A Curriculum-Based Approach to Enhance Medical Student Confidence and Performance with Slit Lamp Funduscopy and Indirect Ophthalmoscopy

Background: As ophthalmology instruction in medical school curricula continues to decrease, opportunities for structured training in slit lamp funduscopy and indirect ophthalmoscopy remain scarce. Furthermore, most educational interventions in ophthalmology rely heavily on self-reported confidence rather than objective measures of technical performance. Purpose: To validate a slit lamp funduscopy and indirect ophthalmoscopy educational curriculum for medical students. Methods: Third- and fourth-year medical students enrolled in an ophthalmology elective were invited to participate in a slit lamp funduscopy and indirect ophthalmoscopy teaching session. Students’ subjective confidence levels were assessed via Likert-scale questions on pre- and post-teaching questionnaires (1 = not at all confident, 5 = completely confident) addressing various parts of each examination and pre- and post-teaching skills examinations to assess objective performance. Skills examinations were performed on an eye model containing a retina image with letter-number pairs distributed across it. Performance was measured by the time required to correctly identify the first letter-number pair and by the total number of correctly reported pairs. Results: Of 18 students enrolled in the curriculum, 12 completed all surveys and examinations. After the teachings, student confidence increased from 2.3 ± 1.1 to 3.7 ± 1.0 (p = 0.002) for the slit lamp funduscopy examination and from 1.9 ± 1.0 to 3.1 ± 1.1 (p = 0.002) for the indirect ophthalmoscopy examination. Student performance also improved: for the slit lamp funduscopy examination, students identified more correct pairs (from 3.8/10 to 6.8/10, p = 0.014) and required less time to identify their first pair (from 27 to 12.9 sec, p = 0.045). Similarly, for the indirect ophthalmoscopy examination, the number of correctly identified pairs increased from 4.4/10 to 7.1/10 (p = 0.009) with an average faster identification of the first pair (12.8 to 7.0 sec, p = 0.025). Conclusions: Our structured slit lamp funduscopy and indirect ophthalmoscopy training session was an effective teaching tool for increasing both medical student confidence and performance.