Evaluation of Competence of Medical Students in Performing Direct Ophthalmoscopy

Megbelayin, Emmanuel Olu; Asana, Edet Uduak; Nkanga, George Dennis; Duke, Roseline; Ibanga, Affiong; Etim, Archibong Bassey; Okonkwo, Sunday Nnamdi

doi:10.4103/0189-9171.154612

Cited by 4 publications

(6 citation statements)

References 7 publications

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“…[8] Limited dedicated ophthalmic curricula time is a common finding globally affecting medical schools in both high and low resource countries. [9, 10] Perhaps unsurprisingly, cross-sectional studies highlight that medical students’ self-reported confidence in DO can be low. [10] These findings are continued after graduation, with UK studies of Foundation Year and ED doctors highlighting that the majority lack confidence using an ophthalmoscope correctly and in identifying pathology.…”

Section: Introductionmentioning

confidence: 99%

Does access to a portable ophthalmoscope improve skill acquisition in direct ophthalmoscopy? A method comparison study in undergraduate medical education

et al. 2019

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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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Section: Introductionmentioning

confidence: 99%

Does access to a portable ophthalmoscope improve skill acquisition in direct ophthalmoscopy? A method comparison study in undergraduate medical education

et al. 2019

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“…This, however, would require taking time from another specialty. The ease, and promptness of learning of the Arclight when compared to a traditional ophthalmoscope, points to it being a reasonable solution to the teaching burden of ophthalmoscopy (1) .…”

Section: Discussionmentioning

confidence: 99%

“…Worldwide, ophthalmology is experiencing a reduction in its time allocation within medical school curricula (1) , an issue which has been recognised for almost a century (2) .…”

Section: Introductionmentioning

confidence: 99%

The Arclight vs. traditional ophthalmoscope: a cross-over trial

Hytiris

Fioratou

Gillan

2020

Eye

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Background/objectives. To compare skill acquisition of the new, cost-effective Arclight ophthalmoscope, with the traditional ophthalmoscope, in medical students with no prior experience of ophthalmoscopy. Subjects/Methods. University of Dundee medical students took part in a cross-over trial. Students were divided into two groups and were alternately taught each device using a video tutorial. In period one, Group A was taught the traditional ophthalmoscope first; Group B was taught the Arclight. They were then assessed using simulated OSCEs, examining four model heads with lettered fundal photographs of varying sizes of font. Groups crossed over following a two-week washout period and were taught the second device and reassessed. A questionnaire was distributed to ascertain students' opinions and preferences. Results. Forty medical students participated. Overall, 92.5% of students performed better with the Arclight, irrespective of cross-over trial period. The mean difference in score in period one of the cross-over trial was 16.77 (95% C.I 11.63-21.93), with students performing better with the Arclight (p <0.0001). The mean difference in score in period two was 8.02 (95% C.I. 4.52-11.52), with students performing better with the Arclight (p<0.0001). Additionally, performance with the traditional ophthalmoscope improved by 52.9% following initial exposure to the Arclight. The Arclight was the preferred device by 82.5% of students, and 82.5% of students would chose this device for future practice. Conclusion.

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“…However, the judgement of any changes, normal or pathological, is still dependent on the subjective assessment of the clinician especially when automated estimation is not available. The estimation of VCDR can be subjective and a trainee's ability is typically benchmarked against an examiner who has years of clinical experience [9]. As the accuracy of clinical judgements may be correlated with clinical experience [5,10], it is hypothesized that trainees with more clinical experience are better at discriminating cup-to-disc ratio than their more junior peers.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of vertical cup-to-disc ratio discrimination among clinical optometry trainees with different years of clinical experience

Hairol

Lee

2022

PLoS ONE

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Purpose Accurate evaluation of the cup-to-disc ratio is crucial for optometrists and may be influenced by their clinical experience. The study’s objective was to compare the thresholds for discriminating vertical cup-to-disc ratio (VCDR) between years 2, 3, and 4 clinical optometry trainees. Methods One hundred fundus photos with various VCDR sizes were selected from a clinic database. The median VCDR (0.43) photo was assigned as the standard, while the other 99 were assigned as the test photos. The participant’s task was to discriminate using a 2-alternate-forced-choice paradigm whether the test photos’ VCDR were larger or smaller than the standard VCDR. Data were fit with a Weibull function, and three discrimination thresholds were determined: the point of subjective equality (PSE), the range of VCDR uncertainty, and the ability to judge VCDR that was 0.1 unit larger than the standard photo. Results Year 4 trainees had better VCDR discrimination thresholds. However, the difference between the three participant groups was not statistically different for all measurements (PSE: F(2,27) = 0.43, p = 0.657; VCDR uncertainty range: F(2,27) = 0.12, p = 0.887), and thresholds for correctly discriminating VCDR 0.1 larger than the standard photo’s VCDR: F(2,27) = 0.69, p = 0.512). Conclusion Although Year 4 optometry trainees performed slightly better at estimating VCDR than their Year 3 and Year 2 peers, the number of years of clinical experiences did not significantly affect their VCDR discrimination thresholds when 2-dimensional fundus photos were used as stimuli.

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Evaluation of Competence of Medical Students in Performing Direct Ophthalmoscopy

Cited by 4 publications

References 7 publications

Does access to a portable ophthalmoscope improve skill acquisition in direct ophthalmoscopy? A method comparison study in undergraduate medical education

Does access to a portable ophthalmoscope improve skill acquisition in direct ophthalmoscopy? A method comparison study in undergraduate medical education

The Arclight vs. traditional ophthalmoscope: a cross-over trial

Accuracy of vertical cup-to-disc ratio discrimination among clinical optometry trainees with different years of clinical experience

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