked redness. The aim of this project was to improve primary care assessment and referral of patients presenting with red-flag features based on the NICE ‘Red Eye’ Clinical Knowledge Summary recommendations. Data was collected retrospectively from 139 red eye consultations. A practice meeting highlighted poor awareness of red-flag features, low confidence levels in eye assessments, and time-constraints during appointments. Interventions were based on feedback from staff. These included a primary care teaching session on red-flag features, a VA measurement tutorial, and provision of a red eye toolkit, including VA equipment, to each consultation room. At baseline, each patient had on average 0.9 red-flag features assessed. Only 36.0% (9/25) of patients with red-flag features were appropriately referred to same-day ophthalmology services. Following two improvement cycles, a significant improvement was seen in almost every parameter. On average, each patient had 2.7 red-flag features assessed (vs 0.9, p<0.001). VA was assessed in 55.6% of consultations (vs 7.9%, p<0.001), pain was quantified in 81.5% (vs 20.9%, p=0.005), eye-trauma or foreign-body (51.8% vs 8.6%, p<0.001), extent of redness was documented in 66.7% (vs 14.4%, p<0.001). Only photophobia remained poorly assessed (18.5% vs 14.4%, p=0.75). Following this, 75.0% (6/8) of patients were appropriately referred. This project reflected the literature regarding low confidence and inexperience amongst GPs when faced with ophthalmic conditions. Improvements in education are required to ensure accurate assessments can be undertaken in a time-constrained environment.
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Wu DJ, Greenberg PB. A Self-Directed Preclinical Course in Ophthalmic Surgery. JOURNAL OF SURGICAL EDUCATION 2016; 73:370-374. [PMID: 26705060 DOI: 10.1016/j.jsurg.2015.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 09/30/2015] [Accepted: 11/02/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Medical students receive limited exposure to ophthalmology and ophthalmic surgery in the preclinical curriculum. To address this gap, the authors designed a self-directed preclinical elective course in ophthalmic surgery offered in the 2013-2014 academic year to all first- and second-year students at the study institution. DESIGN Prospective cohort study with anonymous Likert-style questionnaires and qualitative responses. SETTING Warren Alpert Medical School of Brown University, Providence, RI. PARTICIPANTS All current first- and second-year medical students at the Warren Alpert Medical School of Brown University enrolled in the preclinical elective in 2013-2014 were eligible to participate in the study. METHODS The course had 3 components: (1) 4 web-based didactic modules on common ophthalmic conditions with slide sets, surgical procedure videos and animations, and mandatory premodule and postmodule quizzes to assess for competency; (2) a 3-hour interactive virtual surgery simulation session on cataract surgery-related tasks; (3) a total of 2 shadowing experiences in the clinic and in the operating room. Each student completed an anonymous precourse and postcourse Likert-style questionnaire that assessed exposure to ophthalmology, favored components of the course, and interest in ophthalmology as a career. RESULTS Of the 22 students who signed up, 18 (81.8%) completed the course. Most students (76.5%; 14/18) felt there was inadequate exposure to ophthalmology in the medical curriculum. Students scored a mean of 44.0% on premodule assessments and 97.0% on postmodule assessments. All students completed the postcourse questionnaire: they all recommended the course to other medical students and increased their understanding of ophthalmology as a career. The most popular components of the course were the practical aspects of the elective (44.4%; 8/18) and virtual surgery simulation (44.4%; 8/18). CONCLUSIONS This course increased preclinical medical students' knowledge of ophthalmic surgery and suggests that flexible preclinical electives can help medical students explore clinical interests and career choices earlier in their medical education.
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Affiliation(s)
- Dominic J Wu
- Division of Ophthalmology, Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Paul B Greenberg
- Division of Ophthalmology, Warren Alpert Medical School of Brown University, Providence, Rhode Island; Section of Ophthalmology, Providence Veteran Affairs Medical Center, Providence, Rhode Island.
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Affiliation(s)
| | - Aamir Khan
- Surgery Department, Glasgow Royal Infirmary, Glasgow, UK
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37
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Schulz C. Value of undergraduate ophthalmology attachment: response. CLINICAL TEACHER 2015; 12:440. [DOI: 10.1111/tct.12439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Christopher Schulz
- Eye Department; Portsmouth Hospitals NHS Trust; Queen Alexandra Hospital; Portsmouth UK
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Succar T, Grigg J, Beaver HA, Lee AG. A systematic review of best practices in teaching ophthalmology to medical students. Surv Ophthalmol 2015; 61:83-94. [PMID: 26363187 DOI: 10.1016/j.survophthal.2015.09.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 09/04/2015] [Accepted: 09/04/2015] [Indexed: 10/23/2022]
Abstract
Ophthalmic medical student education is a cornerstone to improving eye health care globally. We review the current state of the literature, listing barriers to potential best practices for undergraduate ophthalmology teaching and learning within medical curricula. We describe recent advances and pedagogical approaches in ophthalmic education and propose specific recommendations for further improvements and research. Future research should concentrate on developing teaching and learning innovations that may result in a more time- and resource-effective models for interactive and integrated learning. As well as demonstrating that a competency-based approach results not just in better eye health, but also improvements in patient care, education, and medical care in general. By optimizing teaching available through improved evidence-based education, the ultimate goal is to increase medical students' knowledge and produce graduates who are highly trained in eye examination skills, resulting in improved patient eye care through timely diagnosis, referrals, and treatment.
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Affiliation(s)
- Tony Succar
- Department of Ophthalmology, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, The University of Sydney, Sydney NSW, Australia; Envision Research Institute, Envision, Wichita, Kansas, USA; The Smith-Kettlewell Eye Research Institute, San Francisco, California, USA
| | - John Grigg
- Department of Ophthalmology, Save Sight Institute, Discipline of Ophthalmology, Sydney Medical School, The University of Sydney, Sydney NSW, Australia
| | - Hilary A Beaver
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, USA; Department of Ophthalmology, The University of Texas Medical Branch, Galveston, Texas, USA; Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA
| | - Andrew G Lee
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, Texas, USA; Department of Ophthalmology, The University of Texas Medical Branch, Galveston, Texas, USA; Department of Ophthalmology, Weill Cornell Medical College, New York, New York, USA; Department of Neurology, Weill Cornell Medical College, New York, New York, USA; Department of Neurological Surgery, Weill Cornell Medical College, New York, New York, USA; Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, USA; Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA; Department of Ophthalmology, University of Iowa Hospitals and Clinics.
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Yusuf IH, Salmon JF, Patel CK. Direct ophthalmoscopy should be taught to undergraduate medical students-yes. Eye (Lond) 2015; 29:987-9. [PMID: 26043702 DOI: 10.1038/eye.2015.90] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- I H Yusuf
- Paediatric Vitreoretinal Service, Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK
| | - J F Salmon
- Paediatric Vitreoretinal Service, Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK
| | - C K Patel
- Paediatric Vitreoretinal Service, Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK
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Purbrick RMJ, Chong NV. Direct ophthalmoscopy should be taught to undergraduate medical students--No. Eye (Lond) 2015; 29:990-1. [PMID: 26043708 DOI: 10.1038/eye.2015.91] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
| | - N V Chong
- Oxford Eye Hospital, Oxford University Hospitals, Oxford, UK
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Yusuf I, Yang E, Knight K, Leaver L. Direct ophthalmoscopy: teaching in primary care. CLINICAL TEACHER 2015; 13:235-7. [PMID: 25982427 DOI: 10.1111/tct.12354] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Imran Yusuf
- Oxford Eye Hospital, John Radcliffe Hospital, Oxford, UK
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Re: Shah et al.: The state of ophthalmology medical student education in the United States and Canada, 2012 through 2013 (Ophthalmology 2014;121:1160-3). Ophthalmology 2015; 122:e19-20. [DOI: 10.1016/j.ophtha.2014.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 08/11/2014] [Indexed: 11/24/2022] Open
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Gout T, Gaunt D, Maling S. Importance of a clinical ophthalmology placement in the UK undergraduate medical syllabus. MEDICAL TEACHER 2015; 37:887. [PMID: 25665627 DOI: 10.3109/0142159x.2015.1009430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Taras Gout
- a Hull Royal Infirmary, Hull and East Yorkshire Hospitals NHS Trust , UK
| | - David Gaunt
- b Emergency Department , Watford General Hospital, West Hertfordshire Healthcare NHS Trust , UK and
| | - Sarah Maling
- c Ophthalmology Department , Stoke Mandeville Hospital, Buckinghampshire Healthcare NHS Trust , UK
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Amin S, Cartledge J. What opportunities do Foundation Year 1 doctors (FY1s) get to assess and manage acutely ill patients? MEDICAL TEACHER 2012; 34:178-179. [PMID: 22289003 DOI: 10.3109/0142159x.2012.644834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Malik U, Kirkby E, Tah V, Bunce C, Okhravi N. Effectiveness and acceptability of a cataract surgery teaching video for medical students. MEDICAL TEACHER 2012; 34:178. [PMID: 22289004 DOI: 10.3109/0142159x.2012.644835] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
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