The first phases of the FOTO-ED study found that emergency providers perform significantly better with fundus photography than with direct ophthalmoscopy in the detection of fundus abnormalities. The authors hypothesised that by providing additional training to emergency providers, this would result in a further improvement in their performance. A web-based training package aimed at improving the review of fundus photography by these emergency providers was therefore evaluated. Emergency providers spent 31 minutes (median) training and evaluated 359 patients. Median post test scores improvement was six percentage points (p=0.06). Pre vs. post training, the emergency providers reviewed 45% vs. 43% of photographs; correctly identified abnormal findings in 67% vs. 57% of cases; and correctly identified normals in 80% vs. 84%. The web-based training showed a trend towards improved post test scores, however, it did not result in any changes in provider performance in the clinical setting at the specific institution. One reason for this failure to improve performance could be the short length of training; 30 minutes on average. It is possible that more intensive training may result in a more noticeable clinical improvement. The authors conclude that future efforts may prove more useful if directed at demonstrating the value of fundus photography and better integration of fundus photography reading into routine practice.

Fundus photography vs. ophthalmoscopy outcomes in the emergency department (foto-ed) phase iii: web-based, in-service training of emergency providers.
Bruce BB, Bidot S, Hage R, et al.
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Claire Howard

Salford Royal NHS Foundation Trust, Salford, UK.

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