Abstract
BackgroundDirect ophthalmoscopy (DO) is an essential skill for medical graduates but there are multiple barriers to learning this. Medical students and junior doctors typically lack confidence in DO. Most students do not own an ophthalmoscope and learn via ward devices that vary in design and usability. The Arclight ophthalmoscope (AO) is an easy to use, low-cost and portable device that could help address device access. This study aimed to assess the impact of personal ownership of an AO on DO skill acquisition and competency amongst medical students in the clinical environment.MethodsMethod comparison study with 42 medical students randomised to either traditional device ophthalmoscope (TDO) control or AO intervention group during an 18-week medical placement. Three objective assessments of DO competency were performed at the beginning and end of the placement: vertical cup to disc ratio (VCDR) measurement, fundus photo multiple-choice questions (F-MCQ) and model slide examination (MSE). DO examinations performed during the placement were recorded via an electronic logbook.ResultsStudents in both groups recorded a median number of six examinations each during an eighteen-week placement. There was no statistically significant difference between the groups in any of the objective assessment measures (VCDR p = 0.561, MCQ p = 0.872, Model p = 0.772). Both groups demonstrated a minor improvement in VCDR measurement but a negative performance change in F-MCQ and MSE assessments.ConclusionsStudents do not practice ophthalmoscopy often, even with constant access to their own portable device. The lack of significant difference between the groups suggests that device access alone is not the major factor affecting frequency of DO performance and consequent skill acquisition. Improving student engagement with ophthalmoscopy will require a more wide-ranging approach.
Highlights
Direct ophthalmoscopy (DO) is an essential skill for medical graduates but there are multiple barriers to learning this
Direct ophthalmoscopy is an essential skill for medical graduates as outlined by the General Medical Council (GMC) and supported by the Royal College of Ophthalmologists. [1, 2] Specific ophthalmic problems are estimated to make up approximately 1.46–6% of UK Emergency Department attendances and 1.5% of GP consultations. [3, 4] Timely and accurate DO can be life-saving in some
Despite the importance of and frequent need to perform DO, there are multiple barriers to learning this skill at an undergraduate level. [6, 7] Ophthalmology is not a compulsory clinical attachment for all UK medical schools and some students graduate without any ophthalmoscopy exposure
Summary
Direct ophthalmoscopy (DO) is an essential skill for medical graduates but there are multiple barriers to learning this. Most UK medical students do not own a direct ophthalmoscope or have easy access to a functioning device on hospital placements. [16] Availability of ophthalmoscopes in hospital attachments is recognised to be limited This is multifactorial: NHS procurement can lack consistency in which models are purchased and ward staff may not provide ongoing maintenance leading to non-functioning devices due to burst bulbs or flat batteries. These issues present further challenges to skill mastery. These issues present further challenges to skill mastery. [11]
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