Objective:

To evaluate the role of a multimodal funduscopic examination workshop in improving resident funduscopic examination confidence.  

Background:

The funduscopic examination is an accessible non-invasive diagnostic tool for identifying critical CNS disorders. However, non-ophthalmology trainees often defer this examination because of technical challenges in performing non-dilated ophthalmoscopic evaluations and/or lack of confidence in funduscopic examination skills. This study evaluates the impact of a dedicated funduscopic examination workshop in a series of neuro-ophthalmology workshops.  

Design/Methods:

This is a single-center, mixed methods, quantitative-qualitative (convergent parallel design) survey-based study evaluating neurology resident responsiveness to a combined didactic and simulation-based neuro-ophthalmology/funduscopic examination workshop, developed using feedback from a pilot workshop established one year prior. A survey with Likert scales (1=strongly agree, 5=strongly disagree) and open-ended questions was administered pre- and post-workshop. 

Results:

Nine adult neurology residents (median training-year 3 [range 2-4]) participated in a 1-hour funduscopy workshop and a 1-hour basic neuro-ophthalmology examination workshop the day prior. Using pre-workshop surveys, residents reported an inadequate amount of formal funduscopic training during medical school and residency (median score 4 [range 3-5] and 4 [range 2-4] respectively). They were least confident in identifying retinal vessel abnormalities and disc edema (median score 4 [range 3-5] and 4 [range 2-4] respectively). Post-workshop surveys revealed a significant increase (p<0.05) in confidence in identifying disc edema, vessel abnormalities, and in overall funduscopic examination skills. Residents most appreciated simulation-based learning by practicing a non-dilated examination on fellow residents and on pathology-displaying Eye Examination Simulators. Residents requested increased workshop frequency, up to twice per quarter. 

Conclusions:

A combined didactic and simulation-based funduscopic examination workshop may improve resident funduscopic examination confidence, particularly in an iterative educational environment modified yearly based on trainee feedback. These findings also highlight learners' desires for simulation-based learning in the medical trainee curriculum. Their utility can continue to be assessed using this study design.