Chahal Noor, Lee Maria, Eng Emily, Huynh-Tran Thanh-Liem, Lee Jenny Ji-Hyun, Rasool Nailyn, Terrelonge Mark, Bonelli Laura, Onclinx Tania, Jiang Alice, Yung Madeline
Department of Ophthalmology, University of California, San Francisco.
Department of Optometry, University of California, San Francisco.
Neurol Educ. 2025 Sep 5;4(3):e200242. doi: 10.1212/NE9.0000000000200242. eCollection 2025 Sep.
Direct ophthalmoscopy (DO) is a core diagnostic skill for neurology residents. Although the importance of DO is accepted among neurology faculty and residents, proficiency in DO has declined because of limited training opportunities. The objectives of this study were to (1) provide neurology residents with supervised and unsupervised DO practice, (2) improve their competency and confidence in performing DO, and (3) develop a curriculum model adaptable to residencies with limited neuro-ophthalmology exposure.
A longitudinal, practice-based optometry or ophthalmology elective was implemented at 2 neurology residency programs, guided by Kern's 6-step approach to curriculum development. The rotation included both supervised and graduated independent practice. Residents completed anonymized pre-rotation and post-rotation questionnaires measuring confidence in performing DO and underwent objective skills assessments to measure competence in DO.
A total of 13 neurology residents in postgraduate years 2-4 participated in the elective for an average of 4.8 half-days per resident over the course of the academic year. Residents demonstrated a significant increase in the number of ocular examinations performed by the end of the rotation. On completion of the elective, residents reported a mean increase in confidence (Likert scale 1-5) in focusing on the retina (+2.0 [95% CI 1.3-2.7], = 0.005), finding the optic disc (+1.7 [0.9-2.6], = 0.013), finding retinal blood vessels (+1.8 [1.1-2.5], = 0.008), and recognizing optic disc pathology (+1.4 [0.7-2.1], = 0.013). Mean DO objective assessment scores improved by 46.6% [27.8%-64.7%] ( = 0.006). Residents who performed 50 or more undilated DO examinations and those who were confident in finding the optic disc were more likely to incorporate DO into their clinical practice.
Integrating an optometry or ophthalmology rotation into neurology residencies enhanced both subjective confidence and objective competence in DO, underscoring the importance of deliberate, structured practice in mastering diagnostic examination skills. Incorporation of self-regulated learning techniques and user-friendly technology may further enhance curricular efficacy. These findings demonstrate the feasibility of adopting this curriculum across various residency programs, particularly those that recognize the value of fundoscopic examination but lack adequate training opportunities.
直接检眼镜检查（DO）是神经科住院医师的一项核心诊断技能。尽管神经科教员和住院医师都认可DO的重要性，但由于培训机会有限，DO的熟练程度有所下降。本研究的目的是：（1）为神经科住院医师提供有监督和无监督的DO实践；（2）提高他们进行DO的能力和信心；（3）开发一种适用于神经眼科接触有限的住院医师培训项目的课程模式。
在2个神经科住院医师培训项目中实施了一项基于实践的纵向验光或眼科选修课程，以克恩的课程开发6步法为指导。轮转包括有监督的和逐步递增的独立实践。住院医师完成了匿名的轮转前和轮转后问卷，以评估他们进行DO的信心，并接受客观技能评估以衡量DO的能力。
共有13名2至4年级的神经科住院医师参加了该选修课程，在学年期间每位住院医师平均参加了4.8个半天的课程。住院医师在轮转结束时进行的眼部检查数量显著增加。选修课程结束后，住院医师报告在聚焦视网膜（+2.0 [95%可信区间1.3 - 2.7]，P = 0.005）、找到视盘（+1.7 [0.9 - 2.6]，P = 0.013）、找到视网膜血管（+1.8 [1.1 - 2.5]，P = 0.008）以及识别视盘病变（+1.4 [0.7 - 2.1]，P = 0.013）方面的信心平均增加。DO客观评估平均得分提高了46.6% [27.8% - 64.7%]（P = 0.006）。进行了50次或更多次未散瞳DO检查的住院医师以及对找到视盘有信心的住院医师更有可能将DO纳入他们的临床实践。
将验光或眼科轮转纳入神经科住院医师培训提高了DO方面的主观信心和客观能力，强调了在掌握诊断检查技能方面进行有计划、结构化实践的重要性。纳入自我调节学习技术和用户友好型技术可能会进一步提高课程效果。这些发现表明在各种住院医师培训项目中采用该课程的可行性，特别是那些认识到眼底检查价值但缺乏足够培训机会的项目。
