Referral Notes:

  • NYU Langone was one of the nation’s first academic centers to acquire an advanced suite of ophthalmic clinical simulation tools to enhance ophthalmology education.
  • The suite includes a slit lamp, an indirect ophthalmoscope, and a direct ophthalmoscope, with simulated clinical sessions tapping into a comprehensive database of ocular diseases.
  • Ongoing studies are assessing how effectively clinical simulation correlates with the real-world performance of trainees.

In 2023, the Department of Ophthalmology at NYU Langone Health became one of the first academic centers in the nation, and the first in New York City, to acquire a suite of advanced simulation tools to teach ophthalmology residents how to perform clinical examinations. Housed in the Ophthalmology Simulation Lab, the tools enable trainees to perform exams on digital model eyes, closely simulating the experiences they will likely see in clinical practice.

“Our new clinical simulation tools allow trainees to refine their exam skills in a low-stress simulation environment. [They] improve both the trainee and patient experience.”

Christina R. Prescott, MD, PhD

“Our new clinical simulation tools allow trainees to refine their exam skills in a low-stress simulation environment. These tools improve both the trainee and patient experience, since the trainees are much better prepared for their actual patient exams,” says Christina R. Prescott, MD, PhD, director of the Division of Cornea Services and vice chair for education in the department.

“Patients generally feel uneasy sitting still while having a bright light shone in their eye,” Dr. Prescott adds. “Ensuring trainees have their skills honed before they start working with patients makes the experience better for everyone involved.”

Simulation Hones Clinical Skills

Surgical simulators have been used in ophthalmology for over 15 years, with NYU Langone’s Simulation Lab also among the early adopters of cataract surgery simulation. However, integrating simulator-based training into clinical education frameworks is relatively new.

The suite contains three tools: a slit lamp, an indirect ophthalmoscope, and a direct ophthalmoscope. During a simulated session, trainees can practice with each of the tools and obtain real-time feedback on their performance.

The system includes a comprehensive database of ocular diseases that is continually being updated. As trainees progress, they can test their ability to identify the ocular findings associated with different ocular conditions.

“In addition to common conditions, the database contains diseases that residents are unlikely to encounter in routine clinical practice,” says Dr. Prescott. “Take Zika virus, for example. The model will showcase all the findings of an eye infected by the virus.”

Early feedback on the simulation equipment has been overwhelmingly positive, Dr. Prescott says. “Our trainees love it. The medical students and early residents mostly use the slit lamp. The more senior residents use the indirect to perfect their peripheral retina exam and the gonioscopy modules on the slit lamp.”

Training Beyond Ophthalmology

While the clinical simulation tools will be mostly used to train ophthalmology residents, other specialties such as neurology, pediatrics, and emergency medicine, may also benefit from training on the direct ophthalmoscope.

Dr. Prescott notes that this device is sometimes used by these specialists to assess the optic nerve, but its potential is much broader.

“Many providers are not using the direct ophthalmoscope to its full potential,” says Dr. Prescott. “With the proper technique, you can check for macular degeneration, glaucoma, and other eye conditions.”

Dr. Prescott is currently working with neuro-ophthalmologist Janet C. Rucker, MD, and other members of the neurology department to develop training modules for the direct ophthalmoscope simulation tool. Though starting as a collaboration with neurology, the goal is to make the training program available for other specialties, including emergency medicine.

Fostering Original Research

Since the arrival of the new tools, trainees have already begun to conduct their own independent research. A recently completed resident-led project assessed how accurately the simulation equipment translates to clinical performance. The results have been submitted for publication.

“We assessed the degree to which clinical simulation correlates with the real-world performance of medical students, residents, and attending physicians and found a strong correlation between level of training and performance on specific modules on the simulators,” says Dr. Prescott.

Given the past success of surgical simulators in ophthalmology training, Dr. Prescott is optimistic that the clinical simulation tools will yield similar results—and is excited that NYU Langone will be leading the way.