Curriculum Innovations: Implementation of a Targeted Longitudinal Rotation to Enhance Direct Ophthalmoscopy Learning
Noor Chahal1, Maria Lee1, Emily Eng2
1Department of Ophthalmology, University of California, San Francisco.
Background And Objectives:
Direct ophthalmoscopy (DO) is a core diagnostic skill for neurology residents. Although the importance of DO is accepted among neurology faculty and residents, proficiency in DO has declined because of limited training opportunities. The objectives of this study were to (1) provide neurology residents with supervised and unsupervised DO practice, (2) improve their competency and confidence in performing DO, and (3) develop a curriculum model adaptable to residencies with limited neuro-ophthalmology exposure.
Methods:
A longitudinal, practice-based optometry or ophthalmology elective was implemented at 2 neurology residency programs, guided by Kern's 6-step approach to curriculum development. The rotation included both supervised and graduated independent practice. Residents completed anonymized pre-rotation and post-rotation questionnaires measuring confidence in performing DO and underwent objective skills assessments to measure competence in DO.
Results:
A total of 13 neurology residents in postgraduate years 2-4 participated in the elective for an average of 4.8 half-days per resident over the course of the academic year. Residents demonstrated a significant increase in the number of ocular examinations performed by the end of the rotation. On completion of the elective, residents reported a mean increase in confidence (Likert scale 1-5) in focusing on the retina (+2.0 [95% CI 1.3-2.7], p = 0.005), finding the optic disc (+1.7 [0.9-2.6], p = 0.013), finding retinal blood vessels (+1.8 [1.1-2.5], p = 0.008), and recognizing optic disc pathology (+1.4 [0.7-2.1], p = 0.013). Mean DO objective assessment scores improved by 46.6% [27.8%-64.7%] (p = 0.006). Residents who performed 50 or more undilated DO examinations and those who were confident in finding the optic disc were more likely to incorporate DO into their clinical practice.
Discussion:
Integrating an optometry or ophthalmology rotation into neurology residencies enhanced both subjective confidence and objective competence in DO, underscoring the importance of deliberate, structured practice in mastering diagnostic examination skills. Incorporation of self-regulated learning techniques and user-friendly technology may further enhance curricular efficacy. These findings demonstrate the feasibility of adopting this curriculum across various residency programs, particularly those that recognize the value of fundoscopic examination but lack adequate training opportunities.
