The Decline of Basic Ophthalmology in General Medical Education: A Scoping Review and Recommended Potential Solutions

OBJECTIVE

This literature review aims to explore research and conceptual pieces on the state of ophthalmology education and suggest potential ways to address current challenges.

METHODS

A search was conducted in PubMed, ERIC, Web of Science, and Google Scholar with combinations of the following search terms: "ophthalmology education," "undergraduate medical education," "medical student," "United States," and "Canada." Eliminating irrelevant articles yielded 47 articles. Three were excluded because of region and focus, leaving 44. After examining the citations, we generated an additional 22 texts for review, totaling 66 articles.

RESULTS

Four primary themes were identified: (1) challenges to ophthalmological education in the U.S. and Canada, (2) potential remedies for optimizing ophthalmology curriculum, (3) technology in ophthalmology education, and (4) innovative ophthalmology teaching approaches. Major challenges included the lack of a standardized curriculum and inadequate clinical exposure and skills training. A number of remedies were proposed, such as standardizing curriculum and furthering faculty involvement, utilizing technology as time-effective learning aids, and employing innovative teaching approaches such as service learning.

CONCLUSION

In light of challenges in ophthalmology education, curriculum designers should consider Cognitive Load Theory (CLT) to assist students to remember meaningful exposures to ophthalmology knowledge and techniques. Based on CLT, we suggest two potential approaches to incorporating ophthalmology curriculum. The first is to embrace interdisciplinary collaborations and place ophthalmology knowledge in varied contexts to facilitate schema construction. The second is to incorporate ophthalmology diagnostics requirements into OSCEs and utilize simulation models for students to gradually increase the fidelity of tasks and devote cognitive resources fully to learning.

eFOCUS 2: A randomised crossover trial of smartphone fundoscopy and direct ophthalmoscopy aiming to improve optic disc interpretation by medical students with e-learning support

BACKGROUND

Ophthalmoscopy and its interpretation are complex. We aimed to compare the diagnostic accuracy of smartphone fundoscopy with traditional direct ophthalmoscopy for optic disc interpretation, with e-learning support.

METHODS

We conducted a randomised, crossover study of 102 medical students. Students were offered e-learning for optic disc interpretation. A fundoscopy objective structured clinical examination was conducted after an introductory lecture and 10-min practical training session on smartphone fundoscopy and traditional ophthalmoscopy. Participants examined patients and simulator slides with a randomised crossover between smartphone [D-eye (Padova, Italy) or iExaminer (Welch Allyn, Macquarie Park, Australia)] and traditional ophthalmoscopy (Welch Allyn). Optic discs were graded independently by three masked ophthalmologists. The primary outcome was the ability to interpret an optic disc as normal or abnormal. Secondary outcomes included other optic disc aspects; student preferences; and e-learning performance.

RESULTS

Students' agreement with the gold standard for an abnormal or normal disc was significantly greater using a smartphone (74.4%) than with direct ophthalmoscopy (68.1%, p = 0.032). More students preferred smartphone (74%) over direct ophthalmoscopy (26%, p < 0.001). E-learning led to an improvement in optic disc interpretation scores (mean improvement = 4.5%, 95% CI = 3.7-5.2, p < 0.001).

CONCLUSIONS

Medical students are more accurate at recognising an abnormal optic disc using smartphone fundoscopy than traditional direct ophthalmoscopy, and have a strong preference for smartphone fundoscopy. E-learning may improve the interpretation of optic disc abnormalities. Smartphone fundoscopy may mitigate some technical challenges of fundoscopy and reinvigorate use of this valuable clinical examination.

Using non-mydriatic fundus photography to detect fundus pathology in Australian metropolitan emergency departments: A prospective prevalence and diagnostic accuracy study

OBJECTIVE

To determine the prevalence of fundus pathology in metropolitan Australian EDs utilising a non-mydriatic fundus photography screening programme. Secondary objectives include diagnostic accuracy among emergency physicians compared to telehealth ophthalmologist review.

METHODS

Prospective cross-sectional study investigating non-mydriatic fundus photography as a new diagnostic test in two tertiary Australian EDs. Consecutive adult patients were enrolled if they presented with headache, focal neurological deficit, visual disturbance or diastolic BP >120 mmHg. Diagnostic agreement was determined using kappa statistics and sensitivity and specificity using a reference standard consensus ophthalmology review.

RESULTS

A total of 345 consecutive patients were enrolled among whom 56 (16%, 95% confidence interval [CI] 13-21) had urgent fundus pathology. Agreement between emergency physician and ophthalmic assessment of fundus photographs was 74% (kappa = 0.196, P = 0.001). Emergency physicians had 40% sensitivity (95% CI 27-54) and 82% specificity (95% CI 76-86) for detecting urgent pathology on photographs.

CONCLUSIONS

Fundus photography detects a clinically significant proportion of fundus pathology and urgent diagnoses. Telehealth specialist image review is important to detect some important, time-critical illnesses that can be missed in routine care. This offers an accurate alternative to direct ophthalmoscopy that warrants further research in Australian EDs.

A systematic review of best practices in teaching ophthalmology to medical students

Ophthalmic medical student education is a cornerstone to improving eye health care globally. We review the current state of the literature, listing barriers to potential best practices for undergraduate ophthalmology teaching and learning within medical curricula. We describe recent advances and pedagogical approaches in ophthalmic education and propose specific recommendations for further improvements and research. Future research should concentrate on developing teaching and learning innovations that may result in a more time- and resource-effective models for interactive and integrated learning. As well as demonstrating that a competency-based approach results not just in better eye health, but also improvements in patient care, education, and medical care in general. By optimizing teaching available through improved evidence-based education, the ultimate goal is to increase medical students' knowledge and produce graduates who are highly trained in eye examination skills, resulting in improved patient eye care through timely diagnosis, referrals, and treatment.