Pelletier Jessica, Facciani John, Gines Francesca, Kuehl Damon
Virginia Tech Carilion School of Medicine, Carilion Clinic, Department of Emergency Medicine, Roanoke, VA.
Vistar Eye Center Vision and Surgery Specialists, Roanoke, USA.
J Educ Teach Emerg Med. 2022 Oct 15;7(4):SG1-SG14. doi: 10.21980/J86H0M. eCollection 2022 Oct.
This tutorial should be utilized for emergency medicine (EM) interns and junior residents.
Ophthalmology is characteristically a weak area in both medical school and resident education. Medical students are rarely given formal didactic education on the use of the slit lamp or a systematic approach to examining the eye. For EM residents, this leads to inefficient and uncomfortable encounters with patients with eye complaints. We sought to develop a comprehensive emergency ophthalmology tutorial utilizing asynchronous learning followed by a hands-on skill session that would address this need.
By the end of this small group didactic, learners will be able to: 1) demonstrate ability to focus on the various components of the slit lamp exam 2) demonstrate understanding of a systematic approach to the eye exam 3) demonstrate appropriate use of the Diaton, iCare, and Tonopen tonometers.
This two-hour small group didactic combines hands-on learning sessions to learn the slit lamp exam and tonometry measurement, with a systematic review of the eye exam to help learners better organize their exams and understand the use of necessary tools.
The emergency ophthalmology tutorial was initially designed as an education project in which we collected pre- and post-participation surveys regarding resident comfort with various components of the emergency eye exam. After the course residents received a post-course survey to complete. Given the positive feedback we received from our residents regarding the tutorial, we applied for Institutional Review Board (IRB) approval to publish our retrospective survey data. Our IRB waived the need for participant consent.
Twelve emergency medicine residents including 11 interns and one post-graduate year (PGY) 2 resident participated in the emergency ophthalmology tutorial as part of our intern boot camp in July of 2021. Twelve PGY-1 residents initially signed up for the course and filled out the pre-participation survey but one of them was not able to attend their scheduled class, so a PGY-2 resident requested to attend.Prior to the course, we used a Likert scale from 1-7, finding that 61.5% (8/13) of participants felt very uncomfortable with performing slit lamp exams, 84.6% (11/13) felt very uncomfortable with using the Diaton tonometer, 76.9% (10/13) felt very uncomfortable with using the iCare tonometer, and 69.3% (9/13) felt uncomfortable or very uncomfortable with using a systematic approach to examining the eye. After the course, 75% (9/12) of participants felt that the course exceeded expectations in ensuring their ability to perform the subcomponents of the slit lamp exam, 75% (9/12) and 83.3% (10/12) of participants felt that the course exceeded expectations in ensuring their ability to use the Diaton and iCare tonometers, respectively, and 91.7% (11/12) felt that the course exceeded expectations in ensuring their ability to perform a systematic eye exam.
Participation in a 2-hour emergency ophthalmology tutorial with assigned asynchronous pre-course work improved emergency medicine resident comfort with various components of the eye exam.
Emergency ophthalmology, eye exam, slit lamp, tonometry.
本教程适用于急诊医学（EM）实习生和低年资住院医师。
眼科学在医学院校教育和住院医师培训中向来是薄弱环节。医学生很少接受关于裂隙灯使用或眼部系统检查方法的正规理论教育。对于急诊医学住院医师而言，这导致他们在接诊眼部不适患者时效率低下且体验不佳。我们试图开发一个全面的急诊眼科学教程，采用异步学习方式，随后进行实践技能培训，以满足这一需求。
在本次小组理论教学结束时，学习者将能够：1）展示聚焦裂隙灯检查各个组成部分的能力；2）展示对眼部系统检查方法的理解；3）展示正确使用Diaton眼压计、iCare眼压计和Tonopen眼压计的能力。
这个两小时的小组理论教学结合了实践学习环节，用于学习裂隙灯检查和眼压测量，并对眼部检查进行系统回顾，以帮助学习者更好地组织检查并理解必要工具的使用。
急诊眼科学教程最初作为一个教育项目设计，我们收集了参与教程前后关于住院医师对急诊眼部检查各个组成部分舒适度的调查问卷。课程结束后，住院医师收到一份课程后调查问卷以完成。鉴于我们从住院医师那里收到的关于该教程的积极反馈，我们申请了机构审查委员会（IRB）批准以公布我们的回顾性调查数据。我们的IRB免除了参与者同意的要求。
2021年7月，包括11名实习生和1名二年级住院医师在内的12名急诊医学住院医师参加了急诊眼科学教程，作为我们实习生集训营的一部分。12名一年级住院医师最初报名参加该课程并填写了参与前调查问卷，但其中1人未能参加预定课程，因此一名二年级住院医师请求参加。在课程之前，我们使用1 - 7的李克特量表，发现61.5%（8/13）的参与者对进行裂隙灯检查感到非常不舒服，84.6%（11/13）对使用Diaton眼压计感到非常不舒服，76.9%（10/13）对使用iCare眼压计感到非常不舒服，69.3%（9/13）对使用系统方法检查眼睛感到不舒服或非常不舒服。课程结束后，75%（9/12）的参与者认为该课程在确保他们进行裂隙灯检查子组件的能力方面超出预期，75%（9/12）和83.3%（10/12）的参与者分别认为该课程在确保他们使用Diaton和iCare眼压计的能力方面超出预期，91.7%（11/12）的参与者认为该课程在确保他们进行系统眼部检查的能力方面超出预期。
参与一个配有课前异步作业的两小时急诊眼科学教程提高了急诊医学住院医师对眼部检查各个组成部分的舒适度。
急诊眼科学、眼部检查、裂隙灯、眼压测量。
