Teaching Slit Lamp Funduscopy with a Self-guided e-Learning Module with Model Eye and Validation of a Self-Assessment Tool

Background: Slit lamp funduscopy is an essential diagnostic tool used by ophthalmologists to visualize the posterior structures of the eye. However, the fast-paced nature of outpatient care in ophthalmology often limits preceptor teaching opportunities for medical students during clerkships. This challenge is exacerbated by the minimal preclinical exposure to ophthalmology and the technical complexity of the slit lamp examination. Therefore, curricular reform is needed to improve medical student competency in ophthalmic examination skills. Purpose: To develop a self-guided e-learning module to teach medical students slit lamp funduscopy and evaluate a self-assessment tool for slit lamp funduscopy skills. Methods: Medical students (MS1-4) at a single institution were recruited by email for a skills workshop and randomized into two groups. The “self-guided” group received 30 minutes to watch a prerecorded instructional video with model eye practice, while the “preceptor teaching” group received 30 minutes of in-person instruction. Both received another 30 minutes of standardized patient practice. Participants answered questionnaires before and after training, completed self-assessments on slit lamp funduscopy skills, and received objective assessments from a grader masked to participant identity. Results: Nineteen students participated: 9 in the self-guided group and 10 in the preceptor group. There were no significant differences between the two instructional groups in mean objective assessment scores, mean completion times on objective assessment, and proportion of students able to visualize the retina, retinal blood vessels, and optic nerve. Learners’ self-evaluations and graders’ objective evaluations were found to agree substantially, with a mean agreement rate of 87% across all learner-grader pairs and a mean Gwet’s AC1 of 0.80. Confidence in performing slit lamp funduscopy significantly increased for both the self-guided and preceptor teaching groups by the end of the workshop (p < 0.01). Conclusion: A self-guided e-learning module is comparable in quality and efficacy to preceptor instruction in teaching medical students slit lamp funduscopy. Self-assessments can be reliable in gauging learner proficiency in slit lamp fundoscopy skills. These educational tools may be a promising adjunct to the traditional methods of instruction and evaluation of highly technical examination techniques.