The book is written for the clinical skills subject of the medical curriculum. Medical schools teach this at varying stages, some introducing the subject in the beginning years (graduate medical schools years 1 & 2) and others at year 3 (traditional/hybrid curricula, usually 5 or 6 years). Specialty Colleges and RACP teach a clinical skills subject in the early part of basic training which takes place after PGY1 & 2.
Smartphone fundoscopy was found to be significantly more useful and easier to use than other modalities. Educators should optimise student access to novel fundoscopy technologies such as smartphone fundoscopy which may mitigate the technical challenges of fundoscopy and reinvigorate use of this valuable clinical examination.
Fundoscopy remains one of the great teaching challenges despite being a core skill for clinicians [1, 2], recognised by the International Council of Ophthalmology as one of seven basic ophthalmic medical education competencies . Fundoscopy offers a non-invasive view of the central nervous system, revealing clinical signs of raised intracranial pressure [4, 5], end-organ damage from hypertension and diabetes [6, 7] and even the risk of stroke [8, 9]. Despite the clinical benefits of fundoscopy for patients, it is infrequently performed in routine clinical practice across community internists , hospital physicians , emergency physicians  and even neurologists . Current fundoscopy practice is not only infrequent but poorly reliable. Bruce et al. found that 13% of ED patients who warranted fundoscopy had acute life or vision-threatening fundus pathology, yet none of these findings were identified by emergency physicians using the traditional direct ophthalmoscope (TDO) .
While current clinical practice is limited by the shortcomings of TDO, novel fundus imaging technologies offer a potential solution. The changed optics of the panoptic ophthalmoscope offer a wider field of view than the TDO, probably contributing to higher diagnostic accuracy in some studies [14,15,16]. Fundus photography is closer to the gold standard of dilated expert examination than TDO [17, 18]. Where novel technologies create a digital fundus image, the difficulties of interpreting findings may be mitigated  by the ability to modify, review and transmit the fundus image. Technological improvements to fundus imaging utilising the ubiquitous smartphone could improve device availability [20,21,22] alongside reduced technical barriers, and have shown similar diagnostic accuracy to fundus photography in some studies . In the era of COVID-19 social distancing, the physical proximity of patient and clinician when using the TDO is potentially hazardous to both . Despite the burgeoning availability of fundus-viewing technologies  and fundoscopy simulators, there is a paucity of comparative effectiveness studies  and a lack of validated tools for comparing their performance.
The present decline in fundoscopy has been attributed to technical difficulties in performing traditional ophthalmoscopy, compounded by the challenge of interpreting clinical findings . From the perspective of doctors choosing to examine the fundus or not, these causes align respectively with perceived ease of use (PEOU) and perceived usefulness (PU), as described in the Technology Acceptance Model . Perceived ease of use and usefulness have been repeatedly shown to predict future use of technologies [28,29,30,31], and underlie attitudes and behaviours towards health technology [32,33,34,35]. If fundoscopy is easier to perform and interpret, uptake by medical students and clinicians will likely improve. This should lead to better patient outcomes, so long as future studies concurrently demonstrate acceptable diagnostic accuracy of novel fundoscopy devices.
After each station students rated: the quality of training; their perceived ease of viewing the fundus; and confidence with the equipment. At the end of the training day, students were also asked to score the modalities of fundoscopy according to PU and PEOU; and how frequently they would examine the fundus during future general examinations (see Additional file 2).
There was no difference in the perceived quality of training between modalities (one-way ANOVA N=85, F (2, 15)=1.50, p=0.19). Eighty-five participants (58%) stated that they would perform fundoscopy as a regular part of their general examination if not asked to do so by their supervisor.
The difficulty of using a TDO in our study is consistent with previous literature [18, 41, 42]. A study of 101 medical students conducted after our trial found TDO was harder to use than the smartphone-mounted D-Eye on an unvalidated Likert scale . Mamtora et al. found smartphone fundoscopy improved the accuracy and quality of fundal examinations by medical students when compared with TDO . Mandal and colleagues developed an ease of use score for fundoscopy based on the capacity to identify anatomical details , but the methodology for developing this scale was not reported, and no psychometric validation was performed. To our knowledge, our study is the first to report a validated score of ease of use or usefulness for fundoscopy.
Limited confidence with fundoscopy examination has been widely reported, and identified as a significant barrier to usage [42, 47, 54]. We found after brief training that medical students were significantly less confident viewing the fundus using the traditional ophthalmoscope (p=0.001) or prototype (p=0.019) than the Panoptic, despite additional instruction for TDO. We found no significant differences in confidence between the novel fundoscopy technologies NMC, D-Eye, iExaminer or Panoptic.
Our study has some notable limitations. The response rate was 43% (146/343), although the known characteristics of our participants were not significantly different to the entire student cohort. Our participants were second-year medical students with limited clinical experience whose perceptions of usefulness are likely to differ from experienced clinicians. However, perceived ease of use is less likely to be confounded by clinical experience and may therefore have a more general application. This could be tested by future studies exploring perceived ease of use and usefulness amongst experienced clinicians.
The Westmead Hospital Dept of Ophthalmology has received research funding for other clinical trials from Hill-Rom/Welch Allyn. Welch-Allyn, TOPCON and Sydney Scientific loaned the training equipment used during this study to the University of Sydney and provided technical assistant staff for the study. The authors have not received any personal funds, and retained independence over the design, analysis and publication of this study.
Two research nurses were appointed at each clinical setting to collect data. On the predetermined day of data collection, research nurses identified and screened all patients in the selected ICUs at the medical settings who met the inclusion criteria in coordination with charge and bedside nurses. Then research nurses used screening forms among all eligible patients which included reviewed medical records, performed skin examination for pressure injuries found on the skin or mucous membranes with a medical device in use at the location of the injury and documented all MDs attached to the patient. Skin assessment was coordinated with routine nursing care to reduce the patient's physical and psychological burden.
Preservation Section members came up with four program proposals which were submitted for consideration for the 2001 meeting in Washington. We are also co-sponsoring two more proposals with other sections. Thank you to Linda Overman for coordinating this effort. If you're interested in learning about or discussing a topic, this is your chance! Put your idea into proposal form this summer. We have a problem with people being overwhelmed because the deadline to submit proposals comes very soon after the Annual Meeting and when folks are gearing up for Archives Week activities. Let's avoid the last-minute scramble next year. The Committee Chairs and I are looking forward to hearing from you.Preservation Section LeadershipSarah Talley, Chair (Utah State Archives & Records Administration)email@example.com Diana Vogt-O'Connor, Vice Chair/Chair-Elect (National Park Service)firstname.lastname@example.orgPamela Hackbart-Dean, Chair, Nominating Committee (Georgia State University)email@example.com Glenda Stevens, Member-at-Large(Texas Christian University) firstname.lastname@example.orgClark Center, Member-at-Large(University of Alabama) email@example.com Cathy Lynn Mundale, Chair, Education Committee(Atlanta University)firstname.lastname@example.org Sheila McAlister, Chair, Outreach Committee(University of Georgia)email@example.com Julie Graham, Web Administrator(University of California, Los Angeles)firstname.lastname@example.org Linda Overman, Chair, Program Committee (Alabama Department of Archives & History)email@example.comElli Bambakidis Co-Chair Publications Committee(Dayton & Montgomery County Public Library)firstname.lastname@example.orgAnke Voss-Hubbard, Co-Chair Publications Committee(Illinois Wesleyan University)email@example.com Clark Center & Anke Voss-Hubbard, Newsletter Co-editorsThomas Connors, Council Liaison(University of Maryland)firstname.lastname@example.org[Back to Top]
Moving Theory into Practice: Cornell's Digital Imaging Tutorial As a follow-up to its book and workshop, Cornell University's Preservation & Conservation Department has now issued an online tutorial version of "Moving Theory into Practice: Digital Imaging for Libraries & Archives." The book, by Anne R. Kenney and Oya Y. Rieger, is available from RLG, see: >. The workshop continues into 2001, when it will be offered three times at Cornell: May 14-18 (registration begins December 15, 2000); July 23-27 (registration from March 1); and October 1-5 (registration from June 1). For further information on the workshop, see: The National Park Service Museum Management Program announces the publication of the next supplement of the Conserve O Gram technical leaflets with leaflets on the following topics: * 19/21 Planning Digital Projects for Preservation and Access * 19/22 Managing Digital Projects for Preservation and Access * 02/12 Safe Techniques for Archival Surveying and Assessment *02/12 An Introduction to Respirator Use in Collections Management. The Leaflets will be posted shortly with the several hundred other Conserve O Gram leaflets on the Museum Management Program Web site of the National Park Service at: www.cr.nps.gov/csd/publications/index.htm. While at the Web site, please take a few minutes to look at the other features, including: Additional Publications, such as: - Disaster Planning Primer for downloading - A Museum Management Bibliography with direct links to many publications on preservation; A Number of Online Exhibitions featuring NPS Collections and Activities, such as: - A New Lease on Life: Museum Conservation in the National Park Service - Legends of Tuskegee: Booker T Washington, The Tuskegee Airmen, and George Washington Carver - Camp Life: Civil War Collections from Gettysburg National Military Park - Symbols in Battle: Civil War Flags in NPS Collections - American Visionaries: Frederick Douglass - American Visionaries: Thomas Moran; Park Profiles, or Brief Summary Descriptions of the archival and museum collections in the parks; Treasures of the Nation, or a brief illustrated tour of some of the high points of NPS archival and museum collections."Submitted by:Diane Vogt-O'Connor, National Park Service The National Preservation Office (NPO) of the British Library website now contains some of NPO's preservation leaflets. The leaflets are available in PDF format at Paper copies of the same leaflets are available from the National Preservation Office, The British Library, 96 Euston Road, London, NW1 2DB, England or email: email@example.comNational Archives & Records Administration 16th Preservation ConferenceThe 16th Annual National Archives and Records Administration (NARA) Preservation Conference 2001, A Case Oddity: Preserving the Physical Evidence of Artifacts and Records, is scheduled for March 27, 2001, National Archives at College Park, 8601 Adelphi Road, College Park, MD.The 2001 conference will bring together conservation scientists, preservation professionals, archivists and records managers to discuss technical issues related to maintaining and handling artifacts and records found in holdings subjected to or subject to forensic examination. 2b1af7f3a8