A Systematic Review of Ophthalmology Education in Medical Schools: The Global Decline

Abstract

TopicThis systematic review examines geographical and temporal trends in medical school ophthalmology education in relation to course and student outcomes. Clinical RelevanceThere is increasing evidence suggesting a decline in ophthalmology teaching in medical schools, raising concern for the adequacy of eye knowledge across the rest of the medical profession. MethodsSystematic review of Embase and SCOPUS, with inclusion of studies containing data on medical school ophthalmological course length, and/or one or more outcome measures on student ophthalmology knowledge, skills, self-evaluation of knowledge or skills, or student course appraisal. The systematic review was registered prospectively on PROSPERO, ID CRD42022323865. Results were aggregated with outcome sub-group analysis and description in relation to geographical and temporal trends. Descriptive statistics including nonparametric correlations were utilised to analyse data and trends. ResultsSystematic review yielded 4 596 publication titles, of which 52 were included in the analysis, with data from 19 countries. Average course length ranged from 12.5-208.7 hours, with significant continental disparity between mean course length. Africa reported the longest average course length at 103.3 hours, and North America reported the shortest at 36.4 hours. On average course lengths have been declining over the last two decades, from an average overall course length of 92.9 hours in the 2000s, to 52.9 hours in the 2020s. Mean student self-evaluation of skills was 51.3%, and student self-evaluation of knowledge was 55.4%. Objective mean assessment mark of skills was 57.5%, and of knowledge was 71.7%, compared to an average pass mark of 66.7%. On average 26.4% of students felt confident in their ophthalmology knowledge, and 34.5% in their skills. ConclusionsThe majority of the evidence describes declining length of courses devoted to ophthalmology in the last 20 years, significant student dissatisfaction with courses and content, and suboptimal knowledge and confidence.