Kohler James, Tran Tu M, Sun Susan, Montezuma Sandra R
Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN, USA.
Clin Ophthalmol. 2021 May 13;15:2013-2023. doi: 10.2147/OPTH.S266123. eCollection 2021.
To assess attitudes of pre-clinical undergraduate medical students toward learning smartphone funduscopy (SF) and its appropriateness as a teaching tool.
Second year medical students received instruction on direct ophthalmoscopy (DO) and SF; they were then paired with a peer and randomly assigned to perform DO or SF first. The SF technique involved freehand alignment of the axes of the smartphone camera with a condenser lens. Both techniques were done through a maximally dilated pupil. A questionnaire was completed to acquire data on baseline experience, performance of both examination techniques, attitudes, and appropriateness. Statistical significance testing and Bland-Altman analysis were used to determine differences between DO and SF, and a multivariable mixed regression model was fitted to identify any predictors for positive attitudes toward DO or SF.
One hundred thirty-seven (137) individuals completed the study. A similar proportion of students could identify the optic nerve, macula, and vessels using DO and SF. However, self-reported quality scores were higher for DO for the optic nerve (p = 0.006) and macula (p = 0.08). The mean (standard deviation) attempts to identify these major structures were 2.7 (SD 2.3) for DO and 4.5 (SD 2.9) for SF (p < 0.001). Attitudes of students were consistently more positive toward DO across the five questions assessed. A small subset of students had equally positive attitudes toward DO and SF. Improved quality scores were predictive of positive attitudes for both DO and SF. Ultimately, 24% of students preferred SF over DO.
Among inexperienced examiners of the fundus through a dilated pupil, SF is a non-inferior technique to DO in identifying structures. Despite overall favorable attitudes towards the more familiar DO, those students who quickly learned the SF technique had similar satisfaction scores. Teaching SF should be considered in undergraduate medical education.
评估临床前本科医学生对学习智能手机眼底镜检查（SF）的态度及其作为教学工具的适用性。
二年级医学生接受直接检眼镜检查（DO）和SF的指导；然后他们与一名同伴配对，并随机分配先进行DO或SF检查。SF技术包括将智能手机摄像头的轴与聚光透镜徒手对齐。两种技术均通过最大散瞳的瞳孔进行。完成一份问卷以获取关于基线经验、两种检查技术的操作情况、态度和适用性的数据。使用统计学显著性检验和Bland-Altman分析来确定DO和SF之间的差异，并拟合多变量混合回归模型以确定对DO或SF持积极态度的任何预测因素。
137名个体完成了研究。使用DO和SF能够识别视神经、黄斑和血管的学生比例相似。然而，视神经（p = 0.006）和黄斑（p = 0.08）的自我报告质量评分DO更高。识别这些主要结构的平均（标准差）尝试次数，DO为2.7（标准差2.3），SF为4.5（标准差2.9）（p < 0.001）。在评估的五个问题中，学生对DO的态度始终更为积极。一小部分学生对DO和SF的态度同样积极。质量评分的提高是对DO和SF持积极态度的预测因素。最终，24%的学生更喜欢SF而不是DO。
在通过散瞳进行眼底检查的无经验检查者中，SF在识别结构方面是一种不劣于DO的技术。尽管对更熟悉的DO总体态度良好，但那些快速学会SF技术的学生的满意度评分相似。本科医学教育中应考虑教授SF。
