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Undergraduate ophthalmology education in Canadian medical schools: a cross-sectional survey

Published:September 29, 2020DOI:https://doi.org/10.1016/j.jcjo.2020.08.009
      In recent years, concerns have been raised about the adequacy of ophthalmology education in Canadian medical schools. A 2009 survey of recent Canadian medical school graduates reported that the majority of graduates believed that they did not obtain sufficient ophthalmology knowledge or skills during medical school.
      • Noble J
      • Somal K
      • Gill HS
      • Lam W-C.
      An analysis of undergraduate ophthalmology training in Canada.
      To improve undergraduate ophthalmology training, it is necessary to have an understanding of the current curricula in Canadian medical schools. The last study to describe the ophthalmology training provided in preclerkship and clerkship in Canada was conducted in 1998, and therefore an updated evaluation was warranted.
      • Bellan L.
      Ophthalmology undergraduate education in Canada.
      We conducted a survey-based study of the 17 Canadian medical schools. An online survey, designed using the Qualtrics Online Survey Software (Qualtrics, Provo, UT), was distributed via email to representatives at each medical school, and follow-up was performed with emails and phone calls. The survey was adapted from 3 previous studies conducted in the United Kingdom, Asia/Australia, and Canada; the Medical Council of Canada (MCC) medical expert learning objectives; and the International Council of Ophthalmology (ICO) curriculum guidelines.
      • Bellan L.
      Ophthalmology undergraduate education in Canada.
      • Baylis O
      • Murray PI
      • Dayan M.
      Undergraduate ophthalmology education – a survey of UK medical schools.
      • Fan JC
      • Sherwin T
      • McGhee CN.
      Teaching of ophthalmology in undergraduate curricula: a survey of Australasian and Asian medical schools.

      Medical Council of Canada. Examination Objectives Overview. https://mcc.ca/objectives/; 2019 [accessed 1 April 2019].

      International Council of Ophthalmology
      Principles and guidelines of a curriculum for ophthalmic education of medical students.
      This study was approved by the Health Sciences Research Ethics Board at Queen's University (OPTH-226-18).
      The survey was completed by 14 of 17 Canadian medical schools (82%). One school did not devote any time to ophthalmology in its curriculum. The remaining 13 schools all devoted time to ophthalmology in preclerkship. The median number of hours devoted to ophthalmology in preclerkship was 20 with considerable variability between schools (range 0–100). The most common teaching style was lecture followed by clinical experience and small group/problem-based learning (Fig. 1). Seven schools also offered an ophthalmology rotation as part of their core clerkship. The percentage of students who participated in the rotation was variable (median 100%, range 10%–100%), because some schools offered ophthalmology as a selective rotation, whereby only a subset of the medical school class completed the rotation. The most common duration was 1 week (median 1 week, range 0.2–4 weeks), and the most common teaching settings were general clinics, specialty clinics, and emergency clinics (Fig. 2). The MCC objectives (eye redness, diplopia, strabismus and amblyopia, acute vision loss, and chronic vision loss) were well addressed by all of the schools, with the exception of the one aforementioned school that did not devote any time to ophthalmology in preclerkship or clerkship (Table 1). There was greater variability with regard to the ICO topics and clinical skills; however, the majority were still addressed by most schools (Table 1).
      Fig 1
      Fig. 1Preclerkship curricular time by teaching style at each medical school.
      Fig 2
      Fig. 2Composition of clerkship rotations at each medical school.
      Table 1Learning objectives addressed by Canadian medical schools
      MCC objectives, n (%)
       Eye redness13 (93)
       Diplopia12 (86)
       Strabismus and amblyopia13 (93)
       Acute vision loss13 (93)
       Chronic vision loss13 (93)
      ICO topics, n (%)
       Fundamentals and principles of ophthalmology (anatomy and examination)11 (79)
       Cornea and external diseases (red eye)12 (86)
       Lens and cataract11 (79)
       Neuro-ophthalmology9 (64)
       Vitreoretinal diseases10 (71)
       Glaucoma12 (86)
       Pediatric ophthalmology and strabismus11 (79)
       Disease of the eyelid, lacrimal system, and orbit10 (71)
       Ocular manifestations of systemic diseases9 (64)
       Intraocular tumours6 (43)
       Refraction and contact lens4 (29)
       Refractive surgery2 (14)
      ICO clinical skills, n (%)
       Visual acuity testing12 (86)
       External inspection with a penlight10 (71)
       Slit lamp examination10 (71)
       Pupillary reaction testing11 (79)
       Ocular motility testing10 (71)
       Direct ophthalmoscopy12 (86)
       Pupillary dilation7 (50)
       Intraocular pressure measurement7 (50)
       Anterior chamber depth assessment8 (57)
       Confrontation field testing10 (71)
       Upper lid eversion7 (50)
       Fluorescein staining of the cornea9 (64)
       Red reflex9 (64)
       Cover testing7 (50)
      MCC, Medical Council of Canada; ICO, International Council of Ophthalmology.
      In 1998, the median number of hours devoted to ophthalmology in preclerkship was 16 (range 1–45), and 7 of 16 medical schools (44%) had mandatory clerkship rotations. Therefore, the amount of curricular time devoted to ophthalmology has overall remained relatively stable over the past 20 years. However, the majority of Canadian medical students are still not being exposed to ophthalmology in a clinical environment, which is likely contributing to the previously reported deficiencies in the understanding of ophthalmology. Previous studies have advocated for the nationwide adoption of a minimum 1 week core ophthalmology clinical rotation that is based jointly on the ICO guidelines and the unique perspectives of Canadian medical schools.
      • Noble J
      • Somal K
      • Gill HS
      • Lam W-C.
      An analysis of undergraduate ophthalmology training in Canada.
      ,
      • Gostimir M
      • Sharma RA
      • Bhatti A.
      Status of Canadian undergraduate medical education in ophthalmology.
      Our results certainly lend further support to this proposal. Future research to determine the structure and feasibility of this clinical rotation is warranted.

      Footnotes and Disclosure

      The authors have no proprietary or commercial interest in any materials discussed in this article.

      Appendix. Supplementary materials

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