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M. Bal, Y. Khan; Assessing Competency in Ophthalmology in Undergraduate Medical Students With the Objective Standardized Clinical Examination. Invest. Ophthalmol. Vis. Sci. 2010;51(13):5356.
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Medical education in ophthalmology is lacking and requires more attention in medical programs. We assessed the competency in ophthalmology in medical students at McMaster University with the Objective Standardized Clinical Examination (OSCE). Also, we attempted to determine specific areas requiring improvement such as certain aspects of an ophthalmic examination.
Data collected from 102 pre-clerkship students from the first year class and 100 clerkship students from the second year class was analyzed for this study. Participants in both groups were tested in an OSCE station during their regular OSCE administrations. The station featured a common ocular complaint (blurry vision with markedly reduced visual acuity) and students were asked to take an appropriate history (part 1), provide 2-3 differential diagnoses to explain the symptoms (part 2) and perform an ophthalmic examination (part 3). Examiners were given the OSCE checklist and scoring rubric.
Overall, the performance of both groups was satisfactory according to the averages calculated for parts 1 and 3 and the number of students able to pass part 2. However, there was considerable spread in the results (based on the standard deviation of the mean) indicating a large group of students in both groups had scores that were unsatisfactory. In parts 1 and 3, the history taking and ophthalmic examination sections respectively, clerks performed better overall with few specific exceptions within each section. However, more pre-clerkship students were able to provide 2-3 differential diagnoses (92 %) than clerkship students (81 %). For the history taking section, most pre-clerkship students were able to ask general history questions such as temporal features of the complaint (83 %) or past medical history (96 %) but failed to characterize the ocular complaint itself in satisfactory detail. For the ophthalmic examination, only 9 % of the clerks were able to perform an anterior segment exam, a weakness of the pre-clerks as well (23 %). The pre-clerks also performed poorly for visual field testing (51 %) and checking pupillary responses (65 %).
The OSCE identified some key areas of weakness in competency in ophthalmology in the medical students and awareness of such knowledge can allow medical educators to incorporate focused programs into the curriculum to help address these issues.
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