Department of Ophthalmology
Medical Subject Headings
Physical Examination; Eye; Students, Medical; Education, Medical, Undergraduate; Ophthalmology; Curriculum; Educational Measurement
Life Sciences | Medicine and Health Sciences | Ophthalmology
Background: As medical education moves towards integrated programs, ophthalmology is being increasingly pushed towards the sidelines. It is important for all future physicians, and especially those going into primary care, to have competency in examining the eye and identifying basic pathology in order to better serve their patients.
Objectives: The purpose of this study was to assess the self-perceived competence in the basic eye exam by medical students at the University of Massachusetts Medical School. The secondary purpose was to compare this assessment to medical education content from nationwide medical schools.
Methods: The study sample consisted of 273 University of Massachusetts Medical School students divided into groups by graduating class (50 entering first year students, 67 entering second year students, 81 entering third year students, and 75 entering fourth year students). Online surveys were distributed in July 2009 with the following questions (based on a 5-point Likert scale ranging from 1- “Not confident at all” to 5- “Very confident”) : “I can test visual acuity,” “I can use a direct ophthalmoscope,” and “I can perform a dilated eye exam.” For the nationwide medical school data collection, online surveys were distributed to 152 medical deans from US accredited allopathic and osteopathic medical schools. The deans were instructed to forward the survey to the appropriate person in charge of designing the medical curriculum if they were not able to answer the questions themselves. These surveys were distributed from August 2009-March 2010 and consisted of the following yes/no statements: “Students learn how to perform visual acuity testing,” “Students are evaluated on performing visual acuity testing,” “Students learn how to use a direct ophthalmoscope,” “Students are evaluated on direct ophthalmoscopy,” and “Students perform a dilated eye exam.”
Results: Response rates ranged from 40-81% of medical students by class group and 26% of medical deans (n=40). Wilcoxon-Mann-Whitney non-parametric tests using SPSS were used to compare Likert scores between medical student classes. By the time students entered their final year of medical school, 4% were not confident at all testing visual acuity, 5.3% were not confident at all using the ophthalmoscope, and 74.3% were not confident at all performing a dilated eye exam. In terms of education, 97.5% of schools report teaching students how to perform visual acuity testing and 52.5% state that they evaluate their students on performing this skill. 100% of schools teach students how to use a direct ophthalmoscope and 82.5% evaluate their students on this. 57.5% of medical schools report teaching their students how to perform a dilated eye exam.
Conclusion: Current ophthalmology education at the University of Massachusetts Medical School provides opportunities for students to build confidence in performing visual acuity tests and in the basic ophthalmoscope exam, but inadequate training in performing a dilated eye exam. This appears to fit well with the national data, in which most schools taught their students visual acuity testing and direct ophthalmoscopy, but nearly half did not teach the dilated eye exam. Increasing rates of evaluation of student skills would be an effective way to build confidence and self-efficacy in these tasks.
Presented as part of the Senior Scholars Program at the University of Massachusetts Medical School, May 3, 2010.
Kleinberg, Teri T.; Kaushal, Shalesh; and Asdourian, George, "Ophthalmology Education in Medical School Curriculum Design: Assessing the Home Front" (2010). University of Massachusetts Medical School. Senior Scholars Program. Paper 106.