Abstract:

Project Rationale:
Despite its importance to practice, ocular teaching has been marginalised in modern medical curricula. In metropolitan students and graduates this has engendered low confidence in ophthalmic knowledge and clinical skills. The confidence of this population rurally may be even lower given challenges posed by education in this setting. Remit therefore exists to examine tertiary eye teaching in regional areas. This thesis will also compare confidence in ophthalmology between a rural and metropolitan study cohort.

Methods:
A cross-sectional survey of final-phase medical students and junior medical officers (JMOs) was conducted across rural universities and hospitals to characterise tertiary ophthalmology teaching. The questionnaire was modelled on published research. Self-confidence in knowledge and skill topics comprising the International Council of Ophthalmology (ICO) graduate curriculum were recorded on a 5-point Likert scale. Exploratory factor and multivariate linear regression analyses were conducted.

Results:
Among the 221 participants, lectures were the most received teaching modality while small-group tutorials were most preferred. Rural students received fewer hours of teaching than their metropolitan counterparts. Surveyed knowledge and clinical skill topics were grouped into three factors: ophthalmic knowledge, ophthalmology-only and neuro-ophthalmic skills. Rural confidence was lower in ophthalmology-only skills (rural = 2.27/5, 95% CI = 2.13–2.41; metropolitan = 2.54/5, 95% CI = 2.47–2.62; =. 001) and ophthalmic knowledge (rural = 2.57/5, 95% CI = 2.47–2.68; metropolitan = 2.86/5, 95% CI = 2.81–2.91; = .000) but higher in neuro-ophthalmic skills (rural = 3.67/5, 95%CI = 3.53-3.81; metropolitan = 3.40/5, 95%CI = 3.33-3.47; = 0.001).

Conclusion:
Ophthalmological instruction received by regional final-phase medical students and JMOs is insufficient compared to that received in metropolitan centres. It is likely that this has manifested itself in lower rural confidence across key areas of ophthalmic clinical skills and knowledge. To rectify these shortcomings, university curriculums must devote greater time to ophthalmology teaching and adopt more clinically orientated teaching methodologies. To ensure the graduate workforce is proficient in managing ocular presentations, research into associations between confidence and objective competence must be performed. Given the endemic health issues which afflict country Australia, it is critical that shortcomings in rural ophthalmology education are rectified.

Keywords:

Ophthalmology education, Rural Health education, Self-Assessment, Education, Medical, Undergraduate, Ophthalmology Knowledge.