Validity of direct ophthalmoscopy skill evaluation with ocular fundus examination simulators

Akaishi, Yu; Otaki, Junji; Takahashi, Osamu; Breugelmans, Raoul; Kojima, Kimiko; Seki, Masayasu; Komoda, Takayuki; Nagata-Kobayashi, Shizuko; Izumi, Miki

doi:10.1016/j.jcjo.2014.06.001

Cited by 18 publications

(13 citation statements)

References 14 publications

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“…We chose a range of assessments to provide an overview of student performance in an attempt to overcome this. VCDR and EOU scoring [17, 20], F-MCQ [13, 21] and MSE [22, 23] have all been used in similar studies before but not directly compared or formally validated for assessing competence.…”

Section: Discussionmentioning

confidence: 99%

Does access to a portable ophthalmoscope improve skill acquisition in direct ophthalmoscopy? A method comparison study in undergraduate medical education

et al. 2019

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Background Direct ophthalmoscopy (DO) is an essential skill for medical graduates but there are multiple barriers to learning this. Medical students and junior doctors typically lack confidence in DO. Most students do not own an ophthalmoscope and learn via ward devices that vary in design and usability. The Arclight ophthalmoscope (AO) is an easy to use, low-cost and portable device that could help address device access. This study aimed to assess the impact of personal ownership of an AO on DO skill acquisition and competency amongst medical students in the clinical environment. Methods Method comparison study with 42 medical students randomised to either traditional device ophthalmoscope (TDO) control or AO intervention group during an 18-week medical placement. Three objective assessments of DO competency were performed at the beginning and end of the placement: vertical cup to disc ratio (VCDR) measurement, fundus photo multiple-choice questions (F-MCQ) and model slide examination (MSE). DO examinations performed during the placement were recorded via an electronic logbook. Results Students in both groups recorded a median number of six examinations each during an eighteen-week placement. There was no statistically significant difference between the groups in any of the objective assessment measures (VCDR p = 0.561, MCQ p = 0.872, Model p = 0.772). Both groups demonstrated a minor improvement in VCDR measurement but a negative performance change in F-MCQ and MSE assessments. Conclusions Students do not practice ophthalmoscopy often, even with constant access to their own portable device. The lack of significant difference between the groups suggests that device access alone is not the major factor affecting frequency of DO performance and consequent skill acquisition. Improving student engagement with ophthalmoscopy will require a more wide-ranging approach.

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Section: Discussionmentioning

confidence: 99%

Does access to a portable ophthalmoscope improve skill acquisition in direct ophthalmoscopy? A method comparison study in undergraduate medical education

et al. 2019

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“…The largest proportion of dry-lab models were designed for practising examinations, including slit lamp and fundoscopy (direct and indirect) [ 128 – 136 ]. Two studies tested the validity and effectiveness of the EYE Exam Simulator (Kyoto Kagaku Co., Japan), a popular tool for fundoscopy practice.…”

Section: Resultsmentioning

confidence: 99%

“…Survey responses also indicated that there was low user satisfaction with the model as trainees did not feel it was realistic or that the exercise improved their skills. On the other hand, Akaishi et al showed that there was a strong correlation between accuracy of examination on the EYE simulator and previous experience of performing fundoscopy in the clinic, providing some evidence for its validity [ 128 ].…”

Section: Resultsmentioning

confidence: 99%

A systematic review of simulation-based training tools for technical and non-technical skills in ophthalmology

Lee

Raison

Lau

et al. 2020

Eye

100

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To evaluate all simulation models for ophthalmology technical and non-technical skills training and the strength of evidence to support their validity and effectiveness. A systematic search was performed using PubMed and Embase for studies published from inception to 01/07/2019. Studies were analysed according to the training modality: virtual reality; wet-lab; dry-lab models; e-learning. The educational impact of studies was evaluated using Messick’s validity framework and McGaghie’s model of translational outcomes for evaluating effectiveness. One hundred and thirty-one studies were included in this review, with 93 different simulators described. Fifty-three studies were based on virtual reality tools; 47 on wet-lab models; 26 on dry-lab models; 5 on e-learning. Only two studies provided evidence for all five sources of validity assessment. Models with the strongest validity evidence were the Eyesi Surgical, Eyesi Direct Ophthalmoscope and Eye Surgical Skills Assessment Test. Effectiveness ratings for simulator models were mostly limited to level 2 (contained effects) with the exception of the Sophocle vitreoretinal surgery simulator, which was shown at level 3 (downstream effects), and the Eyesi at level 5 (target effects) for cataract surgery. A wide range of models have been described but only the Eyesi has undergone comprehensive investigation. The main weakness is in the poor quality of study design, with a predominance of descriptive reports showing limited validity evidence and few studies investigating the effects of simulation training on patient outcomes. More robust research is needed to enable effective implementation of simulation tools into current training curriculums.

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“…18,[23][24][25][26] The early role of fundus photographs in medical education was as an integral part of most ophthalmoscopy simulators, but without an emphasis on any potential stand-alone role for the photographs. 18,23,27 Initially, simulators simply served as a tool for assessing students' direct ophthalmoscopy skills, but the simulators and fundus photographs themselves have more recently been used as tools to teach the ocular fundus examination. [24][25][26]28 This trend and the use of ocular fundus photography in medical education are summarized in ►Table 1.…”

Section: Fundus Photography In Medical Educationmentioning

confidence: 99%

“…One such product, the EYE Examination Simulator (Kyoto Kagaku Co., Ltd., Tokyo, Japan), which includes one normal and nine abnormal fundus image slides, incorporates ocular fundus photographs as a means of both teaching and assessing direct ophthalmoscopy skills. 25,27 Akaishi and colleagues modified the stock fundus slides to include six 4-digit numbers printed in the vicinity of important fundus landmarks, which participants were asked to find using a direct ophthalmoscope. 27 They concluded that the ability to identify the numbers on simulators with pupils 3.5 mm in diameter correlated with study participants' self-reported cumulative experience with direct ophthalmoscopy.…”

Section: Fundus Photography In Medical Educationmentioning

confidence: 99%

Ocular Fundus Photography as an Educational Tool

Mackay

Garza

2015

Semin Neurol

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(150 word maximum):The proficiency of non-ophthalmologists with direct ophthalmoscopy is poor, which has prompted a search for alternative technologies to examine the ocular fundus. Although ocular fundus photography has existed for decades, its use has been traditionally restricted to ophthalmology clinical care settings and textbooks. Recent research has shown a role for nonmydriatic fundus photography in non-ophthalmology settings, encouraging more widespread adoption of fundus photography technology. Recent studies have also affirmed the role of fundus photography as an adjunct or alternative to direct ophthalmoscopy in undergraduate medical education. In this review, we examine the use of ocular fundus photography as an educational tool and suggest future applications for this important technology. Novel applications of fundus photography as an educational tool have the potential to resurrect the dying art of funduscopy.

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Validity of direct ophthalmoscopy skill evaluation with ocular fundus examination simulators

Cited by 18 publications

References 14 publications

Does access to a portable ophthalmoscope improve skill acquisition in direct ophthalmoscopy? A method comparison study in undergraduate medical education

Does access to a portable ophthalmoscope improve skill acquisition in direct ophthalmoscopy? A method comparison study in undergraduate medical education

A systematic review of simulation-based training tools for technical and non-technical skills in ophthalmology

Ocular Fundus Photography as an Educational Tool

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