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OBJECTIVE: To describe the conception and evaluation of a novel educational intervention to teach direct ophthalmoscopy with retinal simulators using a peer-assessed group objective structured clinical examination (OSCE) format. DESIGN: Prospective, single-centre educational trial at Oxford University Medical School, Oxford, U.K. PARTICIPANTS: A total of 160 consecutive undergraduate fifth-year medical students participated in the study. METHODS: Students identified prior experience, teaching, examination, and feedback relevant to direct ophthalmoscopy. Students self-evaluated their perceived confidence across 6 domains of direct ophthalmoscopy examination before and after the educational intervention using a Likert-type psychometric scale. Wilcoxon matched pair testing was used to determine statistical significance for each domain. RESULTS: The group OSCE intervention increased confidence in direct ophthalmoscopy overall from 2.5% to 63.8% (p < 0.001). Confidence improved in all 6 domains, most significantly in controls of ophthalmoscope (p < 0.001) and sequence of examination (p < 0.001) but also in the identification and interpretation of retinal signs (p < 0.001). Students rated the tutorial as very effective or effective across all 6 domains, and 96.29% rated the tutorial as effective overall. CONCLUSIONS: Retinal simulation, integrated with a peer-assessed group OSCE format, is effective in increasing confidence in all aspects of direct ophthalmoscopy. It may be insufficient alone for training in the identification and interpretation of posterior segment clinical signs. Diminishing ophthalmology clerkships worldwide require ophthalmologists to identify innovative teaching methods, using modern technology and pedagogy to deliver high-quality, yet high-throughput, training in direct ophthalmoscopy. This novel teaching strategy may be considered by ophthalmologists responsible for direct ophthalmoscopy training in a teaching hospital context.

Original publication




Journal article


Can J Ophthalmol

Publication Date





392 - 397


Clinical Competence, Computer Simulation, Education, Medical, Undergraduate, Educational Measurement, Female, Humans, Male, Ophthalmology, Ophthalmoscopy, Prospective Studies, Retinal Diseases, Teaching