To assess resident baseline and post-simulation (SIM) learning sessions for neuro-ophthalmologic examination skills.

The neuro-ophthalmologic examination is a critical skill-set for accurate diagnosis; yet, trainees find the examination challenging.  Specific tasks, including fundoscopic examination and ocular alignment testing, require extensive instruction and hands-on practice.  We evaluated the impact of an educational SIM session, consisting of instruction and practice of neuro-ophthalmologic examination techniques, on self-reported levels of confidence in abilities to perform examination elements among a cohort of neurology residents.

An in-person SIM session led by neuro-ophthalmology faculty was attended by neurology residents at an academic center.  Detailed instruction on performing fundoscopy and ocular alignment testing was provided; this was followed by practice with volunteers and simulation mannequins for fundoscopy.  Participants completed surveys detailing self-reported levels of examination skill confidence and abilities prior to starting the session and immediately post-SIM session.

Using Likert scale assessments, residents (n=9 for this session) were significantly more likely to report that they agreed or strongly-agreed that they had received adequate training for the neuro-ophthalmologic examination following the SIM session (11.1% for the pre-SIM survey vs. 44.4% for post-SIM, p=0.02, Wilcoxon signed-rank test).  Likewise, 44.4% of participants were confident in their skills with the Maddox rod pre-SIM session, compared to 76.8% post-SIM (p=0.03).  Proportions of residents who reported that they were confident in their overall neuro-ophthalmologic examination skills, interestingly, decreased between the pre- (55.5%) and post-SIM (11.1%) sessions (p=0.03).  All participants either agreed or strongly agreed that they would be interested in attending comparable sessions in the future.

The skills involved in performing a detailed neuro-ophthalmologic exam are challenging yet important to neurologic care.  Our results demonstrate that SIM education sessions in neuro-ophthalmology can increase self-reported confidence in certain examination skills and also result in positive and realistic self-assessments of abilities for the neuro-ophthalmologic evaluation.