Prospective, Randomized Trial Comparing Simulator-based versus Traditional Teaching of Direct Ophthalmoscopy for Medical Students,American Journal of Ophthalmology

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Prospective, Randomized Trial Comparing Simulator-based versus Traditional Teaching of Direct Ophthalmoscopy for Medical Students
American Journal of Ophthalmology ( IF 4.2 ) Pub Date : 2021-11-19 , DOI: 10.1016/j.ajo.2021.11.016
Grant L Howell ₁ , Germán Chávez ₁ , Colin A McCannel ₂ , Peter A Quiros ₃ , Saba Al-Hashimi ₁ , Fei Yu ₄ , Simon Fung ₁ , Christopher M DeGiorgio ₅ , Yue Ming Huang ₆ , Bradley R Straatsma ₁ , Clarence H Braddock ₇ , Gary N Holland ₁

Affiliation

UCLA Stein Eye Institute, David Geffen School of Medicine at UCLA, University of California, Los Angeles; Department of Ophthalmology, David Geffen School of Medicine at UCLA, University of California, Los Angeles.
UCLA Stein Eye Institute, David Geffen School of Medicine at UCLA, University of California, Los Angeles; Department of Ophthalmology, David Geffen School of Medicine at UCLA, University of California, Los Angeles; UCLA Simulation Center, David Geffen School of Medicine at UCLA, University of California, Los Angeles.
Department of Ophthalmology, David Geffen School of Medicine at UCLA, University of California, Los Angeles; Doheny Eye Institute, Pasadena.
UCLA Stein Eye Institute, David Geffen School of Medicine at UCLA, University of California, Los Angeles; Department of Ophthalmology, David Geffen School of Medicine at UCLA, University of California, Los Angeles; Department of Biostatistics, UCLA Jonathan and Karin Fielding School of Public Health, Los Angeles.
Departments of Neurology, Cardiology, and Neurobiology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, California, USA.
UCLA Simulation Center, David Geffen School of Medicine at UCLA, University of California, Los Angeles; Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, California, USA.
Office of the Dean, David Geffen School of Medicine at UCLA, University of California, Los Angeles, California, USA.

Objective

To compare results of simulator-based versus traditional training of medical students in direct ophthalmoscopy.

Design

Randomized controlled trial.

Methods

First-year medical student-volunteers completed 1 hour of didactic instruction regarding direct ophthalmoscopes, fundus anatomy, and signs of disease. Students were randomized to an additional hour of training on a direct ophthalmoscope simulator (n=17) or supervised practice examining classmates (traditional method, n=16). After 1 week of independent student practice using assigned training methods, masked ophthalmologist-observers assessed student ophthalmoscopy skills (technique, efficiency, global performance) during examination of five patient-volunteers, using 5-point Likert scales. Students recorded findings and lesion location for each patient. Two masked ophthalmologists graded answer sheets independently using 3-point scales. Students completed surveys before randomization and after assessments. Training groups were compared for grades, observer- and patient-assigned scores, and survey responses.

Results

The simulator group reported longer practice times than the traditional group (p=0.002). Observers assigned higher technique scores to the simulator group after adjustment for practice time (p=0.034). Combined grades (maximum points=20) were higher for the simulator group (median 5.0, range 0.0-11.0) than for the traditional group (median 4.0, range 0.0-9.0), although the difference was not significant. The simulator group was less likely to mistake the location of a macular scar in one patient (odds ratio 0.28, 95% confidence interval, 0.056-1.35, p=0.013).

Conclusions

Direct ophthalmoscopy is difficult, regardless of training technique, but simulator-based training has apparent advantages, including improved technique, the ability to localize fundus lesions, and a fostering of interest in learning ophthalmoscopy, reflected by increased practice time.

中文翻译：

比较基于模拟器与传统医学生直接检眼镜教学的前瞻性随机试验

客观的

比较在直接检眼镜检查中基于模拟器与传统医学生培训的结果。

设计

随机对照试验。

方法

一年级医学生志愿者完成了 1 小时关于直接检眼镜、眼底解剖和疾病迹象的教学指导。学生被随机分配到直接检眼镜模拟器（n = 17）或监督练习检查同学（传统方法，n = 16）的额外小时培训。在使用指定的培训方法进行为期 1 周的学生独立练习后，蒙面眼科医生观察员在对五名患者志愿者进行检查期间，使用李克特 5 点量表评估了学生的检眼镜技能（技术、效率、整体表现）。学生记录每位患者的发现和病变位置。两名蒙面眼科医生使用 3 点量表独立对答卷进行评分。学生在随机化之前和评估之后完成了调查。比较训练组的成绩，

结果

模拟器组报告的练习时间比传统组长（p=0.002）。在调整练习时间后，观察者将更高的技术分数分配给模拟器组（p=0.034）。模拟器组的综合成绩（最高分=20）（中位数 5.0，范围 0.0-11.0）高于传统组（中位数 4.0，范围 0.0-9.0），尽管差异不显着。模拟器组不太可能误判一名患者的黄斑瘢痕位置（优势比 0.28，95% 置信区间，0.056-1.35，p=0.013）。