A new teaching method of direct fundoscopy for daily clinical practice

Direct Fundoscopy (DF) is a vital clinical skill used in ophthalmology, neurology, and emergency care. Despite its importance, many medical students graduate without mastering DF, often due to limited practical training and insufficient understanding of ophthalmoscope use. This study proposes a teaching methodology, incorporating theoretical instruction, ophthalmoscope practice, and peer-to-peer simulated examinations in small groups, to enhance students' understanding of direct ophthalmoscopy and improve their ability to apply this knowledge in clinical settings. The aim of this study is to describe an effective methodology for teaching DF, fostering the development of confident and competent future physicians capable of performing this essential examination.

Medical students, divided into groups of five, participated in a supervised DF training period that included both theoretical and practical components. The instruction covered ophthalmoscope operation, proper positioning relative to the patient, and techniques for visualization of the posterior pole of the eye. Students first practiced the complete examination procedure using a poster, followed by peer-to-peer examinations to build confidence. Questionnaires were administered before and after the training to assess students' competence in performing direct fundoscopy.

Following the training, the percentage of students able to visualize any structure of the eye fundus significantly increased from 68.5% to 98.6% (p < 0.0001). Similarly, significant improvements were observed in the visualization of all major retinal structures (p < 0.0001), with the exception of the fovea (p = 0.62). Students also reported a marked increase in their confidence in performing the examination.

The implementation of a standardized teaching methodology was associated with improvement in skills for performing DF when applied to medical students previosly naive to the method.