|Year : 2017 | Volume
| Issue : 3 | Page : 223-227
Needs assessment of ophthalmology education for undergraduate medical students – A study from a medical college in South India
Karuppannasamy Divya1, Kannappan Suvetha2, Alo Sen1, Devisundaram Sundar1
1 Department of Ophthalmology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
2 Department of Community Medicine, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
|Date of Web Publication||18-Apr-2018|
Department of Ophthalmology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Background: Adequate ophthalmic diagnostic and clinical skills are essential for practitioners in primary care settings as well as specialty care physicians. The objectives of this study were to assess the adequacy of ophthalmology teaching in undergraduate medical education and to evaluate the comfort of medical students in diagnosing common eye problems and performing ophthalmic skills. Methods: A questionnaire based, cross-sectional survey was conducted among third-year undergraduate students from a medical college in South India at the end of ophthalmology training from February 2014 to December 2014. The main outcome measures were hours of classroom-based instruction and clinical exposure to ophthalmology received by the students and their comfort level in diagnosing common eye problems and performing ophthalmic skills. Results: 134 students participated in the study. They had received an average of 96.2 ± 5.9 and 112.5 ± 11.3 hours of classroom and clinic-based instruction, respectively. The participants' comfort in diagnosing eye problems was satisfactory for cataract and eyelid disorders but not for ophthalmic emergencies. Only 45.5% had satisfactory knowledge in community ophthalmology. Respondents were more proficient in visual acuity testing (93.3%) and assessment of pupillary reaction (80.6%) than direct ophthalmoscopy (41%). Discussion: Undergraduate medical students from India received a greater amount of ophthalmology instruction compared to the International Council of Ophthalmology task force recommendations. Gaps in community ophthalmology and knowledge-skills discrepancies were noted. Review of curriculum, appropriate training resources, and effective teaching methods tailored towards primary care may be useful to improve the training.
Keywords: Comfort, knowledge, ophthalmology, undergraduate medical education
|How to cite this article:|
Divya K, Suvetha K, Sen A, Sundar D. Needs assessment of ophthalmology education for undergraduate medical students – A study from a medical college in South India. Educ Health 2017;30:223-7
|How to cite this URL:|
Divya K, Suvetha K, Sen A, Sundar D. Needs assessment of ophthalmology education for undergraduate medical students – A study from a medical college in South India. Educ Health [serial online] 2017 [cited 2019 May 20];30:223-7. Available from: http://www.educationforhealth.net/text.asp?2017/30/3/223/229512
| Background|| |
Ophthalmology makes up a significant proportion of primary care consultations. A basic knowledge of ophthalmology is essential in the management of several neurologic, endocrine, rheumatic, and infectious conditions. Despite the relevance of ophthalmology to medical practice, little time is allocated to teaching of ophthalmology in undergraduate medical education and the majority of primary care physicians do not feel that they have received adequate undergraduate ophthalmic education. Also several studies have noted that medical students receive too little ophthalmic training.,,
In India, the five and one-half year undergraduate medical training consists of four and one-half years of teaching of subjects comprising the medical curriculum and one year of internship. Ophthalmology is being taught in the third year after preclinical and paraclinical subjects.
The state of undergraduate ophthalmology training from medical colleges in India has not been studied so far. Evaluation of ophthalmic knowledge and skills of undergraduates at the end of ophthalmology training would help in generating critical feedback on undergraduate ophthalmic curriculum planning. The objectives of this study were:
- To assess the adequacy of ophthalmology teaching in undergraduate medical education
- To assess the comfort level of medical students in diagnosing and treating common eye problems and performing ophthalmic skills.
| Methods|| |
After approval from the institutional review board, undergraduate medical students from a medical college in South India were included in the study at the end of their ophthalmology training (February 2014 to December 2014). The adequacy of ophthalmology education was quantified by determining the hours of classroom-based instruction and clinical exposure to ophthalmology received by the students and comparing these with the recommendations of the Medical Council of India (MCI) as well as the International Council of Ophthalmology (ICO).
A validated questionnaire [Appendix 1] was given to the students and their responses collected anonymously. The questionnaire consisted of three parts. Parts 1 and 3 assessed the students' comfort with respect to diagnosing specific ophthalmology conditions and performing ophthalmology-related skills on a Likert scale from 1 to 5 (1 = not at all comfortable, 2 = somewhat comfortable, 3 = moderately comfortable, 4 = comfortable, and 5 = very comfortable). In terms of comfort level, we examined the ease with which study participants reported they were able to diagnose common eye problems and perform ophthalmic skills.
The second part assessed knowledge on certain topics on a Likert scale, also from 1 to 5 (1 = very poor, 2 = poor, 3 = average, 4 = good, and 5 = very good). The conditions and skills covered in the questionnaire were based on the topics covered in the undergraduate ophthalmology curriculum recommended by the MCI.
Participants were also asked about the number of hours spent in self-directed learning and how comfortable they felt in managing ophthalmology-associated issues overall.
Likert scale-based responses were subsequently dichotomized and reduced to proportions by categorizing scores 1–2 as unsatisfactory or inadequate and 3–5 as satisfactory or adequate. Data were entered using the Statistical Package for the Social Sciences (version 19 (SPSS, Inc., Chicago, IL, USA) and examined using descriptive and analytical statistics to yield frequencies, percentages, and proportions.
| Results|| |
Of the 150 undergraduate medical students, 134 responded to the questionnaire (response rate = 89.6%).
The main modes of ophthalmology exposure were didactic lectures (35 hours), tutorials (37.5 ± 3.8 hours), seminars (23.7 ± 2.2 hours), and clinic-based learning. Our study participants had received an average of 96.2 ± 5.9 hours of classroom-based instruction. They also had received 112.5 ± 11.3 hours of clinic-based instruction in the eight weeks of clinical posting. 121 participants (90.3%) had spent up to 10 hours in self-directed learning while 13 participants (9.7%) had spent more than 10 hours in self-directed learning.
The results of the participants' comfort in diagnosing ophthalmic conditions are presented in [Figure 1]. [Figure 2] shows the students' adequacy of knowledge in community and systemic ophthalmology as well as indications for ophthalmic referral. [Figure 3] shows the study participants' comfort in performing MCI recommended clinical skills. [Table 1], [Table 2], [Table 3] show the numerical data for the corresponding figures. Finally, 101 participants (75.4%) felt comfortable in managing ophthalmology associated issues overall.
|Figure 1: Medical students' comfort in diagnosing common ophthalmic conditions|
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|Figure 3: Students' self-reported proficiency in performance of ophthalmic skills|
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| Discussion|| |
This cross-sectional observational study attempted to quantify the adequacy of undergraduate ophthalmic education and students' comfort with regard to the management of ocular conditions.
In comparison with MCI recommendations, our study participants received a satisfactory number of hours of both classroom and clinic-based instruction. The MCI recommends clinical training of 8 weeks and a total of 100 teaching hours in ophthalmology, which includes 30 h of didactic lectures, 60 h of tutorials and seminars (including integrated learning), and 10 h of self-directed learning. These guidelines suggest a greater amount of ophthalmology exposure in undergraduate medical education in India when compared with ICO guidelines. The ICO recommends 40–60 h of ophthalmology exposure during undergraduate training.
According to the curriculum recommended by the MCI, the goal of teaching ophthalmology to undergraduate medical students is to provide such knowledge and skills to the students that shall enable them to practice as a clinical and primary eye care physician. The curriculum provides a list of competencies which need to be demonstrated by the student at the end of ophthalmology training. These include knowledge of common eye problems in the community; ability to manage common eye problems and identify indications for referral; recognize visual impairment and blindness in the community; and implement the National programme as applicable in the primary care setting.
Most of the participants in the study reported a satisfactory level of comfort in diagnosing common ophthalmic problems. The fact that 97.8% reported a satisfactory level of comfort in diagnosing cataract is encouraging since cataract is the leading cause of preventable blindness in the developing world. Yet, despite this satisfactory level of comfort in managing common eye problems, most study participants' comfort in diagnosing ophthalmic emergencies such as endophthalmitis, rupture globe, and chemical injuries was found to be inadequate.
Nearly 60% reported to have adequate knowledge in ocular manifestations of systemic diseases. This could be because of better teaching resources as well as integration of ophthalmology topics into other subjects of the medical curriculum horizontally and longitudinally. The self-rated knowledge of more than one-half of the study participants was found to be unsatisfactory in community ophthalmology. With greater emphasis placed on teaching disorders of the eye, in theory lectures as well as in hospital settings, community ophthalmology is often neglected. A study on the status of ophthalmic medical education in the South-East Asia Region of World Health Organization has also highlighted this concern, where students have little exposure to community ophthalmology.
The knowledge of most study participants on the indications of medical treatment and referral to eye clinics was adequate. With a significant shortage of ophthalmologists in developing countries, an adequate level of comfort of primary care physicians in providing medical care and accuracy in referral is essential. A high rate of referral places pressure on the limited resources of ophthalmic casualty departments and outpatient clinics.
More than 80% reported competency in ophthalmic history taking, visual acuity and color vision testing, and pupil examination. These are relevant not only in ophthalmology but also in general medicine, neurology, and trauma care. However, only 44% reported an adequate level of comfort in interpretation of fluorescein staining and 54.5% in Schiotz tonometry. This is an area of concern because corneal blindness and glaucoma contribute to a major extent to the burden of blindness in India; adequate proficiency of the primary care physician in these skills will help in early diagnosis and treatment or referral, thereby reducing the risk of visual loss.
Only 41% of respondents indicated that they had adequate proficiency in performing direct ophthalmoscopy which is consistent with studies elsewhere., This could be because of the limited time devoted to teaching ophthalmoscopy in the medical school curriculum as well as the technical challenges involved.
Although most students were comfortable in managing ophthalmology associated issues overall, gaps were noted in certain key areas. Review of the curriculum with greater emphasis on community eye care and blindness control strategies, adequate training resources, and effective teaching methods tailored toward primary care would help to increase the medical students' comfort in managing common eye problems.
Since our observations are from a single center, generalization of results is limited. Subjective bias due to the candidates varying ability to accurately self-evaluate is also a limitation. The choice of the study population was medical students at the end of ophthalmology training rather than interns because of the possibility of recollection bias. A similar study on interns or junior medical officers would provide more insight into the knowledge and gaps in training.
In spite of these limitations, this needs assessment study is the first of its kind in India to assess the adequacy of ophthalmic teaching and the knowledge and clinical skills of undergraduate medical students. Ophthalmology in India is being taught as part of the essential undergraduate medical curriculum and not exclusively as an elective. Students receive adequate exposure to ophthalmology, and the undergraduate curricular hours are greater than the guidelines published by the ICO. Since ophthalmology related topics and examination skills are included in most of the standardized medical licensing examinations and internal medicine boards, medical graduates from India are at a distinct advantage.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3]