Training activity information
Details
Use an ophthalmoscope to visualise a patient’s eye
Type
Entrustable training activity (ETA)
Evidence requirements
Evidence the activity has been undertaken by the trainee repeatedly, consistently, and effectively over time, in a range of situations. This may include occasions where the trainee has not successfully achieved the outcome of the activity themselves. For example, because it was not appropriate to undertake the task in the circumstances or the trainees recognised their own limitations and sought help or advice to ensure the activity reached an appropriate conclusion.
Reflection at multiple timepoints on the trainee learning journey for this activity.
Reflective practice guidance
The guidance below is provided to support reflection at different time points, providing you with questions to aid you to reflect for this training activity. They are provided for guidance and should not be considered as a mandatory checklist. Trainees should not be expected to provide answers to each of the guidance questions listed.
Before action
- What does success look like?
- Identify what is expected of you in relation to this specific activity, considering learning outcomes related to performing and interpreting a range of ophthalmic imaging modalities, employing effective communication, assessing and managing risks in the testing environment, and selecting and operating ophthalmic imaging equipment.
- What does successfully using a direct or indirect ophthalmoscope involve, including patient positioning, using the correct aperture and lens power, achieving red reflex, focusing on the retina, and systematically examining the optic disc, macula, vessels, and periphery?
- Discuss with your training officer to gain clarity on what is expected of you when using an ophthalmoscope.
- What is your prior experience of this activity?
- Think about what you already know about the principles of direct and indirect ophthalmoscopy, operating the instrument, and identifying major retinal landmarks (e.g., optic disc, macula).
- Consider possible challenges you might face during the procedure, such as achieving a clear view (due to media opacities, small pupils), maintaining patient fixation, dealing with reflections, disorientation within the fundus, or identifying subtle pathology, and think about how you might handle them.
- Recognise the scope of your own practice for this activity, i.e., know when you will need to seek advice or help, and from whom, regarding difficult views, complex pathology, or using indirect ophthalmoscopy with lenses.
- Acknowledge how you feel about independently using an ophthalmoscope to visualise a patient’s eye.
- What do you anticipate you will learn from the experience?
- Consider the specific skills you want to develop in mastering direct ophthalmoscopy technique, systematically examining the fundus, recognising the appearance of normal anatomy and common retinal pathologies, and improving your ability to achieve a clear and comprehensive view – drawing upon previous experiences.
- Identify specific insights you hope to gain regarding optimal technique for different pupil sizes or refractive errors, how to navigate the fundus effectively, or the limitations of ophthalmoscopy compared to other imaging techniques.
- What additional considerations do you need to make?
- Consult actions identified following previous experience with fundus examination or using handheld instruments, if any.
- Identify important information you need to consider before embarking on the activity, such as the reason for the examination, whether specific pathology needs to be visualised (e.g., optic disc for glaucoma, macula for degeneration), and potential need for dilation to improve the view.
In action
- Is anything unexpected occurring?
- Are you noticing anything surprising or different from what you anticipate while using an ophthalmoscope to visualise a patient’s eye?
- Are you encountering situations such as difficulty maintaining a clear, steady red reflex or focus despite manipulation, or finding unexpected, subtle posterior pole pathology that requires immediate, careful re-examination?
- How is this experience comparing with previous experiences of similar activities, like using other visualisation equipment?
- How are you reacting to the unexpected development?
- Identify how this is impacting your actions while using the ophthalmoscope. Are you responding to the situation appropriately? Are you adapting or changing your approach? Is it affecting your ability to undertake the activity independently?
- In the moment, what steps are you taking, such as immediately changing the aperture size or filter to adjust for reflections or media opacities, or quickly re-checking your positioning relative to the patient to optimise the view?
- How are you feeling in that moment? Is the difficulty in obtaining a clear view affecting your confidence in your technical skills or ability to diagnose the fundus?
- What is the conclusion or outcome?
- Identify how are you working within your scope of practice when using an ophthalmoscope to visualise a patient’s eye e.g., are you documenting the limitations in visualisation due to patient factors or technical issues?
- Identify what are you learning as a result of the unexpected development e.g., gaining improved efficiency in adjusting the ophthalmoscope settings for different pupil sizes?
On action
- What happened?
- Begin by summarising the key points of the experience of using the ophthalmoscope (direct or indirect) to visualise the patient’s eye.
- Consider specific events, actions, or interactions that felt important during the examination, such as achieving the red reflex, focusing on retinal details, or systematically examining the disc, macula, and vessels.
- Include any ‘reflect-in-action’ moments, where you had to adapt to the situation as it unfolded, for instance, instantly adjusting the lens wheel to compensate for refractive error or changing the aperture to manage a small pupil. How did you feel during this experience?
- How has this experience contributed to your developing practice?
- Identify what learning you can take from this experience regarding ophthalmoscope use.
- What strengths did you demonstrate (e.g., technical proficiency with the instrument, systematic navigation of the fundus)?
- What skills and/or knowledge gaps were evident (e.g., difficulty achieving a clear view in challenging eyes or unfamiliarity with certain peripheral findings)?
- Compare this experience against previous ophthalmoscopy activities. Were any previously identified actions for development achieved? Has your practice in visualising the fundus improved?
- Identify any challenges you experienced during the examination (e.g., patient cooperation, media opacities, reflections) and how you reacted to these. Did this affect your ability to deal with the situation? Were you able to overcome the challenges?
- Identify anything significant about the activity, such as needing to seek advice or clarification on interpreting a difficult finding or escalating due to poor visualisation.
- Acknowledge any changes in your own feelings now you are looking back on the experience.
- What will you take from the experience moving forward?
- Identify the actions or ‘next steps’ you will now take to support the assimilation of what you have learnt, including from any feedback you have received about your use of an ophthalmoscope.
- What will you do differently next time you use an ophthalmoscope? Has anything changed in terms of what you would do if you were faced with a similar situation again?
- Do you need to practise any aspect of the activity further? E.g., Practising ophthalmoscopy on patients with different refractive errors or focusing on systematic peripheral examination.
Beyond action
- Have you revisited the experiences?
- Have you reviewed the actions identified in your previous reflections for using an ophthalmoscope to visualise a patient’s eye?
- What specific actions did you previously identify you would need to take to improve your practice, such as refining your direct or indirect ophthalmoscopy technique for visualising posterior structures?
- Have you completed these previously identified actions? If so, how did completing them impact your subsequent performance of this activity?
- Are you ready to demonstrate this new learning confidently and consistently when using an ophthalmoscope?
- Engage in professional storytelling about refining ophthalmoscopy techniques for complex posterior segment findings or managing patient cooperation during challenging visualisation sessions with peers, near peers, or colleagues. Has discussing these experiences changed your perspective or approach?
- How have these experiences impacted upon current practice?
- Consider how the accumulated learning from performing or reflecting on using an ophthalmoscope will support you in preparing for relevant observed ‘in-person’ assessments for the module, such as DOPS or during clinical experiences where ophthalmoscopy is performed. This relates to demonstrating your ability to use an ophthalmoscope to visualise eyes.
- How has your practice related to using an ophthalmoscope developed and evolved over time? This includes recognising when something related to this activity is beyond your scope of practice, such as when posterior segment findings are complex or require further investigation beyond basic visualisation.
Relevant learning outcomes
| # | Outcome |
|---|---|
| # 2 |
Outcome
Perform and interpret a range of ophthalmic imaging modalities. |
| # 4 |
Outcome
Employ effective communication with a range of individuals including the patient and the multidisciplinary team. |
| # 7 |
Outcome
Assess and manage risks in the testing environment. |
| # 8 |
Outcome
Select and operate ophthalmic imaging equipment. |