Medical Schools' Ophthalmology Course: An Appraisal by Ophthalmology Residents

Terson Syndrome Diagnosed by Ocular Point of Care Ultrasound on the Medical Floor

In acute care environments, accurately assessing complications of intracranial pathology can be challenging. Ocular complications in acute intracranial disease are not consistently evaluated despite their high morbidity. We report on a case of monocular diplopia in a 63-year-old man with subacute traumatic brain injury with localized subarachnoid hemorrhage. Ocular point of care ultrasound (POCUS) identified features of vitreous hemorrhage in one globe, leading to a diagnosis of Terson syndrome and a timely referral to ophthalmology. This finding was made on the medical floor days after the initial presentation during rehabilitation when ophthalmoscopy was not possible, and vitreous hemorrhage had not been identified on presentation. Terson syndrome is a seldom discussed but important complication of intracranial hemorrhage generally associated with poor patient outcomes. Ocular POCUS can provide a useful alternative in assessing ocular complications of acute intracranial disease on the medical floor, particularly when the practicalities of performing ophthalmoscopy are challenged.

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

TOPIC

This systematic review examines geographical and temporal trends in medical school ophthalmology education in relation to course and student outcomes.

CLINICAL RELEVANCE

There 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.

METHODS

Systematic 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.

RESULTS

Systematic 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.

CONCLUSIONS

The 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.

Assessment of Ophthalmology Teaching and its Impact on the Choice of Future Specialties Among Medical Students of Jazan University

BACKGROUND

Ophthalmology is essential for primary and specialty care physicians, as eye complaints are common, accounting for a sizable proportion of general practice consultations and emergency department visits. Fundamental ophthalmology knowledge is also relevant to other specialty fields. Thus, medical schools must provide effective undergraduate curricula to teach students about salient points, visual examination skills, emergency recognition, and referral indications. The International Council of Ophthalmology (ICO) has set guidelines that medical students should imbibe to become proficient in ophthalmology. However, there have been no recent investigations evaluating undergraduate ophthalmology education at Jazan University's Faculty of Medicine. Therefore, this study aimed to compare the curriculum at Jazan University to the ICO's requirements for undergraduate medical education.

METHODS

An observational cross-sectional study was conducted with both male and female student participants enrolled in an ophthalmology course at Jazan University's Faculty of Medicine. Following IRB approval, the questionnaire was distributed on social media to assess if Jazan University's undergraduate ophthalmology curriculum complies with ICO standards.

RESULTS

The study included a diverse sample of 322 participants, predominantly consisting of female students (n=178, 55.3%). The participants' ages ranged from 22 to 36 years, with the majority falling within the 24-25 year age range (n=173, 53.7%). Regarding academic performance, (n=117, 36.3%) of participants had a GPA of less than 4, while 66 (20.5%) had a GPA between 4.76 and 5.00. Among the respondents, 31 (9.6%) indicated having no exposure to ophthalmology, while 117 (36.3%) felt they had insufficient exposure. A considerable percentage of participants expressed competence in various areas, such as obtaining ocular history (n=113, 35.1%), testing visual acuity (n=201, 62.4%), and examining extraocular motility (n=201, 62.4%). In total, 98 participants (30.4%) expressed an interest in ophthalmology, while the majority (n=224, 69.6%) were not interested.

CONCLUSION

Essential improvements include increasing hands-on clinical experience, small-group learning, exposure across academic years, and early mentorship. Developing competency-based curricula aligned with ICO guidelines could significantly strengthen education. Better training quality and exposure will equip students with the necessary skills, boost confidence, and potentially expand the ophthalmology workforce.

Ophthalmology as a career choice among medical students: a survey of students at a Canadian medical school

BACKGROUND

There is a lack of investigations into the factors that lead medical students to pursue increasingly competitive post-graduate training programs. We sought to determine the factors that influence medical students' opinions on ophthalmology as a career and on ophthalmological medical education.

METHODS

An anonymous 36-question survey was distributed to all medical students across the four program years at the Schulich School of Medicine and Dentistry as a non-probabilistic convenience sample. Survey results were analyzed using Mann-Whitney U tests to determine significant differences between study sub-populations. Multivariate regression analysis was performed to identify correlates for positive views towards ophthalmology.

RESULTS

81% of questions had a mean positive response amongst the students. Students held negative views regarding the amount of exposure to ophthalmology in medical school. The greatest differences in opinion regarding ophthalmology were seen between those with more exposure and interest in ophthalmology compared to their counterparts with less. Regression analysis identified interest in ophthalmology as a significant correlate to a positive opinion in the field.

CONCLUSIONS

Our survey demonstrates that while most students had positive views about ophthalmology, some aspects were viewed negatively. Students felt there was a lack of exposure, both educationally and clinically to ophthalmology, which may contribute to some misconceptions of the field. Early exposure appeared to be critical to forming positive opinions of ophthalmology and could be emphasized in medical education.