Structured simulation-based training with frugal ophthalmic instruments rapidly equips non-ophthalmologists to identify malarial retinopathy in simulation eyes: an audit of a training course

Abstract Background Malaria, particularly cerebral malaria, poses a significant health threat, especially for children in sub-Saharan Africa. Identification of malarial retinopathy (MR) has diagnostic value in cerebral malaria but can be impractical due to lack of availability of trained and equipped ophthalmic specialists. Recent developments in low-cost simulation tools and ophthalmoscopes offer the potential to train non-ophthalmologists to offer fundus assessments in low-resource settings. Methods Twenty non-ophthalmologist healthcare providers in Malawi attended a training program focused on identification of MR using direct and binocular indirect ophthalmoscopy. The curriculum included didactic sessions, hands-on practice with simulation eyes, and assessment of skill acquisition with immediate feedback. Pre- and post-training confidence surveys were conducted. Results Participants demonstrated significant improvement in identification of malarial retinopathy in simulation eyes after completing the training, with a mean accuracy of 83%. Clinician confidence levels increased across all domains of retinal examination covered in the course. Conclusions Structured simulation-based training using frugal ophthalmoscopes can equip non-ophthalmologists with skills to identify MR in simulation eyes. Future work should focus on long-term skill retention and validation in a real-world clinical setting.