Direct ophthalmoscopy should be taught to undergraduate medical students--No.

Abstract

Experienced physicians using the direct ophthalmoscope lack confidence and often fail to notice important abnormalities.1, 2, 3 Missed or delayed detection of ophthalmic signs can result in harm to patients: undetected disc swelling could lead to loss of vision from persistently raised intracranial pressure; an undiagnosed retinal artery occlusion could prevent potentially life-saving risk factor modification in a patient at risk of stroke; failure to spot Roth spots could delay the diagnosis of bacterial endocarditis. Ophthalmology—but not direct ophthalmoscopy—is an essential part of undergraduate medical education. The diagnosis of many systemic conditions can be made or assisted by the identification of ophthalmic features, and knowledge of ophthalmology in relation to acute medical and surgical problems in invaluable for any doctor. However, these signs must first be detected before they can be acted upon. The time spent in ophthalmology by undergraduate medical students in the UK is limited, with most students spending 5–10 days of their entire training in compulsory ophthalmology education,4 and trends across the developed world predict further reduction,5 so it is vitally important that these precious hours are used wisely to ensure tomorrow’s doctors are best equipped to serve their patients. Considering such time restraints, rather than struggling to wield a direct ophthalmoscope in busy clinics, further clinical teaching is more of a priority for the modern medical student, which would enhance their ability to interpret signs from fundus images that can be captured by other means.