Simulator Assessment of Funduscopic Skills in Three Consecutive Medical School Classes

Mottow-Lippa L and Boker JR


Purpose: To validate the reproducibility of results from an objective funduscopic simulator assessment used in an entire medical school class, by extending the study to two further class cohorts. Methods: In two subsequent medical school classes subject to the same curricular experience, direct funduscopic skills were prospectively assessed using a funduscopy simulator during the required clinical skills examination at the end of the third year. Performance was assessed across all three years. Results: Documented failure of visualization through a dilated pupil was 22% in the first cohort (n=97), and dropped to 2% in cohort 2 (n=87) and 0% in cohort three (n=86). Only 13 % of students in cohort 1 recognized background diabetic retinopathy, and 38% in cohort 3. Only 27% of students in cohort 2 who visualized the fundus were able to recognize florid disc edema. Only 45% in cohort 2 were able to identify a fundus as normal. Though erroneous “normal” diagnoses dropped from 7% to 1% from the first to third cohort, false positives for papilledema in these two cohorts’ diabetic case were similar (7% vs. 8%). False positives for the normal disc in the cohort 2 headache case occurred in 19%. Neovascularization was erroneously diagnosed in 10% of cohort 1, and 12% of cohort 3. Conclusions: Funduscopic skills were reproducibly found to be weak. Student awareness of impending objective funduscopic testing may have influenced their ability (by inducing skills practice)–or the students’ willingness to admit inability to visualize a dilated fundus in the simulator. Chief complaint bias likely influenced the findings documented. Multi-center studies are required—and are ongoing—to analyze larger student populations in diverse academic settings, to provide robust studies and allow more generalizable conclusions.

Journal of Academic Ophthalmology 2009: 2: 1-5. (c) Journal of Academic Ophthalmology

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