传统直接检眼镜与广角直接检眼镜对医学生眼底检查自信心影响的比较：一年随访
Comparison of conventional and wide field direct ophthalmoscopy on medical students' self-confidence for fundus examination: a 1-year follow-up.
作者信息
Ayub Gabriel, Souza Rafael Boava, de Albuquerque Andrelisa Marina, de Vasconcellos José Paulo Cabral
机构信息
Department of Ophthalmology, Faculty of Medical Sciences, University of Campinas, 251 Vital Brazil St, SP, 13083-888, Campinas, Brazil.
出版信息
BMC Med Educ. 2021 Sep 26;21(1):507. doi: 10.1186/s12909-021-02942-y.
BACKGROUND
Fundus examination is an easy, quick and effective way to diagnose sight- and life-threatening diseases. However, medical students and physicians report lack of proficiency and self-confidence in perform fundoscopy. The aim of this study was to compare students' self-confidence in fundus examination, using two different direct ophthalmoscopes, 1 month and 1 year after practical training.
METHODS
In this prospective cohort, medical students (MS) of the same class were divided in small groups for PanOptic (PO) or conventional (CO) direct ophthalmoscope training. The intervention group encompassed MS of the 4th -year (class of 2019), and the control group encompassed MS of year behind (class of 2020). A questionnaire to measure self-confidence in fundoscopy technique assessing optic nerve, cup-to-disc ratio and macula was translated and validated to Portuguese, and applied 1-month and 1-year after practical training.
RESULTS
One-hundred and sixty-seven MS were enrolled (35 PO group, 38 CO group, and 94 control group). PO group had a significantly higher overall self-confidence comparing either control or CO groups, respectively (3.57 ± 0.65 vs. 2.97 ± 1.03 vs. 2.46 ± 0.87, p < 0.01) as well as in evaluate cup-to-disc ratio (3.09 ± 0.75 vs. 2.32 ± 0.87 vs. 1.46 ± 0.81, p < 0.01), optic disc margins (3.26 ± 0.85 vs. 2.71 ± 0.96 vs. 2.01 ± 0.97, p < 0.01) and macula (3.43 ± 1.12 vs. 2.89 ± 1.08 vs. 2.02 ± 0.89, p < 0.01) 1-month after practical training. One-year after intervention, CO group showed a significantly higher score compared to PO group in overall self-confidence (3.31 ± 0.69 vs. 3.18 ± 0.73, p = 0.03) and in optic disc margins assessing (3.16 ± 0.85 vs. 2.95 ± 0.78, p = 0.03), but not significant in the evaluation of cup-to-disc ratio (2.78 ± 0.97 vs. 2.68 ± 0.94, p = 0.08), and macula (3.34 ± 0.79 vs. 3.27 ± 0.98, p = 0.07).
CONCLUSIONS
Students were more confident in use PO as an instrument to perform direct ophthalmoscopy immediately after practical training, but confidence level of CO was higher compared to PO one year after practical training. These findings would help medical schools decide which ophthalmoscope to choose to teach fundus examination.
背景
眼底检查是诊断威胁视力和生命疾病的一种简便、快速且有效的方法。然而，医学生和医生表示在进行眼底镜检查时缺乏熟练度和自信。本研究的目的是比较在实践培训1个月和1年后，使用两种不同直接检眼镜的学生在眼底检查中的自信心。
方法
在这个前瞻性队列研究中，将同班级的医学生（MS）分成小组进行PanOptic（PO）或传统（CO）直接检眼镜培训。干预组包括四年级（2019级）的医学生，对照组包括低一年级（2020级）的医学生。一份用于测量眼底镜检查技术自信心的问卷，该问卷评估视神经、杯盘比和黄斑，已翻译成葡萄牙语并验证，在实践培训1个月和1年后应用。
结果
共纳入167名医学生（35名PO组，38名CO组，94名对照组）。在实践培训1个月后，PO组在总体自信心方面显著高于对照组和CO组（分别为3.57±0.65 vs. 2.97±1.03 vs. 2.46±0.87，p<0.01），在评估杯盘比（3.09±0.75 vs. 2.32±0.87 vs. 1.46±0.81，p<0.01）、视盘边缘（3.26±0.85 vs. 2.71±0.96 vs. 2.01±0.97，p<0.01）和黄斑（3.43±1.12 vs. 2.89±1.08 vs. 2.02±0.89，p<0.01）方面也是如此。干预1年后，CO组在总体自信心（3.31±0.69 vs. 3.18±0.73，p = 0.03）和评估视盘边缘（3.16±0.85 vs. 2.95±0.78，p = 0.03）方面的得分显著高于PO组，但在杯盘比评估（2.78±0.97 vs. 2.68±0.94，p = 0.08）和黄斑评估（3.34±0.79 vs. 3.27±0.98，p = 0.07）方面差异不显著。
结论
学生在实践培训后立即使用PO作为直接检眼镜进行检查时更有信心，但在实践培训1年后，CO组的自信心水平高于PO组。这些发现将有助于医学院校决定选择哪种检眼镜来教授眼底检查。
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