Abstract
Purpose :
Ocular emergencies account for up to 3% of Emergency Department (ED) visits in the US, requiring emergency physicians (EPs) to have the skills and confidence to identify and manage ocular pathology. However, EPs report limited confidence in performing a comprehensive slit lamp exam, one of the fundamental skill sets for an EP, due to insufficient ophthalmic training during residency. Our objective was to design an evidenced-based, simulation-based mastery learning (SBML) curriculum to empower EPs to perform a structured slit lamp exam.
Methods :
EPs at a tertiary academic institution were enrolled in an SBML curriculum and evaluated using pre- and post-test assessment, and follow-up skill utilization. Ophthalmology and ED faculty created the curriculum and a 20-item checklist based on targeted needs assessment. Participants first completed an in-person baseline slit lamp exam at Wills Eye Hospital (WEH), then received a learning packet, instructional video, and an independent readiness assessment (IRAT). Passing the IRAT (>90%) permits the EP to schedule the in-person SBML deliberate practice and the final exam at WEH. Participants must score above 90% on the final checklist and complete a 2-month follow-up survey on provider confidence and knowledge dissemination to graduate.
Results :
17 EPs enrolled, and all EPs successfully completed the final exam in one attempt. There was a significant increase between pre-curriculum (11.0, 2.78) and post-curriculum (19.22, 0.78) scores, with an average increase of 8.22, p < 0.001. EPs struggled most with anterior chamber evaluation and cell and flare identification, improving from 21% and 7.1% completion pre-training to 100% and 81.8%, respectively, upon curriculum completion.
Conclusions :
This is the first interdisciplinary SBML pilot curriculum between the Department of Ophthalmology and EM that demonstrated a significant improvement in clinician skillset. It is imperative for EPs to master the skill of identifying cells and flare, as uveitis is commonly undiagnosed or misdiagnosed for similar-appearing pathology such as conjunctivitis. Further analysis will evaluate knowledge dissemination and physician attitude regarding the slit lamp curriculum with goals of dissemination and replication by other EM programs.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.