Abstract
Purpose: :
To compare the clinical examination findings of emergency physicians (EPs) to that of resident and attending ophthalmologists in a tertiary care setting. This will allow better definition of deficiencies in ophthalmic teaching.
Methods: :
Two ophthalmology residents prospectively entered ophthalmic physical examination findings as reported by EPs at the time of referral to a tertiary ophthalmology service. Data were collected on a standardized form for a cohort of 100 patients (200 eyes) during referral from 6 emergency departments. Physical examination findings included visual acuity, pupillary responses, ocular movements, confrontational visual field testing, intra-ocular pressure (IOP), anterior segment slit lamp examination findings, and fundus findings. EPs were also asked the most likely diagnosis for each referral. Exam findings were then anonymously compared to that of ophthalmology residents and attending physicians. EPs were masked to their participation in the study.
Results: :
200 eyes of 100 patients were compared and analyzed using a T-test and chi-squared testing. No differences in logMAR visual acuity were noted between the groups. Pupillary abnormalities were noted in 17 eyes by ophthalmologists and in 7 eyes by EPs (P=0.035). One ocular movement abnormality was noted by an ophthalmologist; none were noted by EPs. Visual field defects were found by ophthalmologists in 12 cases, and by EPs in 4 cases (P=0.041). One case of elevated IOP was detected both by ophthalmologist and EP. Anterior segment slit lamp findings by EPs agreed with ophthalmologist findings in 24/52 cases (P=0.00036), and fundus findings were in agreement in 3/33 cases. (P<0.0001). EP final diagnosis concurred with the ophthalmologists in 55/100 patients.
Conclusions: :
Emergency physicians did not appreciably differ from ophthalmologists in examining vision, ocular movements, or noting elevated IOP. However, significant differences were noted between the groups in assessment of pupillary responses, visual fields, anterior segment by slit lamp, and fundus examination. These differences provide direction for improving the teaching of the ophthalmic examination.
Keywords: clinical (human) or epidemiologic studies: health care delivery/economics/manpower