Yusuf Imran H, Ridyard Edward, Fung Timothy H M, Sipkova Zuzana, Patel Chetan K
The Oxford Eye Hospital, John Radcliffe Hospital, Oxford, U.K..
The Oxford Eye Hospital, John Radcliffe Hospital, Oxford, U.K.
Can J Ophthalmol. 2017 Aug;52(4):392-397. doi: 10.1016/j.jcjo.2016.11.027. Epub 2017 Jan 10.
To describe the conception and evaluation of a novel educational intervention to teach direct ophthalmoscopy with retinal simulators using a peer-assessed group objective structured clinical examination (OSCE) format.
Prospective, single-centre educational trial at Oxford University Medical School, Oxford, U.K.
A total of 160 consecutive undergraduate fifth-year medical students participated in the study.
Students identified prior experience, teaching, examination, and feedback relevant to direct ophthalmoscopy. Students self-evaluated their perceived confidence across 6 domains of direct ophthalmoscopy examination before and after the educational intervention using a Likert-type psychometric scale. Wilcoxon matched pair testing was used to determine statistical significance for each domain.
The group OSCE intervention increased confidence in direct ophthalmoscopy overall from 2.5% to 63.8% (p < 0.001). Confidence improved in all 6 domains, most significantly in controls of ophthalmoscope (p < 0.001) and sequence of examination (p < 0.001) but also in the identification and interpretation of retinal signs (p < 0.001). Students rated the tutorial as very effective or effective across all 6 domains, and 96.29% rated the tutorial as effective overall.
Retinal simulation, integrated with a peer-assessed group OSCE format, is effective in increasing confidence in all aspects of direct ophthalmoscopy. It may be insufficient alone for training in the identification and interpretation of posterior segment clinical signs. Diminishing ophthalmology clerkships worldwide require ophthalmologists to identify innovative teaching methods, using modern technology and pedagogy to deliver high-quality, yet high-throughput, training in direct ophthalmoscopy. This novel teaching strategy may be considered by ophthalmologists responsible for direct ophthalmoscopy training in a teaching hospital context.
描述一种新型教育干预措施的概念和评估，该措施使用同伴评估的小组客观结构化临床考试（OSCE）形式，通过视网膜模拟器教授直接检眼镜检查法。
在英国牛津大学医学院进行的前瞻性单中心教育试验。
共有160名连续的本科五年级医学生参与了该研究。
学生们确定了与直接检眼镜检查相关的既往经验、教学、考试和反馈。学生们在教育干预前后，使用李克特式心理量表对直接检眼镜检查的6个领域的自我感知信心进行了自我评估。采用威尔科克森配对检验来确定每个领域的统计学意义。
小组OSCE干预使直接检眼镜检查的总体信心从2.5%提高到63.8%（p<0.001）。所有6个领域的信心均有所提高，在检眼镜控制（p<0.001）和检查顺序（p<0.001）方面提高最为显著，但在视网膜体征的识别和解读方面也有所提高（p<0.001）。学生们对该辅导课程在所有6个领域的评价为非常有效或有效，96.29%的学生对该辅导课程的总体评价为有效。
视网膜模拟与同伴评估的小组OSCE形式相结合，可有效提高直接检眼镜检查各方面的信心。对于后段临床体征的识别和解读培训，仅靠它可能还不够。全球范围内眼科实习机会的减少，要求眼科医生采用现代技术和教学方法，确定创新的教学方法，以提供高质量且高通量的直接检眼镜检查培训。负责教学医院直接检眼镜检查培训的眼科医生可考虑这种新型教学策略。
