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Diagnostic accuracy of ophthalmology residents in emergency department consultations: trends and potential
Rachel Shemesh1,2, Mai Mizrachy1,2, Mattan Arazi3
1Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv, Israel.
Background:
Several studies analyzed the diagnostic accuracy of residents in various specialties with the aim of highlighting the risk of medical errors made by residents, but there are currently no publications on medical error-related studies throughout the years of training of ophthalmology residents. This study aims to evaluate the diagnostic accuracy of ophthalmology residents in an emergency department (ED) and identify factors contributing to diagnostic errors. By identifying these factors, we aim to enhance educational programs and improve patient management.
Methods:
A retrospective analysis of consecutive medical records of all patients seen in an emergency department (ED) from December 27, 2022 to March 3, 2023. The diagnostic accuracy of the resident was divided into "agreement" and "disagreement" with the final diagnosis of attending ophthalmologists. Factors that could predict poorer diagnostic accuracy were also examined.
Results:
A total of 305 consultations conducted by residents were evaluated. There was an 82.3% (251 cases) agreement between their diagnosis and that of the attending ophthalmologist. The agreement rate was significantly higher during the weekday (86%) compared to the weekend (74.2%, P = 0.012), and for residents in postgraduate year 3 (PGY-3, 90.5%) and PGY-4 (87.3%) compared to PGY-1 (71.4%) and PGY-2 (80.2%) (P = 0.025). Residents' diagnoses of neuro-ophthalmological cases were less accurate (67.5%) compared to other etiologies (84.8%, P = 0.008) There was no significant difference in diagnostic accuracy based upon the patient's hour of arrival to the ED (P = 0.48).
Conclusions:
The findings of this study may indicate a trend toward better diagnostic accuracy of ophthalmology residents in the OED. Greater inaccuracy was associated with a lack of clinical experience and occurred more in neuro-ophthalmological cases. These results might suggest a need for educational changes to address ophthalmology residents' needs to even further improve diagnostic accuracy.
