Program in Liberal Medical Education, Brown University, Providence, RI, USA.
Division of Ophthalmology, Alpert Medical School, Brown University, Providence, RI, USA.
Graefes Arch Clin Exp Ophthalmol. 2023 Oct;261(10):2755-2762. doi: 10.1007/s00417-023-06048-7. Epub 2023 Apr 5.
The published information on virtual supervision (VS) in ophthalmology is not well described. This scoping review describes the evidence and potential role for VS in ophthalmic practice and education.
A literature search strategy was developed in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). We included full-text articles published in an English-language peer-reviewed journal that involved physician-physician or physician-trainee VS in ophthalmology. We excluded studies with direct (in-person) supervision. Two investigators independently extracted from each article the year of publication and study location, design, participant characteristics, sample size, and outcomes. We appraised the methodological quality of the studies using the Mixed Methods Appraisal Tool (MMAT).
Seven articles were included in our qualitative synthesis. Supervisees ranged from physicians such as an ophthalmic surgeon and a general practitioner to medical trainees such as ophthalmology residents, vitreoretinal fellows, and emergency medicine residents. Study settings included emergency departments, operating rooms, eye clinics, and a rural hospital. All studies reported successful transmission of real-time images or videos of clinical examinations and surgical or in-office procedures. Various methods were used to ensure high image and video quality during VS, although some technical challenges remained. MMAT ratings revealed limitations in outcome measurement, statistical analysis, sampling strategy, and inclusion of confounding factors.
Virtual supervision in ophthalmology is technologically feasible and permits synchronous communication and transmission of clinical data, which can be used to formulate diagnostic and management plans and learn new surgical skills. Future studies with larger sample sizes and robust study designs should investigate factors that make VS effective in ophthalmic practice and education.
发表的关于虚拟监督（VS）在眼科中的信息描述得并不完善。本范围综述描述了 VS 在眼科实践和教育中的证据和潜在作用。
按照系统评价和荟萃分析扩展的首选报告项目（PRISMA-ScR）制定文献搜索策略。我们纳入了全文发表在同行评议的英文期刊中，涉及眼科医生-医生或医生-学员 VS 的研究。我们排除了直接（面对面）监督的研究。两名调查员独立从每篇文章中提取出版年份和研究地点、设计、参与者特征、样本量和结果。我们使用混合方法评估工具（MMAT）评估研究的方法学质量。
我们的定性综合纳入了 7 篇文章。受督者范围从眼科医生（如眼科外科医生和全科医生）到医学学员（如眼科住院医师、玻璃体视网膜研究员和急诊医学住院医师）。研究地点包括急诊室、手术室、眼科诊所和农村医院。所有研究均报告了实时临床检查和手术或门诊程序的图像或视频的成功传输。尽管存在一些技术挑战，但各种方法都用于确保 VS 期间的图像和视频质量。MMAT 评分显示在结果测量、统计分析、抽样策略和纳入混杂因素方面存在局限性。
眼科中的虚拟监督在技术上是可行的，并且允许实时沟通和传输临床数据，可用于制定诊断和管理计划以及学习新的手术技能。未来的研究应采用更大的样本量和稳健的设计，以调查使 VS 在眼科实践和教育中有效的因素。
