Using Self-assessments to Measure the Impact of Neuro-ophthalmology Rotation on Critical Neuro-ophthalmology Skill Development in a Neurology Residency Program
Objective:
Evaluate the impact of neuro-ophthalmology rotations on neurology residents' self-assessed proficiency in performing key neuro-ophthalmologic examination skills.
Background:
Developing neuro-ophthalmological skills, such as direct ophthalmoscopy, can be challenging for neurology residents due to limited exposure during their residency training. We conducted a pre-and post-survey of 17 neurology residents (PGY 2-4) over a three-year period, assessing the impact of a neuro-ophthalmology clinic rotation. During this rotation, residents engaged in hands-on practice with patients, receiving guided instruction and individualized feedback. The study evaluated the effect of this experience on the residents' self-assessed competency in performing neuro-ophthalmological examinations.
Design/Methods:
Residents completed self-assessments before and after a neuro-ophthalmology rotation, rating their comfort with nine core competencies, including direct ophthalmoscopy, papilledema grading, RAPD detection, eye movement/diplopia/Maddox rod evaluation, and interpreting OCT and visual fields. Improvements were measured by comparing pre-and post-rotation scores, raw score changes, and percentage improvements. Pearson correlation coefficients assessed the relationship between rotation days and skill improvement.
Results:
Of the 17 participants, most were PGY2 residents (n=9), spending an average of 3.5 days on rotation. Pre-rotation scores averaged 40.7% and improved to 66.9% post-rotation, indicating a 64% increase in score. Direct ophthalmoscopy skills improved by 63%, papilledema grading by 71%, and OCT interpretation by 87%. Strong correlations were noted between days on rotation and skill improvement in papilledema grading (r=0.37) and HVF (r=0.35). Weaker or negative correlations were observed for eye movement (r=-0.10) and cover-uncover tests (r=-0.07), indicating less consistent improvement with additional rotation days. This may be attributed to varying baseline competencies among the cohorts.
Conclusions:
Our findings indicate that residents' self-reported competencies improved after the neuro-ophthalmology rotation. Seven of nine skills showed positive correlations between time spent on rotation and improvement, with varying impact across areas. This highlights the value of incorporating much-needed neuro-ophthalmology rotations into neurology residency programs to learn critical neuro-ophthalmology skills.
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