Perceived usefulness and ease of use of fundoscopy by medical students: a randomised crossover trial of six technologies (eFOCUS 1)

Abstract

Background Fundoscopy outside ophthalmology is in decline, and the technical demands of the traditional direct ophthalmoscope examination are likely contributing. Alternative fundoscopy technologies are increasingly available, yet valid comparisons between fundoscopy technologies are lacking. We aimed to assess medical students’ perceptions of usefulness and ease of use of traditional and contemporary fundus-viewing technologies including smartphone fundoscopy. Methods One hundred forty-six second-year medical students participated in a cross-sectional, randomised, cross-over study of fundoscopy methods. Medical students completed small group training sessions using six current fundoscopy technologies including: a non-mydriatic fundus camera; two types of direct fundoscopy; and three types of smartphone fundoscopy. A novel survey of perceived usefulness and ease of use was then completed by students. Results Repeated-measures ANOVA found students rated both the perceived usefulness (p< 0.001) and ease of use (p< 0.001) of smartphone fundoscopy significantly higher than both the non-mydriatic camera and direct fundoscopy. Conclusions Smartphone fundoscopy was found to be significantly more useful and easier to use than other modalities. Educators should optimise student access to novel fundoscopy technologies such as smartphone fundoscopy which may mitigate the technical challenges of fundoscopy and reinvigorate use of this valuable clinical examination.

eFOCUS 2: A randomised crossover trial of smartphone fundoscopy and direct ophthalmoscopy aiming to improve optic disc interpretation by medical students with e‐learning support

“…16 Our group has already shown that medical students perceive smartphone fundoscopy as easier to use and more useful than the TDO, critical differences which predict the future use of technologies. 17 Studies among small groups of medical students have shown a strong preference for smartphone fundoscopy, quicker identification of fundus anatomy, 18 and greater accuracy for common ophthalmic diagnoses. 19 However the generalisability of improved diagnostic accuracy using smartphone devices remains to be shown among a broad student cohort.…”

Fundoscopy use in neurology departments and the utility of smartphone photography: a prospective prevalence and crossover diagnostic accuracy study amongst neurology inpatients

“…This suggests fundal images could be obtained easily by junior doctors, clinic nurses or other allied health staff, possibly at the time of obtaining vital signs. NMFP by ED nurse practitioners was feasible after only 30 min of training in diverse settings [1, 23], and junior medical students have found SF easier to use and more useful than DO [44, 45]. Additionally, a study found no difference in image quality when comparing images obtained by a trained ophthalmic photographer (20 years of experience) with non‐professional photographers (one with 2 days and one with 1 h of training) [46].…”

Optimising fundoscopy practices across the medical spectrum: A focus group study

“…Novel fundoscopy technologies such as smartphone fundoscopy and non-mydriatic cameras have the capacity to obviate many of the technical barriers of TDO [8]. Direct fundoscopy takes years to perform competently [30], whilst most studies have found smartphone fundoscopy is preferred by medical students and junior doctors [9,31] and has greater accuracy [14,32,33]. Such devices offer the advantage of a shared view for feedback during training, which was important to optometry students [34], and has been shown to improve clinical performance [35].…”

“…There has been progress in the ease of fundoscopy, with emerging technologies including smartphone adaptors and increasingly portable non-mydriatic cameras [8,9]. However increasing fundoscopy utilisation has been more elusive [10].…”