Do Checklist-Induced Behavioral Changes Improve Self-Confidence in Fundoscopic Examination? A Mixed-Methods Study

Area of Science:

• Ophthalmology
• Internal Medicine
• Medical Education

Background:

• Fundoscopic exams are vital for diagnosing intracranial diseases and chronic condition complications during outpatient visits.
• Physician confidence in performing fundoscopic exams is often low, leading to infrequent implementation.

Purpose of the Study:

• To evaluate the effectiveness of a checklist intervention in increasing the implementation rate and physician confidence in performing fundoscopic exams.
• To explore qualitative factors influencing physician confidence and exam performance.

Main Methods:

• A mixed-methods study using a before-and-after design with 15 general medicine physicians at a university hospital.
• Implementation ratio and Visual Analog Scale (VAS) for confidence were measured pre- and post-intervention.
• Qualitative data were gathered through interviews analyzed using the Modified Grounded Theory Approach.

Main Results:

• The implementation ratio of fundoscopic exams increased significantly from 19.2% to 64.8% (p<0.001).
• Physician confidence, measured by VAS, significantly improved from 1.89 mm to 4.68 mm (p<0.001).
• The checklist helped reduce forgetting and lack of confidence, while repeated successful experiences built confidence.

Conclusions:

• The checklist intervention successfully increased both the implementation of fundoscopic exams and physician confidence.
• Enhanced confidence and successful experiences motivated physicians to perform fundoscopic exams more frequently.