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Ophthalmology Clinical Skills Fair

Ophthalmology Clinical Skills Fair. Stephanie Baxter, MD, FRCSC Department of Ophthalmology Queen’s University. Objectives. Compare our previous teaching methodology with the new clinical skills fair Discuss the success of this teaching modality with students - evaluations

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Ophthalmology Clinical Skills Fair

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  1. Ophthalmology Clinical Skills Fair Stephanie Baxter, MD, FRCSC Department of Ophthalmology Queen’s 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. 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 What we were doing before

  5. The clinical skills fair was born • Martin ten Hove’s 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 • [12:30 - Boxed lunch with intro lecture] • 1:00 - 1:15 - Arrive in clinic • 1:15 - 2:45 - 3x30 minute stations • 2:45 - 3:00 - Break/snacks • 3:00 - 4:30 - 3x30 minute stations • 4:30 - 4:45 - 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 Queen’s University’s 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

  17. 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. 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 Critique

  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

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