title: Frequency of Direct Funduscopy Upon Initial Encounters for Patients with Headaches, Altered Mental Status, and Visual Changes: A Pilot Study.
abstract: OBJECTIVE
  To determine the performance of direct funduscopy (DF) as part of the initial clinical assessment among different faculty physicians and residents from internal medicine, emergency medicine, and neurology (N).
  
  
  METHODS
  Retrospective study of 163 randomly reviewed charts of patients (>18 years) presenting either to the ED, inpatient units, or outpatient clinics from January 2001 to July 2013, with corresponding ICD-9 codes for headaches, altered mental status, and visual changes.
  
  
  RESULTS
  Although the Neurology Service was the one who performed most DF upon initial evaluation, DF is infrequently done throughout services independent of inpatient or outpatient location. Two thirds of the patients (66%) presenting with visual symptoms had evaluation done by Ophthalmology, which in some instances contributed to the final diagnosis.
  
  
  CONCLUSIONS
  A more robust teaching of DF should be included among the basic clinical competencies during Medical School and Neurology Residency training.
authors.affiliation: Department of Neurology, Stritch School of Medicine, Loyola University Chicago , Maywood, IL , USA.
authors.forename: Esteban
authors.initials: E
authors.lastname: Golombievski
authors.affiliation: Department of Neurology, Stritch School of Medicine, Loyola University Chicago , Maywood, IL , USA.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Doerrler
authors.affiliation: Department of Neurology, Stritch School of Medicine, Loyola University Chicago , Maywood, IL , USA.
authors.forename: Sean D
authors.initials: SD
authors.lastname: Ruland
authors.affiliation: Department of Neurology, Stritch School of Medicine, Loyola University Chicago , Maywood, IL , USA.
authors.forename: Matthew A
authors.initials: MA
authors.lastname: McCoyd
authors.affiliation: Department of Neurology, Stritch School of Medicine, Loyola University Chicago , Maywood, IL , USA.
authors.forename: José
authors.initials: J
authors.lastname: Biller
keywords: basic competency; clinical skills; direct funduscopy; milestones; ophthalmoscope