Utility of Combining a Simulation-Based Method With a Lecture-Based Method for Fundoscopy Training in Neurology Residency

Abstract

IMPORTANCE Fundoscopic examination is an essential component of the neurologic examination. Competence in its performance is mandated as a required clinical skill for neurology residents by the American Council of Graduate Medical Education. Government and private insurance agencies require its performance and documentation for moderateand high-level neurologic evaluations. Traditionally, assessment and teaching of this key clinical examination technique have been difficult in neurology residency training.OBJECTIVE To evaluate the utility of a simulation-based method and the traditional lecture-based method for assessment and teaching of fundoscopy to neurology residents. DESIGN, SETTING, AND PARTICIPANTSThis study was a prospective, single-blinded, education research study of 48 neurology residents recruited from July 1, 2015, through June 30, 2016, at a large neurology residency training program. Participants were equally divided into control and intervention groups after stratification by training year. Baseline and postintervention assessments were performed using questionnaire, survey, and fundoscopy simulators.INTERVENTIONS After baseline assessment, both groups initially received lecture-based training, which covered fundamental knowledge on the components of fundoscopy and key neurologic findings observed on fundoscopic examination. The intervention group additionally received simulation-based training, which consisted of an instructor-led, hands-on workshop that covered practical skills of performing fundoscopic examination and identifying neurologically relevant findings on another fundoscopy simulator. MAIN OUTCOMES AND MEASURESThe primary outcome measures were the postintervention changes in fundoscopy knowledge, skills, and total scores. RESULTS A total of 30 men and 18 women were equally distributed between the 2 groups. The intervention group had significantly higher mean (SD) increases in skills (2.5 [2.3] vs 0.8 [1.8], P = .01) and total (9.3 [4.3] vs 5.3 [5.8], P = .02) scores compared with the control group. Knowledge scores (6.8 [3.3] vs 4.5 [4.9], P = .11) increased nonsignificantly in both groups.CONCLUSIONS AND RELEVANCE This study supports the use of a simulation-based method as a supplementary tool to the lecture-based method in the assessment and teaching of fundoscopic examination in neurology residency.

A Future for Simulation in Acute Neurology

“…There are few devices in use, and currently only fundoscopy training as well as lumbar puncture training has been used for simulation-based methods training in neurology residency-each using commercially available (Kyoto Kagaku America Inc) simulators. [6][7][8][9] In neurocritical care, however, few so-called scenarios (a written script superficially resembling a screenplay) have been systematically tested. We and others have developed scenarios for the determination of brain death, which includes a combination of pitfalls and confounders.…”

Education Research: Teaching and assessing communication and professionalism in neurology residency with simulation

“…5 Over the last 10 years, neurology residencies have been utilizing simulation to enforce principles for managing acute stroke, 6 to train residents to perform lumbar punctures, 7 and to teach residents about direct ophthalmoscopy. 8 There is a dearth of literature suggesting use of a simulation center for developing professionalism and interpersonal communication skills, particularly in neurology residency. Nonetheless, simulation can positively affect physician performance and clinical outcomes, as has been demonstrated with screening for high-risk behaviors, 9 safer opioid prescribing practices, 10 and assessing pain.…”

Simulation in Neurocritical Care: Past, Present, and Future

“…Among neurological skills, an optic nerve sheath diameter trainer has been validated [59], while fundoscopic exam and lumbar puncture task trainers have both exhibited benefit [60,61]. A study comparing the lumbar puncture skills of simulation-trained internal medicine residents to traditionally trained neurology residents found that the simulation-trained residents showed superior performance despite significantly less clinical experience with the procedure.…”