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Background: Overutilisation of the Accident and Emergency Department is an increasingly serious healthcare challenge. Online symptom checkers could help alleviate this challenge by allowing patients to self-triage before visiting the Accident and Emergency Department. Objectives: This study aimed to assess the triage accuracy of online symptom checkers, which would help determine the potential roles of symptom checkers in an Accident and Emergency Department setting. Methods: A total of 100 random Accident and Emergency Department records were sampled from the Queen Mary Hospital in Hong Kong. The inclusion criteria were patients over the age of 18 attending the Queen Mary Hospital Accident and Emergency Department in 2016. Symptom checkers by Drugs.com and FamilyDoctor were selected as representative tools. One triage recommendation was generated by each symptom checker for each case record. Each symptom checker’s triage accuracy was then evaluated using a few outcome measures: overall sensitivity, sensitivity for emergency cases and specificity for non-emergency cases, when compared with the triage categories assigned by the triage nurses. Results: The results showed that Drugs.com had a higher overall triage accuracy than FamilyDoctor (74% and 50%, respectively), but both checkers are inadequately sensitive to emergency cases (70% and 45%, respectively) with low negative predictive values (43% and 24%, respectively). Conclusion: In their current states, symptom checkers are not yet suitable as alternatives to Accident and Emergency Department triage protocols due to their low overall sensitivities and negative predictive values. However, symptom checkers might serve as useful Accident and Emergency Department adjuncts in other ways, such as to provide more information prior to a patient’s arrival to streamline the triage and preparation process at the Accident and Emergency Department.

Our findings highlight the importance of good glycaemic control as a modifiable risk factor for both dry eye symptoms and tear film instability in patients with T2DM.

PurposeThe current crisis of COVID-19 has reduced training opportunities for many ophthalmology residents. This study describes a model of simultaneous bilateral cadaveric surgical simulation for oculoplastic trainees as means to maximise training outcomes in a time- and resource-limited setting. MethodsA total of fourteen participants were included. Bilateral oculoplastic simulation were performed by two trainees assigned to a human cadaver at the same time. One participant started with transethmoidal endoscopic medial wall decompression over one side while another participant learned transcutaneous lateral wall decompression over the other eye, both under the direct supervision of a single experienced oculoplastic trainer. The number of orbital decompression surgeries performed, and participants’ rating of their learning progress and satisfaction with this simulation model were reported. ResultsThe fourteen participants included five ophthalmic residents (34%) and nine oculoplastic fellows (64%). Each participant completed one endoscopic medial and one lateral wall orbital decompression within 4 hours, hence a total four decompression surgeries was performed per human cadaver. Most (88%) participants agreed that simultaneous bilateral learning was preferred over the conventional and sequential unilateral simulation as it offered more hands-on time especially in a setting of limited time, cadavers and operative instruments. All (100%) would recommend fellow ophthalmic trainees to this type of simulation workshop.ConclusionIn this pilot study, simultaneous bilateral surgical simulation using human cadaver maximises the individual learning opportunity and was well received by all participants. It is an effective and resourceful model especially useful for oculoplastic training.