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To enact sustainable change to ophthalmology teaching, we developed a targeted needs assessment study to elicit the perspectives of Canadian medical students based on step 2 of Kern's 6-step method for curricular design.
A cross-sectional needs assessment survey (Appendix 1, available online) was developed using relevant literature on curriculum development and in collaboration with a national panel of 4 ophthalmology educators involved in undergraduate teaching and 2 medical students. From January to May 2021, medical students enrolled in any Canadian medical school were invited to complete the survey. Statistical analysis was done using SPSS version 27 (IBM, Armonk, NY), and participant responses were summarized in frequencies or means. This study was approved by the Dalhousie University Research Ethics Board.
The survey was completed by 155 participants with representation from 15 of 17 Canadian medical schools. Respondents came from the classes of 2021 (12.4%), 2022 (24.2%), 2023 (28.1%), and 2024 (33.3%). The adequacy of the medical school curriculum in providing exposure to ophthalmology was rated on average as 42 of 100 points. Students reported that commonly taught topics in ophthalmology were anatomy (75%) and clinical skills (65%). Most students desired more procedural skills (74%), surgical skills (73%), clinical skills (56%), and clinical reasoning (52%) teaching (Fig. 1). Most students (90%) were interested in virtual teaching modalities (Fig. 2).
Kern's 6-step model for curriculum development is a systematic approach to developing an educational program.
The first step is problem identification and general needs assessment. It has already been well established by residents and educators that there is a need to improve undergraduate medical ophthalmology teaching in Canada.
To our knowledge, this is the first comprehensive study looking at medical student perspectives on Canadian ophthalmology education. Our findings can be used to inform step 3, which is to define the goals and objectives of an undergraduate ophthalmology curriculum, and step 4, which is to determine the most effective educational strategies to deliver this content.
This study had balanced representation from different medical schools and class years. Overall, participants reported less than adequate ophthalmology training. These findings are comparable with previous studies on residents and in international settings.
Considering novel ways to increase the accessibility of ophthalmology, such as through virtual, asynchronous means, may be an equitable and feasible solution to close this knowledge gap. Virtual methods for teaching ophthalmology have previously been found to be effective.
Encouragingly, the majority of students in our survey were interested in virtual teaching. Specifically, more procedural skills, surgical skills, clinical skills, and clinical reasoning teaching were desired by students. It may be beneficial for educators to clarify what the knowledge expectations are for graduating medical students because it is possible that there is a disconnect.
Limitations of this study include the relatively small sample size. Most participants attended large, English-speaking institutions. Any national curricular initiatives should incorporate francophone perspectives. Additionally, this survey was implemented when many institutions were adjusting curricula to be delivered safely during the COVID-19 pandemic. The cancellation of preexisting programming may partially explain the dissatisfaction with ophthalmology education.
Footnotes and Disclosure
The authors have no proprietary or commercial interest in any materials discussed in this letter. The authors received no financial support for the research, authorship, and/or publication of this letter.