Re-imagining Ophthalmic Teaching and Education in Medical Programs: The ROTE Study

Undergraduate ophthalmic teaching has been subject to a global decline as ophthalmology competes for space in an increasingly crowded medical curriculum. Rather than focusing solely on increasing teaching time, strategies are needed to optimise the use of existing time by ensuring that teaching is engaging and effectively improving students' knowledge and confidence in ophthalmic skills. While the literature is rich with innovative teaching approaches for ophthalmology, the vast majority of these studies have been quantitative. This study seeks to fill this gap with a qualitative exploration of student perspectives and ideas for their own learning.  Methods: A mixed-method approach was used to evaluate perspectives, preferences, and ideas regarding ophthalmology teaching among senior medical students and recent graduates of the University of New South Wales, Australia. A quantitative questionnaire was used to assess participant ratings of teaching methods, while one-on-one semi-structured qualitative interviews and thematic analysis were employed to facilitate a richer exploration of participant perspectives.  Results: Quantitative data (n = 46) found that most participants (80%) received very little ophthalmology teaching time, and its effectiveness was considered poor by 57%. The two teaching methods considered least effective (didactic lectures and self-directed learning) were simultaneously the most common modes of teaching. Four themes (and 12 subthemes) emerged from the qualitative interviews (n = 12): a reason to learn, prioritising fundamentals, optimising existing learning opportunities, and re-imagining ophthalmic teaching.

The participants emphasised clinical relevance as a driver of learning in their approach to ophthalmic content, in alignment with adult learning theory (ALT). The participants perceived current ophthalmology teaching as insufficiently clinical, poorly structured, and inadequately integrated. They craved hands-on teaching and clinical exposure to spark their curiosity and intrinsic motivation to learn. A blended learning approach employing well-structured lectures and online modules with self-assessments, hands-on teaching in clinical settings, and competency-based assessments would represent students' and graduates' ideal re-imagining of the ophthalmic curriculum.