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Jennifer Park, Russell M Levine, Lewis A Eisen, Umar Mian, Manuela Calvo, Amanda C Raff, Mimoza Meholli, William B Burton, Jamie B Rosenberg; Loaner ophthalmoscopes in conjunction with simulation and clinical training improve fundoscopy skills of third year medical students. Invest. Ophthalmol. Vis. Sci. 2014;55(13):6090.
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To improve medical students’ confidence and ability in using an ophthalmoscope through simulation training and increased access to ophthalmoscopes on an inpatient medicine floor
Third-year medicine clerks were divided into three groups: Group A participated in simulation training with clinical practice and were also loaned Optyse lens-free ophthalmoscopes (Ophthalmos, Cambridge, UK) to use during the clerkship; Group B participated in training and practice only; Group C received the Optyse only. All were instructed to examine their patients’ eyes. At the end of the rotation, students completed a survey and were tested with a standard direct ophthalmoscope (Welch Allyn, Skaneateles Falls, NY) to identify a letter superimposed on the optic nerve of a simulator (Kyoto Kagaku, Kyoto, Japan), using the large and small pupil settings.
Sixty-six students participated. Group A had 19 students; Group B, 15; Group C, 32. Three students in Group A (15.8%), 1 in Group B (6.7%), and 6 in Group C (18.8%) owned their own ophthalmoscopes. Of all students who had simulation and clinical training, those who were loaned an Optyse were more likely to agree or strongly agree with these statements: I am likely to use an ophthalmoscope in the future (94.7% vs. 60.0%, p=0.03); Fundoscopy is a standard part of the physical exam (79.0% vs. 33.3%, p=0.01). Among students who received loaner ophthalmoscopes, those who also received simulation and clinical sessions agreed or strongly agreed that they were comfortable using an ophthalmoscope (68.4% vs. 31.3%, p=0.02), confident in visualizing the optic nerve (73.7% vs. 28.1%, p=0.003), and likely to use an ophthalmoscope in the future (94.7% vs. 68.8%, p=0.04). Those who received the loan performed significantly more fundoscopic exams (Group A, 3.6 patients; Group C, 2.6 patients vs. Group B, 0.1 patients, p=0.01). Students who received both the Optyse plus simulation and clinical training scored better on the test than those who received the Optyse without undergoing training (large pupil, 100% vs. 78.1%, p=0.04).
Simulation training, clinical practice, and the provision of a free ophthalmoscope loan increase students’ agreement that fundoscopy is a standard part of the physical exam, likelihood of performing fundoscopy, and confidence and ability in performing a fundoscopic exam.
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