The TOS study: can we use our patients to help improve clinical assessment?

Abstract

A patient assessment score can be used by medical staff to raise awareness of the importance of a complete neurological examination from referring physicians.

Teaching ophthalmoscopy to medical students (the TOTeMS study)

“…6 In a study asking patients to recall being examined with use of a tendon hammer, ophthalmoscope and stethoscope, nearly half of patients could not recall having ophthalmoscopy performed, while 95.7% recalled being examined with a stethoscope. 13 These and related studies have not only shown infrequent direct ophthalmoscope use, but also poor performance when the ophthalmoscope is used. Indeed, most primary care interns are unable to perform an adequate screening eye examination at the start of their postgraduate training.…”

Comment on: 'Direct ophthalmoscopy should be taught to undergraduate medical students'

“…3 We feel this data should not be used as an excuse to stop examining patients. Instead we agree with Yusuf et al 2 that despite advances in non-mydriatic fundus photography, basic skills in ophthalmic assessment are essential and advocate that there is no substitute for appropriate clinical examination.…”

Direct ophthalmoscopy should be taught to undergraduate medical students—No

“…[1][2][3] Missed or delayed detection of ophthalmic signs can result in harm to patients: undetected disc swelling could lead to loss of vision from persistently raised intracranial pressure; an undiagnosed retinal artery occlusion could prevent potentially life-saving risk factor modification in a patient at risk of stroke; failure to spot Roth spots could delay the diagnosis of bacterial endocarditis. Ophthalmology-but not direct ophthalmoscopy-is an essential part of undergraduate medical education.…”

“…6 Despite specific changes to the foundation curriculum aimed at improving the quality and completeness of neurological examination in two Birmingham trusts, only one in five doctors felt confident in recognising papilloedema (ie, disc swelling) by the end of their foundation year and 71% had used an ophthalmoscope fewer than ten times in the preceding 6 months. 1 Furthermore, a 1997 survey found that 43% of UK general practitioners lacked confidence in using the direct ophthalmoscope. 2 Fundus examination is performed too infrequently by general physicians and emergency doctors, and, when it is carried out, the quality is poor.…”

“…9 Ophthalmoscopes are expensive and often poorly maintained in hospital departments. 1 Fundus cameras are becoming cheaper and more portable: the Peek Vision project (www.peekvision.org) uses a 3D-printed adapter to allow a smartphone to be used as a fundus camera for a total cost of under $500, which produces images of comparable quality to that of standalone cameras costing fifty times more.…”