Ophthalmology Clinical Skills Fair

1
Ophthalmology Clinical Skills Fair

• Stephanie Baxter, MD, FRCSC
• Department of Ophthalmology
• Queens University

2
Objectives

• Compare our previous teaching methodology with
  the new clinical skills fair
• Discuss the success of this teaching modality
  with students - evaluations
• Discuss its ability to transfer the intended
  examining clinical skills to students
• Discuss if this model could be applied to other
  departments

3
What we were doing before

• Similar to other clinical teaching sessions in
  other areas of medicine
• 1 group/week for 10 weeks
• 10 students/group
• Variable teacher
• No set objectives
• Variable learning experience
• All students in same examining room learning the
  various skills

4
What we were doing before

• Pros
• Spread out the teaching among teachers
• Required only one teacher/session
• Minimal space requirement

• Cons
• Time consuming for teachers who did many sessions
• If several teachers, students potentially had an
  inconsistent experience
• Were we really transferring the appropriate
  skills?
• No set objectives

5
The clinical skills fair was born

• Martin ten Hoves idea
• Based on Halifax model - ophthalmology evening
• Involved me - new UG director for Department
• Brain stormed
• Logistics
• What we would teach - Clinical skills we wanted
  to transfer
• Who would be taught - At what level of med school
  training
• How - of groups/group size, time allocated per
  skill
• Where we would teach - Close clinic for half day
• When would we do it - Week of lectures vs. later
  to reinforce
• Who would teach - Would need all teaching staff
  to help

6
The Fair - What

• The International Council of Ophthalmology (ICO)
  consensus
• All medical students should demonstrate
  competency in these clinical skills
• Measurement of distance near visual acuity with
  and without correction or pinhole (VA)
• Confrontation visual fields (VF)
• Assessment of extraocular motility and ocular
  position (EOM)
• Measurement and interpretation of pupillary size
  and reaction
• Direct ophthalmoscopy
• Penlight examination of anterior segment
  including upper lid eversion
• Removal of superficial corneal or conjunctival
  foreign body
• The ICO Task Force strongly recommends
• Ophthalmology be part of core medical curriculum

7
The Fair - What

• Stations
• Station 1 - Vision pupils
• Station 2 - EOM, IOP, VF
• Station 3 - Slit Lamp - anterior segment
• Station 4 - Ophthalmoscope - posterior segment
• Station 5 - Peds strabismus
• Station 6 - Trauma
• Handout provided
• Reference for session and future

8
The Fair - How

• Format
• 1230 - Boxed lunch with intro lecture
• 100 - 115 - Arrive in clinic
• 115 - 245 - 3x30 minute stations
• 245 - 300 - Break/snacks
• 300 - 430 - 3x30 minute stations
• 430 - 445 - evaluation extra help

9
The Fair - What

• Stations
• 30 minutes each
• 2-3 objectives/station - clearly outlined in
  handout
• 5-10 minutes of didactic/instruction
• How to perform skill
• 20-25 minutes to practice the skill
• HANDS-ON
• Practice on each other and use various models
• Some exercises to highlight/demonstrate findings
• Prisms to demonstrate esotropia/exotropia
• Lens to blur vision/pinhole to sharpen
• Internet simulators

10
The Fair - Who

• Groups
• Phase 2B expanded clinical skills
• 12 groups of 8-9 students - to keep groups small
• 6 stations
• 2 concurrent identical tracks

11
The Fair - When, Where, Who

• Friday afternoon, after ophtho lectures
• Originally 3-4 weeks later
• Now at the the end of the week
• Johnson 6 Eye Clinic
• Closed to patient care
• 18 examining rooms used for teaching
• All teaching faculty and residents, support staff
• Need many teachers
• Helps demonstrates a team approach to eye care

12
Resounding Success

• Student evaluations

13
Resounding Success

• Student evaluations - comments
• Liked
• Hands on, using equipment
• Small groups, comfortable to ask questions
• Focus on primary care
• Rotating stations, reasonable amount of time
• Helped enforce what had been learned
• Snacks

14
Resounding Success

• Student evaluations - comments
• Disliked
• Slit lamp and ophthalmoscope stations too short
• Repetitive
• Reviewing online and again at session
• Friday afternoon

15
Is it working?

• Survey 2005 (first year)
• Does Queens Universitys Ophthalmology Clinical
  Skills Session improve medical student
  self-confidence in performing Direct
  Ophthalmoscopy and Slit Lamp examination?

16
Is it working?

• Survey 2005 (first year)
• Cross-sectional survey was conducted immediately
  before and after ophthalmology clinical skills
  session (CSS)
• Students rated their self-confidence on specific
  direct ophthalmoscopy and slit-lamp examination
  clinical skills
• Students chose from 5 levels of confidence
• 1 Not at all confident
• 2 A little confident
• 3 Somewhat confident
• 4 Quite confident
• 5 Extremely confident

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Is it working?
18
Percentage of Medical Students that Reported to
be Somewhat/Quite/Extremely Confident
19
Percentage of Medical Students that Reported to
be Somewhat/Quite/Extremely Confident
20
Percentage Increase in Medical Students
Self-Confidence Before and After Clinical Skills
Session
Paired t-Test
21
Is it working?

• Question of student confidence
• Question of skill transfer
• Not really answered with this study
• Sister study
• Ability to properly perform skill and detect
  findings pre-clinical skills fair
• Attend the clinical skills fair
• ? Increase in ability to properly perform skill
  and detect findings post-clinical skills fair

22
Critique

• Pros
• All students/one session
• Time economical
• More consistent teaching
• Contact with all faculty
• Popular among students
• Enjoyable for faculty
• Time economical
• Interaction with students
• Wow factor - satisfying

• Cons
• Resource intensive
• Teacher intensive
• 18-20 teachers
• Space intensive
• Many rooms
• Clinic closed
• More pre/post prep
• Focused on N findings
• F/U with Phase 2C
• 2-3 months later

23
Application to other specialties

• Absolutely
• Matter of
• Defining
• How, who, what, when, where
• Having the resources
• Teachers
• Space - Clinical Teaching Centre

24
Conclusions

• Clinical skills fair in ophthalmology
• Not much different than traditional clinical
  skills sessions
• Format
• More successful than could have been predicted
• HANDS-ON
• Skill transfer still needs to be fully assessed
• Offers certain advantages over traditional
  clinical skills
• Set objectives, consistently taught, access to
  many staff
• Could be applied to other areas of medicine
• Depending on resources (space/people) available