Impact of Video-guided Indirect Ophthalmoscopy on Medical Student Confidence and Ability

Background: Binocular indirect ophthalmoscopy (BIO) is a challenging skill to learn and teach. Purpose: To evaluate the utility of video-guided BIO for training medical students without prior BIO experience using Scanoptix, a novel, wireless, ophthalmoscope-mounted camera. Methods: This was a mixed-methods study including a survey and prospective, double-armed intervention. Medical students at the University of Virginia School of Medicine without prior BIO experience were recruited via email and randomized into video-guided and non-video-guided indirect ophthalmoscopy training groups (VIO and nVIO, resp.). Both groups underwent a demonstration session led by a retina specialist followed by an instructional session with real-time feedback on examination technique by the retina specialist. During the VIO sessions, the retina specialist and students had access to live video recordings of the examination, whereas the nVIO group did not. All students were asked to perform BIO examination of a model eye pre- and post-intervention, and deidentified recordings were transmitted wirelessly from a novel ophthalmoscope-mounted camera to a smart tablet. Two independent retina specialists graded students’ examination videos for competency pre- and post-intervention. Students also completed a questionnaire regarding their confidence performing BIO before and after the intervention. Changes in confidence and competency were analyzed in Excel using paired and unpaired t tests. Main outcome measures were medical student confidence and competency performing BIO examination of the posterior pole. Results: A total of 38 medical students participated: 20 in the VIO group and 18 in the nVIO group. Students in both groups demonstrated significant improvement in examination skills and confidence following intervention (for skills, VIO p < 0.0001 and nVIO p = 0.0004; for confidence, VIO and nVIO p < 0.0001). Comparing post-intervention scores, VIO examination scores were not significantly greater than those for nVIO (7.95 vs 7.29, resp. [p = 0.441]); however, the VIO group achieved a greater degree of improvement from baseline compared with nVIO controls (Δ = 6.73 vs Δ = 4.49, resp.), with results approaching significance (p = 0.082). Conclusions: BIO-naive medical students benefitted from formal instruction with or without video guidance. Additional studies are required to determine whether an ophthalmoscope-mounted camera would enhance BIO education for naive learners.