Teaching Ophthalmoscopy to Medical Students (TOTeMS) II: a One-year Retention Study

Abstract

Purpose: Learning direct ophthalmoscopy is challenging, and medical students’ long-term retention of ophthalmoscopy skills is poor. We previously demonstrated that medical students performed more accurately and preferred using photographs than direct ophthalmoscopy to examine the ocular fundus. We hypothesized that these differences would persist over time.

Methods: One year after initial training, second-year medical students were randomized and reevaluated on their ability to examine the ocular fundus using either fundus photographs or direct ophthalmoscopy on eye simulators. Positive and negative affect, preferences, and clinical experiences with ocular fundus examination were assessed.

Results: 107/119 students (90%) who participated in the original study completed this one-year retention study.Students answered 35/48 (73%) questions correctly using photographs and 31/48 (65%) correctly using ophthalmoscopy (p<0.01). Both photograph and ophthalmoscopy groups answered five fewer questions correctly on average than one year prior (p<0.001). Students rated photographs as “easier than ophthalmoscopy” (8/10 vs. 6/10, respectively; p<0.001). Students’ positive affect scores were higher in the photograph group (26.5) than in the ophthalmoscopy group (23.2; p=0.03). Students tested on simulators reported lower positive affect than one year ago (decrease of 6.4 points, p<0.001).Students’ self-reported median frequency of fundus examination over the preceding year was <10% (IQR 0-20%). Ocular fundus examination was not performed because of discomfort with the examination (38%), discouragement by their preceptor (20%), and insufficient time (15%). 79% of students felt uncomfortable with ophthalmoscopy, and 44% stated that they would not perform ophthalmoscopy during a general physical examination. 76% stated they would prefer using photographs instead of ophthalmoscopy for fundus examination.

Conclusions: Students preferred photographs for examining the ocular fundus and were more accurate using photographs vs. direct ophthalmoscopy one year after training. The increasing availability of non-mydriatic ocular fundus photography may allow more frequent and accurate examination of the ocular fundus by medical students and non-ophthalmologists in many clinical settings.

Keywords: 612 neuro-ophthalmology: diagnosis • 579 learning • 550 imaging/image analysis: clinical