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Original Investigation
September 11, 2017

Utility of Combining a Simulation-Based Method With a Lecture-Based Method for Fundoscopy Training in Neurology Residency

Author Affiliations
  • 1The Neurological Institute of New York, Columbia University Medical Center, Columbia University, New York
  • 2Department of Critical Care Medicine, University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, Pennsylvania
  • 3Department of Neurology, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
  • 4Department of Neurology and Biostatistics, Case Western Reserve University, Cleveland, Ohio
JAMA Neurol. Published online September 11, 2017. doi:10.1001/jamaneurol.2017.2073
Key Points

Question  Is a simulation-based teaching method of assessment and teaching of the fundoscopic examination valuable in neurology residency training?

Findings  In this education research study of 48 neurology residents, the intervention group, who received additional simulation-based training, had significantly greater increases in fundoscopy skills and practice confidence compared with the control group, who only received lecture-based training.

Meaning  Use of a simulation-based method may be an effective adjunct to the conventional didactics-based method in fundoscopy education in neurology.


Importance  Fundoscopic examination is an essential component of the neurologic examination. Competence in its performance is mandated as a required clinical skill for neurology residents by the American Council of Graduate Medical Education. Government and private insurance agencies require its performance and documentation for moderate- and high-level neurologic evaluations. Traditionally, assessment and teaching of this key clinical examination technique have been difficult in neurology residency training.

Objective  To evaluate the utility of a simulation-based method and the traditional lecture-based method for assessment and teaching of fundoscopy to neurology residents.

Design, Setting, and Participants  This study was a prospective, single-blinded, education research study of 48 neurology residents recruited from July 1, 2015, through June 30, 2016, at a large neurology residency training program. Participants were equally divided into control and intervention groups after stratification by training year. Baseline and postintervention assessments were performed using questionnaire, survey, and fundoscopy simulators.

Interventions  After baseline assessment, both groups initially received lecture-based training, which covered fundamental knowledge on the components of fundoscopy and key neurologic findings observed on fundoscopic examination. The intervention group additionally received simulation-based training, which consisted of an instructor-led, hands-on workshop that covered practical skills of performing fundoscopic examination and identifying neurologically relevant findings on another fundoscopy simulator.

Main Outcomes and Measures  The primary outcome measures were the postintervention changes in fundoscopy knowledge, skills, and total scores.

Results  A total of 30 men and 18 women were equally distributed between the 2 groups. The intervention group had significantly higher mean (SD) increases in skills (2.5 [2.3] vs 0.8 [1.8], P = .01) and total (9.3 [4.3] vs 5.3 [5.8], P = .02) scores compared with the control group. Knowledge scores (6.8 [3.3] vs 4.5 [4.9], P = .11) increased nonsignificantly in both groups.

Conclusions and Relevance  This study supports the use of a simulation-based method as a supplementary tool to the lecture-based method in the assessment and teaching of fundoscopic examination in neurology residency.