Factors associated with confidence in fundoscopy

Fundoscopy is an important component of the neurological examination. Previous studies have shown that students and junior doctors lack confidence in fundoscopy, but to date little is known about possible barriers to the acquisition of confidence in this skill.

A questionnaire was designed to quantify prior experience, and to assess confidence in direct ophthalmoscopy. This was distributed among fourth- and final-year medical students.

Forty-three per cent of final-year students responding (n = 93) were confident in examining a dilated eye by direct ophthalmoscopy, compared with 88 per cent of fourth-year students (n = 116). Of the 209 students, fewer than 40 per cent felt confident identifying papilloedema, diabetic retinopathy or vascular disease. Students that reported more opportunities to practise were significantly more confident in their ability to examine a dilated (p < 0.001) or undilated (p < 0.01) eye, but were not significantly more confident in recognising pathology. Clinical exposure to abnormal pathology was significantly associated with greater levels of confidence in recognising papilloedema (p = 0.001), diabetic retinopathy (p = 0.015) and vascular disease (p = 0.012). Students that reported receiving no assessment or feedback on their technique were significantly less confident in all aspects of fundoscopy.

Final-year medical students lack confidence in their ability to use the direct ophthalmoscope and to recognise pathology. Based on the findings of this study, we have made focused recommendations in order to improve the confidence of graduating doctors in fundoscopy: (1) early formal instruction, with refresher training for final-year students; (2) increasing clinical exposure to abnormal pathology; (3) the provision of assessment and feedback on student technique. Final-year medical students lack confidence in their ability to use the direct opthalmoscope and to recognise pathology.