Abstract
Purpose: :
To prospectively evaluate the effect of a teaching intervention on fundus pathology recognition by 3rd year medical students
Methods: :
There were 3 study groups (A, B, C), and a test consisting of 30 randomly shuffled fundus images taken during a 1-week core ophthalmology rotation. Groups took the exam as follows: (A) on Fridays only, (B) and (C) on Mondays and Fridays within the same week. Group C also listened to an online instructional lecture between exams. Ophthalmology residents (n=15) took the test once as a measure of test difficulty. The exam was evaluated as a percentage of possible correct responses. Additionally, individual questions were analyzed for accuracy in interpretation of different pathology.
Results: :
Of 96 students who tested, data for 82 individuals were analyzed (A-34, B-27, C-21). Students who didn't take the exam and/or lecture as directed were re-assigned groups (14) or excluded from the analysis (14). Average Friday scores were 33.63%, 39.67%, and 41.43%, for groups A, B, and C, respectively. The difference between the three groups was not statistically significant (p=0.19). In contrast, the average resident score was 86%. Scores for individual students improved in both groups B (average change 14.2%, p=0.0002) and C (average change=13%, p=0.0008); however, comparison of average individual improvements between Groups B and C was not significant (p=0.43). In the Monday exam, more than 50% of students could identify normal optic nerves and cotton wool spots, while less than 20% could identify optic disc edema, atrophy/pallor, drusen, and vein occlusion. On the second exam, recognition of a number of findings improved, while only with the intervention was there improved recognition of edema, atrophy/pallor, and drusen.
Conclusions: :
The 1-week clinical ophthalmology experience did improve shortterm recognition of important fundus pathology. An online didactic session designed specifically to teach medical students to recognize important fundoscopic findings did not effect overall learning, but did modify the students’ abilities to identify specific ocular pathology. Focused online didactics can have measurable impact on modifying clinical recognition of fundus pathology; its effects are not obvious without prospective studies. More work is needed to optimize the education of non-ophthalmic physicians to recognize vision threatening fundus findings and to assess long term learning.
Keywords: anatomy • optic disc • retina