Undergraduate Ophthalmology Education & Covid-19

Undergraduate Ophthalmology Education & Covid-19

January 19, 2021

The coronavirus (COVID-19) pandemic temporarily suspended medical student involvement in clinical rotations, resulting in the need to develop virtual clinical experiences.

The cancellation of clinical ophthalmology electives and away rotations reduces opportunities for exposure to the field, to network with faculty, conduct research, and prepare for residency applications.

The challenges in education posed by the COVID-19 pandemic should be treated as an opportunity to explore new and innovative teaching-learning techniques which could shape the nature of medical education as we currently know it.

Though the platform of online teaching is not a substitute for clinical and practical learning in any way, and is not without its shortcomings, it is helping the students carry on with their academics in these uncertain times.

The steady erosion of undergraduate ophthalmology teaching, which has been acutely exacerbated by the COVID-19 crisis, has led to a lack of basic ophthalmology examining skills and knowledge amongst clinicians of other specialties.

Concurrently, there has been a rise in the proportion of elderly in the population, which is contributing to the increasing prevalence of ophthalmic diseases in the general population.

Consequently, there is a risk that the lack of ophthalmology exposure at medical school will contribute to the misdiagnosis and mismanagement of ocular diseases and an overreliance on allied health specialties.

Ophthalmology teaching at medical schools must be redesigned to readdress this issue, and the disruption of the medical school curriculum caused by COVID-19 represents an excellent opportunity to do so.

As the COVID-19 virus spread, governments soon realized that strict social distancing measures were the only way of stemming the rising infection rate. Lockdowns were imposed, with schools and universities both being shut down.

Some teaching was moved online, but in general, teaching was suspended and exams were delayed or scrapped altogether. As a result, there was a reduction in the available time for medical students to shadow clinicians to further their clinical exposure.

Although many medical schools asked medical students to come back early to make up for the lost clinical time, the compressed timetable on their return did not fully compensate for the lost time. This affected marginalized specialties such as ophthalmology disproportionately, where the time spent by students is already minimal.

Most medical schools in the UK spend no more than two weeks of compulsory dedicated ophthalmology teaching throughout medical school, which often takes place in the final clinical years.

If compressed further, it would indisputably lead to holes in essential ophthalmic knowledge. In medical schools where an ophthalmology placement was protected in length, it is quite plausible that students may have sought to use that time to brush up on skills deemed more essential or core to the medical school curriculum, thus leading to the further neglect of the ophthalmology curriculum.

Given that medical students have been given the task of achieving the same competencies within a shorter period, we must modify ophthalmology teaching to take advantage of recently developed higher yield teaching methods, including online e-learning modules that equip medical graduates with sufficient ophthalmic skills to treat their patients.

Methods for improving undergraduate ophthalmology teaching at the undergraduate level are discussed below.

The Mixture of E-Learning Modules

The COVID-19 pandemic has brought e-learning, lectures over Zoom, and other distance learning initiatives to the forefront of medical teaching. During the pandemic, most medical lectures, ward rounds, or small group teaching groups were administered using Zoom.

Later, lectures were recorded and were uploaded to virtual learning environments so that students could watch them at their convenience. These teaching methods have had a favorable response amongst medical students for specialties including ophthalmology.

This is because the recorded sessions or e-learning modules have allowed students to study whenever it was most convenient for them, to pause the lecture as necessary, and revisit the material easily at a future date.

We suggest that this change brought about by the COVID-19 pandemic should be incorporated into the future curriculum for ophthalmology given its favorable response to date.

Small group teaching
Although recorded teaching and e-learning modules are highly effective, they cannot replace student-teacher interaction completely. This type of interaction is especially vital in the teaching of examination techniques and their nuances.

We suggest that teaching students in small groups should continue for basic ophthalmic examination skills with an opportunity to also explore topics covered in recorded lectures and e-learning modules as well.

A Specific Timetable

William Osler once remarked that “To study the phenomena of disease without books is to sail an uncharted sea, while to study books without patients is not to go to sea at all.” Students must examine patients and observe their treatment in the clinic.

Too often, placements in all specialties are insufficiently structured, and students enter clinics without a clear understanding of what they need to observe and examine in the clinic.

Ophthalmology departments, in conjunction with clinical schools, should have a clear list of problems that medical students should gain competence in preparation for examining and managing patients at a primary care level.

Competency-Based Curriculum & Formative Exam Specific for Ophthalmology

All the above teaching initiatives must be backed up by a competency curriculum and an exam specific to ophthalmology. Many schools incorporate the assessment of ophthalmology into wider exams.

As a result, students often neglect the topic in favor of higher yield specialties leading to a lack of expertise in ophthalmology.

A short formative Single Best Answer(SBA) test administered at the end of an ophthalmology block mapped to the competencies they have been asked to achieve during the block may carry the necessary incentive to persuade medical students to invest the time needed to learn the essential skills of ophthalmology.

Although this test will be entirely formative in that it will not contribute to final rankings or appear on a university transcript, we may use it as a method to identify students who are in further need of basic ophthalmic training. It has been shown that a competency-based curriculum is both more effective and more positively received in comparison to a content-based curriculum.

The COVID-19 pandemic has shown that virtual teaching methods can be employed effectively, and most importantly, have been met with a positive response amongst the medical student cohort.

Moving forwards from the pandemic, these teaching methods should be incorporated into a new ophthalmology curriculum to ensure that medical students graduate with the essential skills to provide basic ophthalmic care for their patients.