Efficacy of a Skills and Education Program in Ophthalmic Disorders for Primary Care Housestaff

Maggie B. Hymowitz, MD, Maayan E. Keshet, MD, and Harry M. Engel, MD


Purpose: To assess the ophthalmic knowledge and eye examination skills of internal medicine residents and determine whether a directed education program improves their ability to recognize ophthalmic disorders.
Methods: Thirty-nine medicine residents at the Montefiore Medical Center participated. Ten individuals were recruited from the Henkind Eye Institute at the Montefiore Medical Center as test patients. Residents were given a pre-test, in which they examined five patients in ophthalmic examination rooms and answered seven sets of questions based on photographs
of various eye conditions. A week later, the residents were exposed to one hour of instruction including examination techniques and thirty minutes for practice under supervision. In the following week, the residents were given a post-test, with the same disorders and diagnoses as the pre-test, but with different live patients. Resident physicians were graded on their ability to answer multiple-choice questions regarding pictures and live patients with ophthalmic disorders.
Results: The residents’ scores showed improvement on the written exam (P=0.005) but not the live patient practical (P=0.724). On the written exam, the residents’ scores improved in each of the seven categories; while on the practical, their scores improved only in the visual acuity and red reflex assessment categories. Basic skills such as assessing pupils, extraocular motility, fundi, discs, and confrontational visual fields deteriorated following the course. Their ability to correctly
name the live patients’ diagnoses improved only slightly.
Conclusions: Resident physicians are deficient in their ability to use penlight and direct ophthalmoscopy to diagnose diabetic retinopathy, advanced glaucoma, and pupillary defects. A 90-minute didactic and skills program enhanced their ophthalmic knowledge and ability to interpret pictures, but failed to enhance their ability to effectively screen for eye disease in
clinical situations.

Journal of Academic Ophthalmology 2010; 3: 25-29. (c) Journal of Academic Ophthalmology

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