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Background The use of simulators for ophthalmology training is growing globally. However, all developed simulators have certain limits based on different circumstances. The study aims to evaluate training performance and student satisfaction of the new refractive adjustment simulator \"ICEyeModel\" compared with a traditional simulator for direct ophthalmoscopy training among medical students. Methods This constitutes a comparative, randomised, cross-over study. Our study enrolled 50 participants from a 6-year medical student training programme at Phramongkutklao Hospital. They underwent a refresher lecture on primary direct ophthalmoscopy use and a short course review of common retinal diseases. They were randomised into two training sequence groups: Training sequence 1 started with a traditional film photograph simulator called Eye Retinopathy Trainer (developed by Adam, Rouilly Co., Sittingbourne, UK) followed by the ICEyeModel. Training Sequence 2 started with the ICEyeModel, followed by a traditional simulator. Participants in both groups completed the fundoscopic description tests and satisfaction questionnaires immediately following each simulator training session. Results On an 18-point prospective rubrics scale, medical students trained with ICEyeModel achieved significantly higher fundoscopic examination scores (14.42 ± 2.34) compared to those trained with traditional simulators (11.30 ± 2.64), with p  < 0.001. For the ICEyeModel, 86% of the participants can correctly adjust the direct ophthalmoscope power match to the refractive state of the trial lens placed in the simulator. The ICEyeModel has a higher satisfaction score regarding picture quality, enhancing motivation and confidence than a traditional simulator. Conclusion In comparison with the Eye Retinopathy Trainer, the ICEyeModel significantly enhanced performance with increased satisfaction and self-confidence in simulated direct ophthalmoscopy training. Although these improvements were observed in a simulation setting and do not necessarily translate to superior performance in patient examinations, our findings suggest that the ICEyeModel may offer a promising alternative for training with direct ophthalmoscopes, indirect ophthalmoscopes, and retinoscopes in clinical settings.

Background Dilated fundoscopic exam is considered the gold standard for detecting retinal hemorrhage, but expertise in obtaining this exam is not always immediately available. MRI can detect retinal hemorrhages, but correlation of the grade or severity of retinal hemorrhage on dilated fundoscopic exam with retinal hemorrhage visibility on MRI has not been described. Objective To determine the value of standard brain protocol MRI in detecting retinal hemorrhage and to determine whether there is any correlation with MR detection of retinal hemorrhage and the dilated fundoscopic exam grade of hemorrhage. Materials and methods We conducted a retrospective chart review of 77 children <2 years old who were seen for head trauma from April 2007 to July 2013 and had both brain MRI and dilated fundoscopic exam or retinal camera images. A staff pediatric radiologist and radiology resident reviewed the MR images. Retinal hemorrhages were graded by a chief ophthalmology resident on a 12-point scale based on the retinal hemorrhage type, size, location and extent as seen on review of retinal camera images and detailed reports by ophthalmologists. Higher scores indicated increased severity of retinal hemorrhages. Results There was a statistically significant difference in the median grade of retinal hemorrhage examination between children who had retinal hemorrhage detected on MRI and children who did not have retinal hemorrhage detected on MRI ( P  = 0.02). When examination grade was categorized as low-grade (1–4), moderate-grade (5–8) or high-grade (>8) hemorrhage, there was a statistically significant association between exam grade and diagnosis based on MRI ( P  = 0.008). For example, only 14% of children with low-grade retinal hemorrhages were identified on MRI compared to 76% of children with high-grade hemorrhages. MR detection of retinal hemorrhage demonstrated a sensitivity of 61%, specificity of 100%, positive predictive value of 100% and negative predictive value of 63%. Retinal hemorrhage was best seen on the gradient recalled echo (GRE) sequences. Conclusion MRI using routine brain protocol demonstrated 61% sensitivity and 100% specificity in detecting retinal hemorrhage. High-grade hemorrhage was more often detected on MRI than low-grade hemorrhage, 76% vs. 14%. GRE images were the most sensitive for detection of retinal hemorrhages. A dilated fundoscopic exam can be difficult to obtain in infancy, especially in critically ill or non-sedated children. MRI is a useful modality for added documentation of retinal hemorrhage and can be used as an alternative exam when ophthalmologic expertise or retinal camera images are unavailable. Additionally, identification of retinal hemorrhage on MRI can raise the possibility of abuse in children presenting with nonspecific findings.

Fundoscopic exams are conducted during outpatient consultations to assess intracranial disease and complications from chronic diseases. Low level of confidence in these skills which physicians have is one of the causes that implementation frequency is low. Research has not yet identified specific measures through which the healthcare system may increase the implementation of fundoscopic exams nor a qualitative process that enables physicians to gain confidence in their fundoscopic exam skills. We introduced a checklist and conducted a mixed-methods study. This study is a before-and-after study, within an embedded-experimental mixed-methods design. We sampled 15 physicians in the department of general medicine at a university hospital assigned to initial consultation. We introduced a checklist to verify whether the fundoscopic exam was implemented. Measures are implementation ratio of the fundoscopic exam to the total number of indication cases, and Visual Analog Scale (VAS) values for the confidence in procedure are measured before and after the intervention. We obtained qualitative data from interviews and used the Modified Grounded Theory Approach. We observed significant increases in the implementation ratio (19.2% (29/151 cases) vs 64.8% (105/162 cases), p<0.001) and in the VAS value for the confidence (1.89 mm vs 4.68 mm (p<0.001)). Analysis of the interviews revealed the following. To increase the implementation, it is necessary to reduce the and , which is prevented by the checklist. The leads to a . Repeated executions result in . The intervention increased the implementation ratio, thereby increasing successful experiences and confidence among physicians. The growth of confidence boosted motivations to implement fundoscopic exams.