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J. A. Sokol, M. E. Keshet, M. B. Hymowitz, H. M. Engel; Assessment of Pediatric Residents: Beyond Simply Looking for a Red Reflex. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4834.
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To assess the ophthalmic knowledge and skills among pediatric residents. Published studies have shown there is lack of ophthalmology education in medical school curricula which has led to a gap in the knowledge base and skills among medical graduates. Currently, the managed healthcare system now places a larger responsibility on primary care physicians to diagnose and treat medical conditions that would otherwise be treated by specialists. Our goal was to identify weaknesses among pediatric residents and to create a customized curriculum to enhance their ophthalmic education and strengthen their skills and confidence.
A survey was administered to 69 pediatric residents (Postgraduate Year 1 - 3) at The Children’s Hospital at Montefiore (CHAM), Bronx NY, to evaluate their fund of knowledge and examination skills. There were 13 knowledge questions, covering pediatric topics such as nasal lacrimal duct obstruction (NLD), amblyopia, eye turn, and cataracts. There were 5 skills questions evaluating pediatric residents’ comfort with the basic eye examination including using the direct ophthalmoscope, performing the cover/uncover test, reading CT scans and MRIs, and identifying various eye conditions. The survey was administered during the weekly pediatric conferences at CHAM with the understanding that a curriculum would be created to further CHAM pediatric residents education. Individuals were excluded if they were not CHAM pediatric residents.
When evaluating all residents’ ability to identify features of certain eye conditions, the following were answered correctly: amblyopia (64%), congenital cataracts (55%), congenital glaucoma (79%), infectious conjunctivitis (91%), corneal abrasion (45%), neonatal conjunctivitis (52%), NLD (76%), orbital cellulitis (76%), orbital neoplasm (91%), red reflex (76%), retinopathy of prematurity (88%), shaken baby syndrome (39%), strabismus (52%). When assessing residents comfort level with the ophthalmic exam skills, they were not very or not comfortable at all in the following categories: cover/uncover test (42%), reviewing orbital CT/MRI (82%), fundus exam (57%), direct ophthalmoscopy (48%). All residents surveyed were somewhat or very comfortable with the red reflex exam. There was insufficient data to compare knowledge and skills between postgraduate levels.
CHAM pediatric residents demonstrate deficiencies in both ophthalmic knowledge and comfort in clinical skills. Further steps need to be taken to improve the education of these primary care physicians.
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