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M. B. Hymowitz, M. E. Keshet, H. M. Engel; An Evaluation of Internal Medicine Residents’ Abilities to Triage Patients With Ophthalmic Complaints. Invest. Ophthalmol. Vis. Sci. 2009;50(13):5064.
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The current managed healthcare infrastructure requires primary care physicians to diagnose and treat medical conditions that would otherwise be treated by specialists. Ophthalmic complaints are no exception. In a previous study, assessing the ophthalmic knowledge and eye examination skills of internal medicine residents and determining whether a directed education program would improve their ability to recognize common ophthalmic disorders, we demonstrated that baseline ophthalmic knowledge and exam skills were limited. We also showed that, although ophthalmic information could be taught and retained after a one-day lecture series, exam skills continued to suffer. The purpose of this study was to determine if internal medicine residents have the ability to properly diagnose and triage patients with eye complaints.
First-year internal medicine residents from Montefiore Medical Center participated in the study. The residents were given a two hour lecture on the anatomy of the eye, common eye diseases, ocular manifestations of systemic diseases, and ophthalmic emergencies. In addition, they were taught to perform various parts of the eye exam, including visual acuity, pupils, relative afferent pupillary defect, confrontational visual fields, extraocular movements, and direct ophthalmoscopy. They were given 45 minutes to practice these skills. After the two hour session, the residents were given an anonymous quiz with eight scenarios in which they were asked "What is the most likely diagnosis?" and "How would you triage the patient?" The choices for triaging included immediate referral to the emergency room, follow-up with ophthalmology the same day or the next day, or routine ophthalmic follow-up. The answers were reviewed with detailed explanation after the quiz was completed.
A total of 41 residents completed the education program and quiz. When evaluating the residents’ ability to diagnose and triage patients, the following were answered correctly: endophthalmitis - 56% diagnosis, 95% triage; subconjunctival hemorrhage - 59% diagnosis, 95% triage; acute angle closure glaucoma - 83% diagnosis, 98% triage; pterygium - 46% diagnosis, 90% triage; corneal ulcer - 76% diagnosis, 83% triage; diabetic retinopathy - 85% diagnosis, 100% triage; hyphema - 63% diagnosis, 97% triage; corneal abrasion - 85% diagnosis, 85% triage.
Primary care internal medicine residents have the ability to properly diagnose common ophthalmic conditions and can triage patients accordingly after a brief educational intervention.
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