Direct Ophthalmoscopy Teaching of Medical Students Based on a Standardised Simulator-based Procedure Versus the Classic Ophthalmoscope

PURPOSE: Direct ophthalmoscopy (DO) teaching in medical curricula may be performed as classical or simulator-based DO. This interventional study evaluated both options. METHODS: 110 medical students received a multiple-choice questionnaire (four theory questions, six fundus photographs) prior to simulator-based (EyeSi Direct, Haag-Streit Simulation, Germany) and classical DO training (Heine BETA200, Heine Optotechnik GmbH, Germany). Training was performed in groups of eight students. Thereafter, they underwent an objective standardised clinical examination containing questions about (1) pupil dilation, (2) mydriasis contraindication, (3) ophthalmoscope adjustment and a practical test checking whether (1) optic nerve head, (2) macula, (3 - 6) upper/lower vessel arcade nasally versus temporally were identified correctly. Subsequently, classic DO was performed mutually and they reported the recognised funduscopic structures. Finally, the questionnaire was repeated one week later in combination with an evaluation of simulator-based versus classic DO. RESULTS: Students improved from an average of 4.0 ± 1.5/10 before to 8.8 ± 1.5/10 correctly answered questions after training (p < 0.0001, Wilcoxon matched-pairs test). 87|34|61 students named pupil dilating time|mydriasis contraindication and adjusted the ophthalmoscope correctly. They successfully identified the optic nerve head (n[simulator]|n[classic] DO: 110|68, p < 0.0001, Fisher's exact test), the macula (93|22, p < 0.0001), the upper (98|75, p = 0.0002) and lower temporal vessel arcade (101|91, p = 0.0672), the upper (84|56, p = 0.0001) and lower nasal vessel arcade (87|48, p < 0.0001). They wished for more simulator-based training, indicated more interest in ophthalmology after training and indicated an improvement in their ophthalmoscopy skills. CONCLUSION: A standardised simulator-based approach improves medical students' skills in ophthalmoscopy and arouses professional interest in ophthalmology.