Constant training in direct ophthalmoscopy

Abstract

Helen-Cara Younan, Rishi Iyer, Janaki Natasha DesaiFaculty of Medicine, Imperial College London, London, UKWe read with great interest the review by Ricci and Ferraz on the advances in training and practice in ophthalmoscopy simulation.1As final year medical students, we have recently experienced direct ophthalmoscopy teaching and agree with the authors that “simulation is a helpful tool in ophthalmoscopy training”.1 Indeed, in our experience, simulation is useful in teaching a wide variety of clinical skills including venepuncture, intravenous cannulation, and catheterization. We were taught all of these clinical skills in our first clinical year of study through use of simulation models. With regards to our direct ophthalmoscopy teaching, we were first taught to recognize the normal retina and different retinal pathologies using images, before practicing our technique and recognition of those images in a model similar to the THELMA (The Human Eye Learning Model Assistant) described by the authors.1However, we feel that the use of simulation models alone is not enough to provide confidence and competency in direct ophthalmoscopy among medical students. The authors conclude that “constant training is a well-known strategy for skill enhancement”,1 and we have found that a lack of constant training in direct ophthalmoscopy is evident. After learning venepuncture, cannulation, and catheterization on the simulation models, we were able to observe doctors performing these skills before performing them on patients either in the wards or in theatre. These are skills that we are constantly trained in across a wide variety of medical and surgical attachments. However, opportunities to observe and practice ophthalmoscopy during our attachments are more limited, and thus we are not continuing to use the skills we learn.Authors' replyLucas Holderegger Ricci,1 Caroline Amaral Ferraz21Department of Ophthalmology, School of Medicine, Laureate International Universities, São Paulo, Brazil; 2Department of Ophthalmology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil We are delighted to see that our review on ophthalmoscopy simulation prompted a new discussion about the need for practice on real patients. As presented in our review, simulated training should be implemented with criteria as it can override patient safety protocols and individual comfort. Further, ophthalmoscopy remains an individual exam, since it is difficult for an outsider to evaluate examiner’s techniques, field position, and correct anatomic identification. Although we mention new devices that allow simultaneous external evaluation, these seem to be not yet widely available.Read the original paper by Ricci and Ferraz

Keywords

• Simulation training Ophthalmoscopy Constant training