Schulz Christopher, Hodgkins Peter
Acute Medicine, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, UK.
Clin Teach. 2014 Oct;11(6):431-5. doi: 10.1111/tct.12171.
Fundoscopy is an important component of the neurological examination. Previous studies have shown that students and junior doctors lack confidence in fundoscopy, but to date little is known about possible barriers to the acquisition of confidence in this skill.
A questionnaire was designed to quantify prior experience, and to assess confidence in direct ophthalmoscopy. This was distributed among fourth- and final-year medical students.
Forty-three per cent of final-year students responding (n = 93) were confident in examining a dilated eye by direct ophthalmoscopy, compared with 88 per cent of fourth-year students (n = 116). Of the 209 students, fewer than 40 per cent felt confident identifying papilloedema, diabetic retinopathy or vascular disease. Students that reported more opportunities to practise were significantly more confident in their ability to examine a dilated (p < 0.001) or undilated (p < 0.01) eye, but were not significantly more confident in recognising pathology. Clinical exposure to abnormal pathology was significantly associated with greater levels of confidence in recognising papilloedema (p = 0.001), diabetic retinopathy (p = 0.015) and vascular disease (p = 0.012). Students that reported receiving no assessment or feedback on their technique were significantly less confident in all aspects of fundoscopy.
Final-year medical students lack confidence in their ability to use the direct ophthalmoscope and to recognise pathology. Based on the findings of this study, we have made focused recommendations in order to improve the confidence of graduating doctors in fundoscopy: (1) early formal instruction, with refresher training for final-year students; (2) increasing clinical exposure to abnormal pathology; (3) the provision of assessment and feedback on student technique. Final-year medical students lack confidence in their ability to use the direct opthalmoscope and to recognise pathology.
眼底镜检查是神经科检查的重要组成部分。以往研究表明，医学生和初级医生对眼底镜检查缺乏信心，但迄今为止，对于获得这项技能信心的可能障碍知之甚少。
设计了一份问卷，以量化既往经验，并评估直接检眼镜检查的信心。该问卷在四年级和五年级医学生中发放。
回复的五年级学生（n = 93）中有43%对通过直接检眼镜检查散瞳眼有信心，而四年级学生（n = 116）中这一比例为88%。在209名学生中，不到40%的学生对识别视乳头水肿、糖尿病视网膜病变或血管疾病有信心。报告有更多练习机会的学生对检查散瞳（p < 0.001）或未散瞳（p < 0.01）眼的能力明显更有信心，但在识别病变方面信心增加不显著。临床接触异常病变与对视乳头水肿（p = 0.001）、糖尿病视网膜病变（p = 0.015）和血管疾病（p = 0.012）识别的更高信心水平显著相关。报告未接受过技术评估或反馈的学生在眼底镜检查的各个方面信心明显较低。
五年级医学生对使用直接检眼镜和识别病变的能力缺乏信心。基于本研究结果，我们提出了针对性建议，以提高即将毕业的医生在眼底镜检查方面的信心：（1）早期正规教学，并为五年级学生提供复习培训；（2）增加临床接触异常病变的机会；（3）提供学生技术评估和反馈。五年级医学生对使用直接检眼镜和识别病变的能力缺乏信心。
