Medical Student Attitudes Toward the Use of Peer Physical Exam for Learning Fundoscopy

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Background Peer physical examination learning is commonly practiced in medical schools during preclinical curricula and has been shown to improve empathy for patients. While there is literature regarding medical student attitudes toward peer physical exam learning, no studies to date have specifically examined student attitudes toward fundoscopy and dilation of the eyes for the purposes of learning fundoscopy. This study evaluates medical student preferences with regards to learning fundoscopy on peers and explores attitudes toward alternate approaches.

Methods First year medical students at the Icahn School of Medicine at Mount Sinai participated in a 2-hour fundoscopy skills workshop in March 2020. Following the session, the authors administered a voluntary survey querying students on attitudes toward peer physical exam learning and its use in learning peer fundoscopy. Primary study endpoints evaluated (1) student attitudes toward the use of peer physical exam learning, (2) learning benefit of the session, including student comfort with conducting the fundoscopy exam, and (3) empathy toward patients experiencing dilation. Secondary endpoints focused on alternative teaching methods and preferences for nonmydriatic fundoscopy. Analysis of survey data was performed using nonparametric Spearman's correlations, chi-square tests, t-tests, and Mann–Whitney U tests.

Results A total of 51/138 (37%) students completed the survey, with 78% indicating they felt peer physical exam learning was a helpful instructional method, including for the fundoscopic exam. The session led to improved self-rated fundoscopy skills and empathy for patients. However, when considering learning with dilation versus alternative nonmydriatic techniques, 96% of students indicated a preference for using alternative nonmydriatic techniques.

Conclusion This study found that students' attitudes toward fundoscopy generally aligned with their overall peer physical exam preferences. However, they preferred not using dilation and learning with nonmydriatic fundoscopic techniques. Assessing student learning preferences and incorporating novel instructional tools can help facilitate more successful fundoscopy skills acquisition. These considerations are particularly important in the context of COVID-19 and with advances in teleophthalmology.

Keywords peer physical exam - fundoscopic exam - medical student - empathy - pupillary dilation Ethics Approval and Consent to Participate

This study was prospectively deemed exempt from full review by the PPHS office at the Icahn School of Medicine at Mount Sinai IRB [GCO#1: 20–0622(0001)] on 3/10/2020. Students read an electronic research information sheet with details about consent at the beginning of the survey. Participants provided informed consent prior to completing the survey. All methods were performed in accordance with relevant guidelines and regulations.


Additional Information

A copy of the survey instrument is included in Appendix 1.


Authors' Contributions

All authors made substantial contributions to study conception and design, data acquisition and analysis, manuscript composition, and critical revision for important intellectual content, and approved the final version to be published.

Publication History

Received: 02 September 2021

Accepted: 01 January 2022

Publication Date:
02 March 2022 (online)

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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