title: Validity of direct ophthalmoscopy skill evaluation with ocular fundus examination simulators.
abstract: OBJECTIVE
  We examined how direct ophthalmoscopy (DO) skills can be evaluated in a clinical setting using a simulator, and determined the appropriate assessment criteria for the DO skills in practical tests such as the Objective Structured Clinical Examination (OSCE).
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Medical students, residents, and attending physicians (73 total participants).
  
  
  METHODS
  We selected the following 3 factors that may indicate the ability to perform nonmydriatic direct funduscopy: (i) experience: total number of cases examined (without mydriasis); (ii) frequency: number of cases examined during the previous month; and (iii) range: viewable fundus field range. We used a fundus simulator with 3-level adjustable pupil sizes (2, 3.5, and 5 mm) and created original test slides for use in the simulator. We counted the number of correct answers of each participant for each pupil size using the simulator and test slides.
  
  
  RESULTS
  There were significant differences in the median number of correct answers for pupil diameters of 2 (p = 0.008) and 3.5 mm (p = 0.007) among groups divided according to the total number of cases examined (without mydriasis). There were no significant differences among groups divided according to the viewable fundus field range (2 mm: p = 0.103, 3.5 mm: p = 0.083, 5 mm: p = 0.347).
  
  
  CONCLUSIONS
  The results suggest a possible relation between the surrogate indicators "experience" and "range" and DO skills using a fundus simulator. The surrogate indicator experience showed a strong relation to DO skills using a fundus simulator.
authors.affiliation: Department of Medical Education, Tokyo Medical University, Tokyo; Department of Primary Care and General Medicine, Tokyo Medical University, Tokyo.
authors.forename: Yu
authors.initials: Y
authors.lastname: Akaishi
authors.affiliation: Department of Medical Education, Tokyo Medical University, Tokyo; Department of Primary Care and General Medicine, Tokyo Medical University, Tokyo; Centre for Medical Education, Graduate School of Medicine, Hokkaido University, Sapporo. Electronic address: jo-tky@umin.ac.jp.
authors.forename: Junji
authors.initials: J
authors.lastname: Otaki
authors.affiliation: Centre for Clinical Epidemiology, St. Luke's Life Science Institute, Tokyo, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Takahashi
authors.affiliation: Department of Medical Education, Tokyo Medical University, Tokyo.
authors.forename: Raoul
authors.initials: R
authors.lastname: Breugelmans
authors.affiliation: Department of Primary Care and General Medicine, Tokyo Medical University, Tokyo.
authors.forename: Kimiko
authors.initials: K
authors.lastname: Kojima
authors.affiliation: Department of Medical Education, Tokyo Medical University, Tokyo.
authors.forename: Masayasu
authors.initials: M
authors.lastname: Seki
authors.affiliation: Department of Medical Education, Tokyo Medical University, Tokyo.
authors.forename: Takayuki
authors.initials: T
authors.lastname: Komoda
authors.affiliation: Department of Medical Education, Tokyo Medical University, Tokyo.
authors.forename: Shizuko
authors.initials: S
authors.lastname: Nagata-Kobayashi
authors.affiliation: Department of Medical Education, Tokyo Medical University, Tokyo.
authors.forename: Miki
authors.initials: M
authors.lastname: Izumi
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000592:standards*; D003198:Computer Simulation; D003430:Cross-Sectional Studies; D004521:Educational Measurement / Q000379:methods; D005260:Female; D005654:Fundus Oculi; D058005:General Practitioners; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D009885:Ophthalmology / Q000193:education*; D009887:Ophthalmoscopy / Q000592:standards*; D016544:Patient Simulation; D010808:Physical Examination / Q000592:standards*; D011680:Pupil / Q000502:physiology; D013337:Students, Medical; D011795:Surveys and Questionnaires; D055815:Young Adult