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Abstracts from the Association of British Neurologists Annual Meeting 2011
036 The TOS study: can we improve the ophthalmological assessment of medical patients by foundation year doctors?
  1. V Cahill,
  2. E Willetts,
  3. D Nicholl
  1. Dept of Neurology, City Hospital, Birmingham, UK


Fundoscopy is a vital part of the neurological examination. We surveyed Foundation trainees confidence in ophthalmoscopy as the 2009 FY curriculum made no mention of ophthalmology.

Methods In 2009, all FY trainees in two acute Trusts (n=65) were surveyed. This was repeated in 2011 in one Trust to assess any change due to interventions:

  • –More ophthalmoscopes,

  • –Trustwide guidelines on papilloedema management

  • –A local newsletter on fundoscopic skills

  • –The inclusion of ophthalmoscopy in the 2010 FY curriculum.

Results In 2009, 88% of trainees had had no training in ophthalmoscopy since graduation and 50% of doctors had used one <5 times in the preceding 6 months, this remained at 89% and fell to 36.8% respectively in 2011. In 2009, 48% were ‘not very confident’ at using an ophthalmoscope, and only 7% were confident at identifying the optic disc, compared with 45% and 13% in 2011. Their self-assessment of their ability to recognise abnormalities was poor—74%, 64%, and 62% in 2009 (63%, 66%, 58% in 2011) were ‘not very confident’ of their ability to identify papilloedema, diabetic and hypertensive retinopathy, although 86% of the consultants agreed that ‘competent use of an ophthalmoscope is an essential skill by graduation’. Only 5% of 2011 FY trainees were aware of the Trust guidelines.

Conclusions The interventions have not led to a significant difference in the self-reported confidence of FY trainees in the use of an ophthalmoscope. Other strategies will need to be adopted.

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  • Email: david.nicholl{at}