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A Pilot Study on Providing Ophthalmic Training to Medical Students While Initiating a Sustainable Eye Care Effort for the Underserved

Julia M. Byrd, MD1; Michelle R. Longmire, MD2; Noah P. Syme, MD3; Cristina Murray-Krezan, MS4; Linda Rose, MD, PhD5
[+] Author Affiliations
1Moran Eye Center, University of Utah Health Care, Salt Lake City
2Department of Dermatology, Stanford University School of Medicine, Stanford, California
3Otolaryngology Division, Department of Surgery, The University of New Mexico, Albuquerque
4Biostatistics Section, UNM Health Sciences Center, The University of New Mexico, Albuquerque
5Cornea and External Diseases Service, Division of Ophthalmology, Department of Surgery, The University of New Mexico, Albuquerque
JAMA Ophthalmol. 2014;132(3):304-309. doi:10.1001/jamaophthalmol.2013.6671.
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Importance  We present a method to reintroduce ophthalmic training into the medical school curriculum.

Objectives  To evaluate knowledge and skills acquired when participating in a service project, the Community Vision Project, and to develop a quantitative method for testing skills with the direct ophthalmoscope in patients.

Design  Second-year medical students participated in the study. After 1 month, their knowledge was compared with that of peers and graduates (internal medicine residents). Also at 1 month, their direct ophthalmoscope skills were compared with those of upperclassmen who had completed all core clerkships. One year later, after the participants had completed their core clerkships, long-term ophthalmoscope skills retention was tested, and their performance was compared with that of their classmates.

Setting and Participants  Training occurred in mobile eye clinics. Knowledge and skills assessments were performed in the hospital eye clinic among students and residents at The University of New Mexico School of Medicine. Patients were recruited from the hospital eye clinic. Participants attended a 3-hour training session held by an attending physician in the hospital eye clinic and took part in at least 1 mobile eye clinic.

Main Outcomes and Measures  A knowledge assessment quiz was administered to participants (n = 12), their classmates (n = 18), and internal medicine residents (n = 33). Skills assessment with the direct ophthalmoscope was performed at 1 month and at 1 year in 5 participants and 5 nonparticipants. Tonometer skills were assessed by comparing participants’ readings with those of an ophthalmologist’s obtained in patients at the mobile eye clinics.

Results  Participants’ median knowledge assessment scores were 48% higher than those of their classmates and 37% higher than those of internal medicine residents (P < .001 for both). Short-term (1 month) direct ophthalmoscopy median scores were 60% (quartile 1 to quartile 3 range, 40%-80%) for participants and 40% (quartile 1 to quartile 3 range, 20%-60%) for nonparticipating upperclassmen (P = .24). Long-term direct ophthalmoscopy median scores were 100% (quartile 1 to quartile 3 range, 75%-100%) for participants and 0% (quartile 1 to quartile 3 range, 0%-25%) for nonparticipating classmates (P = .11). Participants’ tonometer readings were similar to those of the ophthalmologist’s; their median reading was 2 mm Hg (quartile 1 to quartile 3 range, 0-4 mm Hg) higher than that of the ophthalmologist’s (P = .05, sign test).

Conclusions and Relevance  Service-based learning offered an efficient model for incorporating ophthalmic training into the medical school curriculum. A viable tool for quantitatively testing ophthalmoscope skills is presented.

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Figure 1.
Knowledge Assessment Quiz
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Figure 2.
Skills Assessment Sample Item

Students were instructed to examine the patient’s right optic disc and select the correct photograph of the patient. In this example, the photograph corresponding to the patient examined was the myelinated nerve fiber layer seen in D. The other photographs were selected from archives, all demonstrating some feature around the optic disc of the right eye.

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