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Camille Palma, Annapurna Singh; Teaching Ocular Anatomy and Direct Ophthalmoscopy to Medical Students: A Novel Approach. Invest. Ophthalmol. Vis. Sci. 2012;53(14):1443.
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To evaluate a novel approach to teaching direct ophthalmoscopy and basic eye anatomy to medical students that incorporates use of a simple, inexpensive model of the eye and breaks down the goal into small, but progressively more challenging steps.
Medical students were invited to attend a pilot workshop to test the effectiveness of this new method of teaching ocular anatomy and direct ophthalmoscopy.The workshop was setup as follows: 1)The students were taught the anatomic landmarks of the eye while examining a model eye made out of a ping pong ball. By using a spherical model, they learned the important anatomic landmarks in the eye and their relationship to one another and the viewer. 2) Students were taught the proper techniques for using the ophthalmoscope and then 3) practiced using the scope on models that display anatomically correct color photos of papilledema, hemorrage, or various cup-to-disc ratios. 4) Once comfortable with the above, they examined a real person's dilated eye to assess cup-to-disc ratio and finally, 5) they attempted to correctly identify cup -to-disc ratio in an undilated eye. Student’s competency and comfort level with these skills and knowledge were assessed with before and after questionnaires based on a six point Likert scale and their responses were compared with paired student t-tests.
Students self-rated their competency at direct ophthalmoscopy by filling out six-point Likert scale questionnaires before and after the workshops. Comparison of these answers using a paired student’s T-test showed statistically significant improvement (p<0.0001; n=23) in the following areas: confidence using the direct ophthalmoscope, examining dilated and undilated patients, identifying ocular anatomy, identifying cup-to-disc ratio, papilledema, and hemorrhage. One question on the survey addressed confidence in the model as a tool for learning direct ophthalmoscopy. Students rated this concept highly before the session, suggesting that they expected the model to be useful. While the students’ confidence in the model increased after the workshop, the increase was not statistically siginificant (p =0.118).
Providing a structured, step-by-step curriculum that starts with reviewing basic anatomy, incorporates an easy-to-construct model, uses that model to demonstrate basic optic nerve pathology and systematically teaches direct ophthalmoscopy in progressively more difficult settings (photo, model, dilated eye, undilated eye) is an effective way to teach this skill to medical students. A longitudinal study that is incorporated into the regular didactic curriculum of the medical school is planned.
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