ED Slit Lamp Interdisciplinary Training with Longitudinal Assessment in Medical Practice

Introduction: Eye emergencies make up for nearly three percent of the United States emergency department (ED) visits. While emergency physicians (EPs) should be trained to diagnose and treat these ophthalmologic emergencies, many trainees report limited ocular exposure and report insufficient training throughout their residency to confidently conduct a thorough a slit-lamp exam. Objectives: To teach emergency physicians how to complete a throughout slit-lamp exam using a simulation-based mastery learning (SBML) curriculum. Methods: We created an interdisciplinary curriculum on diagnosing eye pathologies and operating the slit lamp with independent readiness assessments (IRAT), multi-modal learning options (i.e. video recordings, PowerPoint, text-book references), targeted towards EP at a tertiary academic center. EPs would first demonstrate their initial slit-lamp competency in-person with a 20-item checklist and be asked to review our learning modules before completing their IRAT. EPs who score a minimal passing IRAT score will then be able to complete their second, in-person, teaching and demonstration session with an ophthalmology attending to demonstrate procedural mastery (minimal score >90%). Results: From 2021-2023,15 EPs (6 females and 9 males) were enrolled in ED SLIT LAMP. All EPs completed the final exam of the curriculum. The pre- and post-curriculum checklist scores increased by an average of seven points (p<0.002). 86.7 percent of EPs felt confident in completing a slit-lamp exam after the curriculum, in contrast to 20% at the beginning of the study. Five out of 15 physicians reported teaching learners within the 2-month post-curricular period, ranging from five to up to 30 students. The hands-on teaching was the most positively reviewed element of the curriculum. Conclusions: The SBML program successfully trained EPs on performing a comprehensive slit-lamp exam with promising results of downstream education to junior learners shortly after our pilot study. We encourage other institutions to leverage SBML as a teaching modality for procedural-based training and advocate cross-disciplined education initiatives.