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Fundus anomalies: what the pediatrician's eye can't see
Yair Morad1, Yaniv Barkana, Isaac Avni
1Department of Ophthalmology, Assaf Harofeh Medical Center, Sackler School of Medicine, Tel Aviv University, Zerifin 70300, Israel. ymorad@013.net.il
Insights
Pediatricians often neglect funduscopy, but a brief training session significantly improves their ability to detect ocular abnormalities. This study highlights the need for enhanced diagnostic skills in pediatric eye examinations.
Area of Science:
- Ophthalmology
- Pediatrics
- Medical Education
Background:
- Routine funduscopy is declining among hospital doctors due to increasing workloads.
- Pediatricians' current proficiency and frequency of performing funduscopy are not well-documented.
Purpose of the Study:
- To evaluate hospital pediatricians' diagnostic skills for ocular fundus abnormalities.
- To determine the effectiveness of a short tutorial in enhancing these skills.
Main Methods:
- Anonymous questionnaires assessed pediatricians' experience and self-perceived competence in funduscopy.
- A 20-image pictorial quiz evaluated diagnostic accuracy before and after a 45-minute tutorial on fundus anomalies.
Main Results:
- Most participants lacked confidence in performing funduscopy (mean visual analog scale score 1.96).
- Pre-tutorial quiz scores averaged 48%, with no significant difference between residents and senior pediatricians.
- Post-tutorial scores significantly improved to 60% for all participants (P = 0.002).
Conclusions:
- Funduscopy is underutilized by pediatricians.
- Even brief educational interventions can substantially improve diagnostic accuracy in fundus examinations.
Background:
With increasing workloads for hospital doctors, routine funduscopy may be abandoned. It is not known how often pediatricians perform funduscopy and how skilled they are in performing it.
Objective:
To assess hospital pediatricians' ability to diagnose abnormalities of the ocular fundi and to determine whether a short tutorial can improve their skills.
Methods:
Physicians working at the pediatric division of a university-affiliated hospital participated in the study. All participants completed an anonymous questionnaire regarding their experience and skills in performing funduscopy. A pictorial quiz containing 20 fundus pictures of common findings in children was given. After completing the quiz, a 45-minute tutorial on common fundus anomalies was given. At the end of the lecture, the same quiz was given again. The percentage of correct answers for each quiz was scored.
Results:
Sixteen physicians completed the study (11 pediatric residents and five senior pediatricians). Most participants did not feel competent at performing a fundus examination [mean score on a visual analog scale 1.96; range 0 (not competent at all) to 7]. The mean score for the fundus pictures quiz given before the tutorial was 48% (range 37-58%). The average score of the residents (47%) did not differ significantly from that of the senior pediatricians (42%). After the tutorial the mean grade increased significantly to 60% (P = 0.002). This was true both for residents (63%; P = 0.001) and seniors (55%; P = 0.004).
Conclusions:
Our study shows that funduscopy is being neglected by pediatricians. Even a short tutorial may significantly improve the diagnostic value of this test.
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