Short, Intensive Ophthalmic Training Boosts Students' Skills

Yael Waknine

January 06, 2014

A short, intense bout of ophthalmic training puts second-year medical students' skills on par with those of residents, according to a small pilot study published online January 2 in JAMA Ophthalmology.

Julia M. Byrd, MD, from the Moran Eye Center, University of Utah Health Care, Salt Lake City, and colleagues found that a 3-hour training session followed by participation in at least a single Community Vision Project mobile eye clinic significantly boosted median ophthalmoscope skills 48% and 37% above those of nonparticipating peers and internal medicine residents, respectively (P < .001 for both).

"[T]he findings of this small sample pilot study are preliminary, but the trend found herein supports the efficacy of an immersion experience of some kind," the authors write. They note that potential predictors of success include intense involvement from an attending ophthalmologist, the near-immediate reinforcement of training with hands-on experience, and the high volume of patients treated at the mobile eye clinic.

Skilled students can then mentor their peers, and even attending physicians, at times, thus reintegrating eye care back into the practice of general medicine, the authors add.

In an interview with Medscape Medical News, Frank J. Weinstock, MD, applauded the effort.

"Anything that will improve eye exams by primary care physicians is beneficial to both them and their patients," Dr. Weinstock said. He noted that ophthalmic training is woefully neglected in most medical schools and that many residents never even use an ophthalmoscope.

"So many diagnoses are made via the eye examination that some training is essential. It is not possible for an internist or family practitioner to adequately follow diabetics without an ophthalmoscopic exam. And yet many patients are referred to specialists because primary care physicians do not know how to examine the eye," Dr. Weinstock emphasized.

Dr. Weinstock is a professor of ophthalmology at Northeast Ohio Medical University in Rootstown; affiliate clinical professor in the Charles E. Schmidt College of Biomedical Science at Florida Atlantic University, Boca Raton; and volunteer professor of ophthalmology at the University of Miami Leonard M. Miller School of Medicine in Florida. He was not involved with the study.

The intervention group in the study consisted of 18 second-year medical students from the Hospital Eye Clinic at the University of New Mexico School of Medicine in Albuquerque; their skill assessment scores at 1 month and 1 year were compared with those of 18 classmates and 33 internal medicine residents.

At 1 month, students who had undergone the training achieved median scores of 60% (quartile 1 to quartile 3 range, 40% - 80%) on direct ophthalmology compared with 40% (range, 20% - 60%) for nonparticipating upperclassmen (P = .24).

Results at 1 year revealed a magnification of the effect difference between students (100% [range, 75% - 100%] vs 0% [range, 0% - 25%]; P = .11), and those who had undergone training had tonometer readings similar to those of the ophthalmologists with a median 2 mm Hg increase (quartile 1 to quartile 3 range, 0 - 4 mm Hg; P = .05).

The authors note that larger studies are needed to confirm their findings, whether by incorporating a service project or using some other innovative method to create a condensed learning experience under expert supervision. "Even if such programs are voluntary, they may assist in restoring adequate ophthalmic training at least to motivated students in the next generation," they conclude.

The research was supported by a grant from the Scholarship in Education Allocation Committee at the University of New Mexico. The equipment used in the service project was purchased using funding from the Association of American Medical Colleges as part of a "Caring for the Community" grant. One coauthor is the recipient of grant support from Genentech for an unrelated project concerning pterygium management. The authors have disclosed no other relevant financial relationships.

JAMA Ophthalmol. Published online January 2, 2014. Abstract

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