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Philip Garza, Linda Kelly, Beau Bruce, Emily Graubart, Nancy Newman, Valerie Biousse; Teaching Ophthalmoscopy to Medical Students: The TOTeMS Study. Invest. Ophthalmol. Vis. Sci. 2013;54(15):4372.
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Learning direct ophthalmoscopy is challenging, and medical students and physicians often perform this skill poorly. The purpose of this study was to determine medical student preferences for learning the ocular fundus examination and assess their accuracy using different examination modalities.
First-year medical students (M1s) received training in direct ophthalmoscopy using anatomically- and optically-correct simulators and human volunteers. Subsequently, M1s were randomized to receive vs. not receive specific training on interpreting fundus photographs prior to accuracy assessments. Students’ preferences for each of the three methods and recognition of normal and abnormal fundus features were assessed.
119/138 (86%) M1s completed all required elements. For learning ophthalmoscopy, 85 (71%) preferred humans to simulators. For learning relevant features of the ocular fundus, 92 (77%) preferred photographs to simulators. Regarding accuracy, M1s correctly answered 3.7 more questions (out of 48 questions per modality) when using fundus photographs vs. using direct ophthalmoscopy on simulators (p<0.001). M1s receiving specific teaching about reading fundus photographs before testing accurately answered 1.7 more fundus photography questions (p=0.02). Regarding patient examination preferences, M1s rated median ease of examination 5/10 for humans, 7/10 for simulators, and 9/10 for photographs (10=easiest); and frustration 4/10 for humans, 3/10 for simulators, and 2.5/10 for photographs (10=most frustrated). Half the M1s reported they would attempt direct ophthalmoscopy ≤40% of the time during clinical rotations, and 84 (70%) would prefer to have fundus photographs instead of using the ophthalmoscope.
Students preferred fundus photographs for both learning and examining the ocular fundus. Identification of ocular fundus features was more accurate on photographs compared to examination by direct ophthalmoscopy; this was further improved by training in interpreting fundus photographs. The increasing availability of non-mydriatic ocular fundus photography may allow replacement of direct ophthalmoscopy in many clinical settings for non-ophthalmologists.
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