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Nisha Chadha, Jessica Maslin, Ji Liu, Christopher C Teng; Resident Identification of Disc Hemorrhages in Glaucoma Patients. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):3714.
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To evaluate resident proficiency in identifying disc hemorrhages before and after a lecture on disc hemorrhages and clinical detection.
A pre-test consisting of a slideshow with 50 optic disc photographs, of which 14 had disc hemorrhages, was administered. 15 ophthalmology residents at one institution participated and were asked to identify whether or not a disc hemorrhage was present. Participants were shown each image for 10 seconds. The pre-test was followed by a lecture on disc hemorrhage pathophysiology, clinical implications, and strategies for improving clinical detection. The test was repeated after the lecture. Overall scores and accuracy with disc hemorrhage identification, before and after the lecture, were analyzed using paired t-test.
15 ophthalmology residents participated in the curriculum and 14 residents completed the post-test. The average overall performance did not change from pre-test to post-test, with average scores of 85% and 85.4% respectively (p=0.60). However, the average number of missed disc hemorrhage images improved from 23% to 14% (p=0.89). Sensitivity in disc hemorrhage detection improved from 79% to 85% while specificity remained relatively stable at 87% and 85%. When stratified by year of training, second and third year residents had the same pre and post-test average scores of 87%, while first year residents scored 78% on the pre-test, with improvement to 82% on the post-test. Similarly, second and third year residents missed fewer disc hemorrhages at 14% and 20% respectively, compared to first year residents who missed 34%. However, all residents improved in disc hemorrhage detection on the post-test to a rate of less than 13%, 9%, and 20% missed disc hemorrhages in the third, second, and first year resident groups respectively.
Disc hemorrhage identification is an essential component of glaucoma evaluations. Resident education on this topic is important for comprehensive patient care and can improve resident proficiency in detection at all levels of training.
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