Rajagopal Alaina Brinley, Slader Mark Joseph, Osborn Megan Boysen
University of California, Irvine, Department of Emergency Medicine, Orange, CA.
J Educ Teach Emerg Med. 2020 Jul 15;5(3):T42-T62. doi: 10.21980/J8GS8W. eCollection 2020 Jul.
Residents and medical students.
The eye is a critical, but often neglected, part of medical learning. This team-based learning (TBL) module was developed for emergency medicine residents and medical students; however, is applicable to any learner who should know basic eye anatomy and pathology. Emergency medicine teams, primary care providers, and ophthalmologists are most likely to encounter ocular emergencies.1-3 These emergencies are uncommon but quite dire when they occur and can result in permanent disability and life-changing morbidity.2, 4 It is critical that medical practitioners who are exposed to these types of emergencies are well prepared to evaluate and treat them.To fully understand how pathology affects the eye, it is critical that learners understand the anatomy and physiology of the eye.5, 6 Many diagnoses are associated with specific parts of ocular anatomy;5, 6 therefore, teaching pathology in an anatomy-based lesson will help learners understand the physiology. This lesson teaches learners about physiology and pathology in a systemic, anatomically oriented way.
By the end of this session the participant will be able to:Describe basic anatomy of the eye.Build a basic model of the eye.Identify which diseases are associated with which parts of the eye.Identify the pathophysiology behind diseases of the eye.Name correct treatment for each disease.
The "build your own eye" lesson was taught as a classic team-based learning (cTBL) exercise. The modality of TBL with hands-on construction of an eye allow for social learning, competition and spatial learning related to anatomy. The creation of an eye allows residents to fully understand ocular anatomy which is not as evident when a two-dimensional paper image is used. Some learners need tactical stimuli for better understanding. This aspect of the exercise was focused on using alternative modalities to enhance spatial learning. These concepts are reinforced by the GRAT and IRAT portions of the exercise which tend to multiple choice learners. The fill-in the-blank aspect of the exercise requires recall and research to match the three-dimensional eye parts with pathology.
Learners were given the opportunity to complete an anonymous survey. Verbal feedback was also obtained from learners during the lesson. The survey asked learners questions about the effectiveness and value of the exercise, whether the content was applicable to work in the emergency department, whether this exercise should be kept as a part of the curriculum, and whether there was any practice-changing information. Learners enjoyed the competitive aspects of the exercise and also noted that they felt much more comfortable with ocular anatomy and pathology after the lesson.
Learners felt that the ocular team-based learning module was effective in teaching more about the eye in an atypical way. Some learners felt that an explanation in advance of the eye building aspects of the project may have been helpful so they could have brought supplies from home. Other learners felt that they would not have brought supplies from home; thus no explanation was necessary.
Learners seemed to enjoy the experience. The competitive aspects of the TBL, where the eye models were judged for accuracy, creativity, and appearance as well as the correct answers on the worksheet, seemed to enhance learner enjoyment and engagement. Learners felt that enough time was provided for the exercise. While some learners would have preferred an explanation in advance of the project in order to bring supplies from home, others felt that this was not necessary. Educators should determine what would be preferred by their particular learning group for future implementations.
Eye lid, tear duct, cornea, conjunctiva, pupil, iris, lens, anterior chamber, vitreous body, posterior chamber, retina, macula, choroid, optic disc, optic nerve, retinal artery, retinal vein, blepharitis, hordeolum, chalazion, canaliculus, dacryocystitis, corneal abrasion, corneal ulcer, ultraviolet keratitis, herpes keratitis, astigmatism, bacterial conjunctivitis, viral conjunctivitis, episcleritis, globe rupture, iritis, uveitis, anterior uveitis, posterior uveitis, hypopyon, hyphema, acute angle closure glaucoma, congenital pupillary deformity, coloboma, globe rupture, nevus, essential iris atrophy, cataracts, presbyopia, myopia, hyperopia, traumatic iritis, iridocyclitis, ciliary body melanoma, vitreous degeneration, vitreous hemorrhage, endophthalmitis, macular degeneration, retinal detachment, choroid nevus, choroid detachment, papilledema, optic nerve glioma, optic nerve meningioma, anterior ischemic optic neuropathy, retinal artery occlusion, retinal vein occlusion.
住院医师和医学生。
眼睛是医学学习中一个关键但常被忽视的部分。这个基于团队学习（TBL）的模块是为急诊医学住院医师和医学生开发的；然而，它适用于任何应该了解基本眼部解剖学和病理学的学习者。急诊医学团队、初级保健提供者和眼科医生最有可能遇到眼部紧急情况。1 - 3这些紧急情况并不常见，但一旦发生就相当严重，可能导致永久性残疾和改变生活的发病率。2, 4接触这些类型紧急情况的医学从业者做好评估和治疗的准备至关重要。为了充分理解病理学如何影响眼睛，学习者理解眼睛的解剖学和生理学至关重要。5, 6许多诊断与眼部解剖学的特定部位相关；5, 6因此，在基于解剖学的课程中教授病理学将有助于学习者理解生理学。本课程以系统的、基于解剖学的方式教授学习者生理学和病理学。
在本课程结束时，参与者将能够：描述眼睛的基本解剖结构。构建眼睛的基本模型。确定哪些疾病与眼睛的哪些部位相关。识别眼部疾病背后的病理生理学。说出每种疾病的正确治疗方法。
“构建自己的眼睛”课程作为经典的基于团队学习（cTBL）练习进行教授。通过动手构建眼睛的TBL模式允许进行社会学习、竞争以及与解剖学相关的空间学习。构建眼睛使住院医师能够充分理解眼部解剖结构，而使用二维纸质图像时这并不那么明显。一些学习者需要触觉刺激来更好地理解。练习的这一方面侧重于使用替代方式来增强空间学习。练习的GRAT和IRAT部分通过多项选择题强化这些概念。练习的填空部分需要回忆和研究以将三维眼部结构与病理学相匹配。
学习者有机会完成一份匿名调查问卷。在课程期间也从学习者那里获得了口头反馈。调查问卷询问学习者关于练习的有效性和价值、内容是否适用于急诊科工作、此练习是否应作为课程的一部分保留以及是否有任何改变实践的信息。学习者喜欢练习中的竞争方面，并且还指出在课程结束后他们对眼部解剖学和病理学感觉更加熟悉。
学习者认为基于团队学习的眼部模块以非传统方式有效地教授了更多关于眼睛的知识。一些学习者认为在项目的眼睛构建方面提前进行解释可能会有所帮助，这样他们就可以从家里带材料。其他学习者认为他们不会从家里带材料；因此无需解释。
学习者似乎喜欢这次经历。TBL的竞争方面，即根据眼睛模型的准确性、创造性和外观以及工作表上的正确答案进行评判，似乎增强了学习者的乐趣和参与度。学习者认为为练习提供了足够的时间。虽然一些学习者希望在项目之前进行解释以便从家里带材料，但其他人认为这没有必要。教育工作者应确定他们特定的学习群体在未来实施中更喜欢什么。
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