Validation of the Queen's University Ophthalmoscopy Objective Structured Clinical Examination Checklist to predict direct ophthalmoscopy proficiency.

OBJECTIVE

To validate the Queen's University Ophthalmoscopy Objective Structured Clinical Examination (OSCE) Checklist (QUOOC) by correlating the score derived from this instrument to the ability of a candidate to correctly identify retinal pathology.

DESIGN

Educational Instrument Validation Study.

PARTICIPANTS

Thirteen second-year medical students and 4 ophthalmology residents participated in an OSCE station examining the posterior segment of a series of patients' left eyes with the direct ophthalmoscope.

METHODS

Participants were asked to evaluate the cup-disc ratio, disc margins, and the macula for the presence of pathology. They were also evaluated for proper direct ophthalmoscopy skills. Each participant was assigned a composite clinical proficiency score. Participants' skills were scored using the QUOOC. Based on this evaluation, we correlated clinical proficiency (QUOOC) score to diagnostic accuracy.

RESULTS

QUOOC was completed successfully within a 3-minute time frame that was deemed to be practical given the physical and time constraints of OSCE stations. Significant (P<0.01) differences were noted between medical students and residents with regard to both technique and clinical proficiency. A strong correlation was found between QUOOC score and a participant's ability to correctly detect retinal pathology (r = 0.71; P = 0.001).

CONCLUSIONS

QUOOC was successful in discriminating between more and less experienced and competent participants. Using the QUOOC to evaluate proficiency at direct ophthalmoscopy is a good predictor of correctly detecting retinal pathology when present. We believe that using the QUOOC with standardized patients without physical findings is an accurate and feasible way of measuring students' proficiency in using direct ophthalmoscope in OSCE stations.