title: Evaluating medical students' proficiency with a handheld ophthalmoscope: a pilot study.
abstract: BACKGROUND
  Historically, testing medical students' skills using a handheld ophthalmoscope has been difficult to do objectively. Many programs train students using plastic models of the eye which are a very limited fidelity simulator of a real human eye. This makes it difficult to be sure that actual proficiency is attained given the differences between the various models and actual patients. The purpose of this article is to introduce a method of testing where a medical student must match a patient with his/her fundus photo, ensuring objective evaluation as well as developing skills on real patients which are more likely to transfer into clinical practice directly.
  
  
  METHODS
  Fundus photos from standardized patients (SPs) were obtained using a retinal camera and placed into a grid using proprietary software. Medical students were then asked to examine a SP and attempt to match the patient to his/her fundus photo in the grid.
  
  
  RESULTS
  Of the 33 medical students tested, only 10 were able to match the SP's eye to the correct photo in the grid. The average time to correct selection was 175 seconds, and the successful students rated their confidence level at 27.5% (average). The incorrect selection took less time, averaging 118 seconds, yet yielded a higher student-reported confidence level at 34.8% (average). The only noteworthy predictor of success (p<0.05) was the student's age (p=0.02).
  
  
  CONCLUSIONS
  It may be determined that there is an apparent gap in the ophthalmoscopy training of the students tested. It may also be of concern that students who selected the incorrect photo were more confident in their selections than students who chose the correct photo. More training may be necessary to close this gap, and future studies should attempt to establish continuing protocols in multiple centers.
authors.affiliation: Physical Medicine and Rehabilitation, Michigan State University, Lansing, MI.
authors.forename: Gregory
authors.initials: G
authors.lastname: Gilmour
authors.affiliation: School of Physical Therapy, Touro University, Henderson, NV, USA.
authors.forename: James
authors.initials: J
authors.lastname: McKivigan
keywords: computer-based testing; education; physical exam; software based; standardized patient