Fundoscopy: a reflection upon medical training?

Despite fundoscopy being a key element of any full neurological examination, experience in acute medical admissions units tells us that fundoscopy is rarely, if ever, performed.

We prospectively studied 92 patients presenting to the acute medical admissions unit of Manor Hospital in Walsall, between February and May 2010, with a range of acute medical conditions for which fundoscopy would be clinically relevant. Appropriate areas of Manor Hospital were surveyed to find the number of available and working fundoscopes. A 23-item questionnaire was designed to establish the views of hospital doctors towards fundoscopy, and their competence in the interpretation of diseased fundi.

Of the 92 patients studied, only 17 patients (18%) had a fundoscopy performed as part of their acute medical assessment. Only five working fundoscopes were found in the areas surveyed. Sixty-eight doctors of all training grades were surveyed. Their perceived competency at performing fundoscopy was directly proportional to the responding grade of doctor. The majority of all doctors felt that more training was required.

Fundoscopy is an under-performed examination in the acute medical assessment. There is a need to develop different methods of learning to help trainees maintain basic clinical skills, with potential lying in the development and institution of model eyeballs into clinical skills labs. Doctors may also benefit from teaching with a real patient within a clinical environment. Therefore, we recommend hospitals focus on incorporating bedside teaching into postgraduate training.