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M. B. Hymowitz, M. E. Keshet, H. M. Engel; Does a Skills and Education Program for Housestaff in Primary Care Residency Programs Improve Their Ability to Diagnose Ophthalmic Disorders?. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4979.
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To assess the ophthalmic knowledge and eye examination skills of internal medicine residents and determine whether a directed education program improves their ability to recognize common ophthalmic disorders.
39 internal medicine residents in post-graduate years one and two (PGY-1 and PGY-2) at the Montefiore Medical Center were given a pre-test that consisted of five live patient examinations. The examinations emphasized assessment of visual acuity, pupils, extraocular movements, confrontational visual fields, fundi, and optic nerves. Patient disorders included cataract, diabetic retinopathy, and glaucoma. In addition, the residents answered seven sets of questions based on photographs of various basic eye conditions (aged-related macular degeneration, hyphema, subconjunctival hemmorhage, hypopyon, pterygium, papilledema, and corneal ulcer). A week later, they were exposed to one hour of didactics and thirty minutes of examination-skills practice in a course based on the Association of University Professors in Ophthalmology Policy Statement on Medical Student Education. The following week, the residents were given a post-test, testing knowledge of the same disorders as the pre-test, but with different live patients.
The residents' scores showed overall improvement on the written exam (p=0.005) but not the live patient practical (p=0.724). On the written exam, the residents' scores improved in each of the seven categories; while on the practical, their scores improved only in the visual acuity and red reflex assessment categories. Basic skills such as assessing pupils, extra-ocular motility, fundi, discs, and confrontational visual fields deteriorated following the course. Their ability to correctly name the live patients' diagnoses improved only slightly.
Resident physicians in internal medicine are sorely deficient in their ability to use a penlight and direct ophthalmoscopy to diagnose diabetic retinopathy, advanced glaucoma, and profound papillary defects. A 90-minute didactic and skills program enhanced their ophthalmic knowledge and ability to interpret pictures, but failed to enhance their ability to effectively screen for severe eye disease in live clinical situations.
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