Direct ophthalmoscopy should be taught to undergraduate medical students—yes

The place of ophthalmology in the undergraduate medical curriculum is slowly fading—with certainty, and yet without objection. Over the past 30 years, the duration of the ophthalmology placement has dwindled in the United States,¹ the United Kingdom,² and elsewhere.³ The inescapable truth is that without renewed activism from ophthalmologists interested in the education of tomorrow’s doctors,¹ the ophthalmology clerkship—exposed by poor representation from ophthalmologists on medical school committees—may soon disappear entirely.^{1, 2, 3} The likely outcome is a generation of clinicians who lack confidence and competence in basic ophthalmic examination,¹ the management of simple eye complaints, and the safe triaging of patients under their care who develop serious ophthalmic disease.⁴

Skills in direct ophthalmoscopy among undergraduates have declined in parallel.⁵ Medical students lack confidence in direct ophthalmoscopy,⁶ and often request additional training to improve their performance.⁷ Several challenges exist for ophthalmologists and others involved in training of direct ophthalmoscopy: (1) reduced exposure to ophthalmology clinics where direct ophthalmoscopy is traditionally taught; (2) ownership of direct ophthalmoscopes in the United Kingdom has fallen since 1986 following withdrawal of grants traditionally used to fund them;⁸ (3) there is no clear consensus as to the standard of proficiency in direct ophthalmoscopy a medical student should satisfy;^{1, 9} (4) direct ophthalmoscopy is poorly represented in undergraduate examinations²—an influential determinant of student learning behaviour.

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