Expansion of a Self-Guided Curriculum and Validation of a Self-Assessment Tool for Ocular Examination Skills

Background: Public interest in vision health is growing, yet ophthalmology remains underemphasized in medical education due to time constraints associated with in-person instruction. Purpose: To demonstrate effectiveness of self-guided e-learning modules for ocular examination skills and to determine whether self-assessments can reliably assess medical student proficiency in these skills. Methods: Medical students at a single institution participated in a skills workshop. Group 1 completed self-guided modules for visual acuity, confrontational visual field testing, pupil examination, and extraocular motility evaluation. Group 2 completed a self-guided module for the slit lamp anterior segment examination. Afterward, each student completed a self-assessment of the learned skill(s), and a grader completed a corresponding objective assessment. Learners also completed pre- and post-questionnaires assessing confidence levels in these skills. Results: A total of 27 students enrolled in the study: group 1, n = 12; group 2, n = 15. Average learner performance after completing the modules ranged from 60.8% (14/23 items correct, slit lamp anterior segment examination) to 92.6% (8.33/9 items correct, confrontational visual field testing). Mean agreement and Gwet’s AC1 between learner self-assessments and grader objective assessments were 91.7% and 0.893 for visual acuity, 90.7% and 0.892 for confrontational visual field testing, 74.4% and 0.689 for pupil examination, 81.9% and 0.756 for extraocular motility evaluation, and 73.0% and 0.580 for slit lamp anterior segment examination. Confidence improved significantly across all skills (p < 0.01) by the end of the workshop, and 92.6% of learners reported “agree” or “strongly agree” that they found the self-assessments useful for their learning. Conclusion: Self-guided e-learning modules can effectively teach medical students ophthalmic skills. Self-assessments can be a valid assessment for proficiency in these skills, especially if test items are written in a concrete and specific manner. These resources represent promising and innovative adjuncts to medical student education in ophthalmology and can facilitate learning ophthalmic examination skills for clinical clerkships.