MedEdPORTAL (Apr 2008)
The Disc Mantra: An Algorithm for Fundus Description
Abstract
Abstract Introduction Students and non-ophthalmologists are intimidated by the use of the ophthalmoscope to view and describe the fundus. Ophthalmoscopy has a steep learning curve, and its practices have been marginalized due to several barriers including frustration because of the intimidating nature of the instrument, lack of availability of equipment because of expense and low priority, and lack of a systematic approach to describing the fundus. The fundus has much to add to physical diagnosis and management in general medical practice, particularly in decision-making involving allocation of other testing modalities, which are expensive and difficult to schedule expeditiously. Methods The purpose of this instruction manual is to discuss the features of different types of viewing instruments, provide hints on obtaining a view, and provide a systematic way to describe structures (both normal and abnormal) in the fundus viewed through an ophthalmoscope, while applying best practices of general medicine. A PowerPoint presentation and a poster are used to present learners with this information. Results Effectiveness of skill transfer has been established over 5 years of conducting workshops at the UC-Irvine School of Medicine, and multiple CME courses at Long Beach Memorial Medical Center, the University of Southern California, and the American College of Physicians. Concrete results have been collected from data collected over 3 years in simulator testing as an interstation exercise in the California Consortium for the Assessment of Clinical Competence's clinical skills examination, and presented by the authors at the 2006 AAMC Research in Medical Education conference. This poster is included as part of the resource. Discussion Ophthalmoscopic skills must be consistently practiced and reinforced for technique to be refined and for diagnostic experience to accrue. This resource provides an overview of viewing instruments, methods on how to obtain appropriate views, and techniques to describe these structures to allow for the development and refinement of these skills.
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