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Can J Neurol Sci. 2018 Feb 19:1-5. doi: 10.1017/cjn.2017.291. [Epub ahead of print]

Evaluation of an Ophthalmoscopy Simulator to Teach Funduscopy Skills to Pediatric Residents.

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1Division of Neurology,The Hospital for Sick Children,University of Toronto,Toronto,ON,Canada.
3Department of Neurosciences & Mental Health,The Hospital for Sick Children,Toronto,ON,Canada.
2Department of Pediatrics,The Hospital for Sick Children,University of Toronto,Toronto,ON,Canada.



Medical school and residency training in ophthalmoscopic evaluation is limited, reducing diagnostic accuracy. We sought to evaluate the efficacy of self-study using an ophthalmoscopy simulator to improve the technical motor skills involved in direct funduscopy in postgraduate pediatric residents.


In this randomized-controlled study, 17 pediatric residents (postgraduate years 1-3) were randomized to control (n=8) or intervention (n=9) groups. Participants were asked to correctly identify the funduscopic findings presented to them on an ophthalmoscopy simulator after being trained on its use. Each participant was asked to review 20 images of the fundus, and then record their multiple-choice response on a scantron sheet listing all possible funduscopic pathologies. Pre- and post-intervention testing was performed. Survey data assessing exposure to funduscopy skills during undergraduate and postgraduate training and overall experience with the simulator were collected.


Most (65% [11/17]) participants reported minimal or no formal teaching in ophthalmology during their undergraduate medical studies. Average pre-intervention score (of 20) was 10.24±1.75 (51%) for the entire group, with no statistically significant difference between average pre-score in the control (10.63±1.77) versus intervention (9.89±1.76, p=0.405) groups. Intervention subjects experienced a statistically significant improvement in scores (9.89±1.76 vs. 12.78±2.05, p=0.006 [95% confidence interval 4.80-0.98]), but control subjects did not.


A single session with an ophthalmoscopy simulator can improve diagnostic accuracy in postgraduate pediatric trainees. Use of ophthalmoscopy simulation represents a novel addition to traditional learning methods for postgraduate pediatric residents that can help trainees to improve their confidence and accuracy in performing this challenging examination.


Direct ophthalmoscopy; Funduscopy; Medical education; Pediatrics; Simulation


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