Ophthalmoscopy: A 7-Step Program

Abstract

Fundoscopy has been depicted as a forgotten art, 1 although there is little evidence that use of the direct ophthalmoscope was ever widely practiced. Examination of the fundus is, however, critical to the appropriate assessment of children who are seen within multiple branches of pediatrics. Physicians are hesitant to look in their patients' eyes, as both medical students and senior faculty often lack the skill and confidence needed to use the direct ophthalmoscope. 1 The reasons for this discomfort include insufficient teaching and exposure during medical school and residency. The difficulties encountered by many trainees are frequently compounded by an inability to merely hold the ophthalmoscope effectively.Physicians are more likely to reach a correct diagnosis if shown a photograph of retinal pathology than if asked to view the fundus directly. 1 We believe that this supports our hypothesis that teaching appropriate motor skills must be the initial step in teaching physicians to master the ophthalmoscope.All residents in pediatrics, adult neurology, psychiatry and first-year ophthalmology at Dalhousie University do a clinical rotation on our pediatric neurology service. These residents are ABSTRACT: Background: Fundoscopy is viewed as a difficult or impossible task by many students and physicians. We have used a novel seven-step approach to teach trainees to use the ophthalmoscope. The technique is based on the premise that success is most easily achieved if the necessary motor skills are mastered first. A step by step approach will enable others to teach their trainees to attain the ability to routinely view the fundi of their pediatric patients. Methods:Step 1 involves examination of the trainee's fundi to ensure there is no impediment to their success. In Step 2 the student examines the teacher. This identifies major errors. The next step teaches the trainee how to hold the ophthalmoscope.Step 4 gets the learner to read a journal article through the ophthalmoscope. In Step 5 they examine the teacher's eyes again and with a little help they are always successful. In the last two steps an older patient is first examined and finally the student examines a young child. Conclusion: This method differs from most other approaches by leaving the cognitive component of ophthalmoscopy until the student is comfortable with handling the instrument. It has been uniformly successful among our students and residents.

Objectives of teaching direct ophthalmoscopy to medical students

“…1976; Kahlenborn et al. 1989; Bradley 1999; Levy & Churchill 2003; Dooley & Gordon 2008; Hoeg et al. 2009) and methods of assessment (Cordeiro et al.…”

“…However, even textbooks, which were published since 1990, appeared to differ widely in their implicit requirements from medical students regarding DO. Published studies related to teaching of DO to undergraduate students Whereas textbooks of physical diagnosis describe the skills of DO, some published studies have described teaching aids (Makepeace et al 1975;Creech & Arsham 1976;Wile et al 1976;Kahlenborn et al 1989;Bradley 1999;Levy & Churchill 2003;Dooley & Gordon 2008;Hoeg et al 2009) and methods of assessment (Cordeiro et al 1993;Bradley 1999;Levy & Churchill 2003;Afshar et al 2010;Asman & Linde´n 2010) in teaching DO, and other authors and institutions have attempted to define the specific learning objectives of undergraduate teaching of DO.…”

The evaluation and management of paediatric headaches

“…Although a frequent parental concern, headaches due to poor visual acuity are easily identified by most patients as induced by reading or watching television. Competent fundoscopy is easily learned by following a simple seven-step approach (14).…”

Evaluation of an Ophthalmoscopy Simulator to Teach Funduscopy Skills to Pediatric Residents

“…9 These techniques do not allow for repeated and careful exposure to various pathologies, and an observer cannot verify what the student visualizes. [9][10][11][12] Using simulation as a method of teaching difficult-tomaster medical diagnostic skills allows for a highly realistic training experience, the ability to vary clinical presentation to meet the need of the learner and most importantly unlimited, repetitive practice to allow for retention of knowledge. Implementation of such a tool with trainees may lead to less reliance on specialists for routine ophthalmoscopic evaluation.…”