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International Journal for Quality in Health Care 2004 16(5):363-365; doi:10.1093/intqhc/mzh065
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International Journal for Quality in Health Care vol. 16 no. 5 © International Society for Quality in Health Care and Oxford University Press 2004; all rights reserved

Fundus anomalies: what the pediatrician’s eye can’t see

Yair Morad, Yaniv Barkana, Isaac Avni and Eran Kozer1

Department of Ophthalmology and the1 Pediatric Emergency Medicine Unit, Assaf Harofeh Medical Center, Sackler School of Medicine, Tel Aviv University, Israel

Background. With increasing workloads for hospital doctors, routine funduscopy may be abandoned. It is not known how often pediatricians perform funduscopy and how skilled they are in performing it.

Objectives. To assess hospital pediatricians’ ability to diagnose abnormalities of the ocular fundi and to determine whether a short tutorial can improve their skills.

Methods. Physicians working at the pediatric division of a university-affiliated hospital participated in the study. All participants completed an anonymous questionnaire regarding their experience and skills in performing funduscopy. A pictorial quiz containing 20 fundus pictures of common findings in children was given. After completing the quiz, a 45-minute tutorial on common fundus anomalies was given. At the end of the lecture, the same quiz was given again. The percentage of correct answers for each quiz was scored.

Results. Sixteen physicians completed the study (11 pediatric residents and five senior pediatricians). Most participants did not feel competent at performing a fundus examination [mean score on a visual analog scale 1.96; range 0 (not competent at all) to 7]. The mean score for the fundus pictures quiz given before the tutorial was 48% (range 37–58%). The average score of the residents (47%) did not differ significantly from that of the senior pediatricians (42%). After the tutorial the mean grade increased significantly to 60% (P = 0.002). This was true both for residents (63%; P = 0.001) and seniors (55%; P = 0.004).

Conclusions. Our study shows that funduscopy is being neglected by pediatricians. Even a short tutorial may significantly improve the diagnostic value of this test.

Keywords: fundus oculi, pediatrics, physical examination

Address reprint requests to Yair Morad, Department of Ophthalmology, Assaf Harofeh Medical Center, Zerifin 70300, Israel. E-mail: ymorad{at}013.net.il

Accepted for publication May 9, 2004.


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