Ophthalmic Medical Student Education

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Ophthalmic Medical Student Education

• Are We Meeting Physicians Needs?
• Brian R. Wong, M.D.
• Scholars In Education
• 2005

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The Graying of America

• There are now 34 million Americans 65 and over
  (13 of total)
• By 2030, 69 million (20 of total)
• By 2050, 80 million

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Age-Related Eye Disease

• Cataracts 20.5 million 40 years and older

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Age-Related Eye Disease

• Age-related macular degeneration (ARMD) 1.6
  million 50 years or older

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Age-Related Eye Disease

• Glaucoma 2.2 million 40 years and older

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Age-Related Eye Disease

• Diabetic Retinopathy Diabetes affects more than
  5.3 million 18 years and older

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Co-morbidities of Vision Loss

• Activities of daily living Driving, Reading,
  Watching TV
• Falls and Fractures
• Depression
• Dementia

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Purpose

• To determine if medical students, especially the
  ones entering primary care specialties, are being
  trained sufficiently in helping to detect the
  major age-related eye diseases

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Pilot Study Survey ofAll UTMB IM and FM
Residents

• Was there opportunity to learn about the four
  most important age-related eye diseases in
  medical school?
• In what setting was the information presented?
• Were the basic principles actually learned?
• Is an appropriate eye screening exam incorporated
  in the general medical work-up?

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Methods

• A survey was distributed to IM and FM residents
  at their noon-time meeting to attempt to increase
  response rate.
• Completed surveys were returned prior to the end
  of the session.
• An IM and FM representative gave out surveys to
  those who were not able to attend the meeting and
  these were collected at a later time.

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Educational Setting

• Required Ophthalmic Clinical Rotation
• Required Non-ophthalmic Clinical Rotation
• Elective Ophthalmic Clinical Rotation
• Elective Non-ophthalmic Clinical Rotation
• Didactic Ophthalmic Lecture
• Didactic Non-ophthalmic Lecture
• Problem-based Learning (PBL) or other small group
  setting
• Practice of Medicine (POM) course or other
  clinical skills course
• Web-based Learning
• Required Textbook Reading
• Self-initiated Elective Reading
• Other

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Summary

• The majority of residents had the opportunity to
  learn about age-related eye disease, especially
  glaucoma and diabetic retinopathy, but only
  reached 100 once with FM residents and glaucoma
• The educational setting was widespread with the
  main three types of exposure being Required
  Ophthalmic Clinical Rotation, Didactic Ophthalmic
  Lecture, and Required Textbook Reading

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Summary

• Of the IM residents exposed to learning
  age-related eye disease, in only diabetic
  retinopathy and ARMD, did greater than half feel
  they mastered the basic principles.
• In no category did 20 of the FM residents feel
  they mastered the basic principles.

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Summary

• In only diabetic retinopathy did over half of the
  IM and FM residents incorporate an evaluation in
  their history and exam.

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Summary

• Both the majority of IM and FM residents asked a
  basic diabetic retinopathy history question. But
  in only one other category was this true. The
  majority of FM residents asked a question
  relating to cataracts.
• Of the basic eye exams, only cataract and
  glaucoma screenings were done by a majority of
  the IM and FM residents.

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Conclusions

• In only diabetic retinopathy did IM and FM
  residents respond in a manner which is acceptable
  for appropriate PCP ophthalmic care. This result
  is most likely due to the association with
  systemic disease.
• However, as the gatekeepers for referral, IM
  and FM residents need to be more educated and
  confident in evaluating for all age-related eye
  disease.

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Conclusions

• Because of the pressure to include ever expanding
  knowledge in medical school curricula,
  ophthalmology has either been dropped from the
  requirements or significantly reduced.
• Ophthalmologist and PCPs, in conjunction with
  curriculum committees, need to incorporate a
  better standardized, time efficient way of
  educating medical students.