Simulator Assessment of Funduscopic Skills in Three Consecutive Medical School Classes
2009, Volume 2, Number 1 1 Introduction Significant longitudinal skills deficiencies in screen-ing eye examination skills performance, particularly in funduscopy, were exposed in a pilot multiple-measures study of a single medical school class [1-2]. In that study, students' funduscopic skills were objec-tively assessed using the CLEO mannequin (Clinical Learning Experience in Ophthalmoscopy), a modifi-cation of a simulator developed for skills teaching by Dodaro and Maxwell [3]. Assessment occurred at the end of the third year of medical school, as an intersta-tion exercise within the required state-wide Clinical Performance Examination (CPX) administered by the California Consortium for the Assessment of Clinical Competence (CCACC). Although a passing grade in the CPX is required in order to graduate from medical school in California, interstation exercises are in-cluded at the discretion of each school, and are not factored into the formal grade. The present study was undertaken to determine whether the funduscopic skills deficiencies found in the pilot study interstation exercise were limited to one particular medical school class, or rather represented a valid general trend among students at the school. Therefore, we followed two additional consecutive classes from that school with simulator assessment CPX interstation exercises and applied the same objective simulator assessment used in our pilot study. Methods In an observational protocol, we studied three succes-sive entire medical school classes at the same Califor-nia public medical school between 2003 and 2005. Simulator Assessment of Funduscopic Skills in Three Consecutive Medical School Classes Linda Mottow-Lippa, MD 1* and John R. Boker, PhD 2 1 Department of Ophthalmology, The Gavin S. Herbert Eye Institute, University of California-Irvine, Irvine, CA 2 Formerly Director of Medical Education Research at University of California-Irvine, is currently Vice President, Aca-demic Affairs, Geisinger Health System, Danville, PA * Corresponding Author & e-mail: llippa@uci.edu Abstract To validate the reproducibility of results from an objective funduscopic simulator assessment used in an entire medical school class, by extending the study to two further class cohorts. In two subsequent medical school classes subject to the same curricular experience, direct funduscopic skills were prospectively assessed using a funduscopy simulator during the required clinical skills examination at the end of the third year. Performance was assessed across all three years. Documented failure of visualization through a dilated pupil was 22% in the first cohort (n=97), and dropped to 2% in cohort 2 (n=87) and 0% in cohort three (n=86). Only 13 % of students in cohort 1 recognized background diabetic reti-nopathy, and 38% in cohort 3. Only 27% of students in cohort 2 who visualized the fundus were able to recognize florid disc edema. Only 45% in cohort 2 were able to identify a fundus as normal.Though erroneous normal diagnoses dropped from 7% to 1% from the first to third cohort, false positives for papilledema in these two cohorts' diabetic case were similar (7% vs. 8%). False positives for the normal disc in the cohort 2 headache case occurred in 19%. Neovascularization was erroneously diagnosed in 10% of cohort 1, and 12% of cohort 3. Funduscopic skills were reproducibly found to be weakStudent awareness of impending objective fundus-copic testing may have influenced their ability (by inducing skills practice)Âor the students' willingness to admit inability to visualize a dilated fundus in the simulator. Chief complaint bias likely influenced the findings documented. Multi-center studies are required and are ongoing to analyze larger student populations in diverse academic settings, to provide robust studies and allow more generalizable conclusions. Accepted for publication September 29, 2008 Revision received January 5, 2009 2009; 2: 1-5. Available via open-access on the web at http://www.academic-ophthalmology.com The author(s) have no personal financial interest in any of the products or technologies cited herein. Â 2009