The usefulness of medical students in a teleretinal screening program, a pilot study

Abstract

Purpose : To identify how effective the role of medical students in a teleretinal screening program is, by examining our experience with our teleretinal screening program in a free clinic setting.

Methods : A teleretinal screening program for patients at risk for diabetic retinopathy (DR) was implemented in a student run free clinic utilizing a non-mydriatic fundus camera. Medical students performed the fundus photography and made preliminary diagnoses. This information was electronically transmitted to the supervising faculty retina surgeon for review, final diagnoses, and instructions for additional patient follow-up. The students’ preliminary diagnoses, the faculty’s feedback, and the screening images were reviewed to evaluate the accuracy of the medical students as well as the usefulness of the images obtained. Statistical modeling was utilized to identify the student learning curve and general effectiveness of the screening program.

Results : 396 photographs were taken during sixteen months, from August 2016 to November 2017. From these 198 patients, 57 have been identified as having need for intervention and follow-up. Of the 396 photographs, 84.09% were considered diagnostically significant by the students yet 76.01% were considered diagnostically useful by the attending reviewing them. Faculty agreed 91.92% with students assessment of image utility. Furthermore, there was a clear increase in the accuracy of the medical students’ preliminary diagnoses based on experience, with a positive cumulative effect (as shown by a statistically significant odds ratio). In 16.16% of patients the screening program also identified signs of other ocular pathology, such as glaucoma (47 patients (11.87%)) and hypertensive retinopathy (16 patients (4.01%).

Conclusions : The potential impact of this type of screening program in underserved settings is substantial. While a larger study is needed, our pilot study points to the potential usefulness of medical student participation in teleretinal screening. Also, risk factors for DR were used to identify patients for screening, yet the screening program also identified other ocular pathology demonstrating potential implications beyond DR. Our results suggest that a teleretinal screening program could be a valuable training tool for medical students, however, a well validated training program would be essential to implementing this type of screening program on a large scale.

This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.