Junior doctors in emergency departments lack confidence when managing ophthalmic emergencies
Reviewed by James Kirkpatrick

This systematic review assessed the confidence of doctors in the UK working in emergency departments (EDs) to manage ophthalmic emergencies, with secondary outcomes looking at doctor’s confidence in performing fundoscopy and using the slit-lamp, and training received in the ED. Following PRISMA guidelines, seven of 462 papers identified were included. Meta-analysis was not possible due to heterogeneity of the data. The studies collectively assessed 721 foundation year / senior house officer (FY1 / FY2 / SHOs), 117 emergency medicine (EM) specialty trainees (STs), 21 specialist, associate specialist (SAS) doctors and 97 consultants. Strong evidence came from three national surveys of SHO / FY2 doctors in 1997, 2003 and 2018; these showed a decline in junior doctors that felt “confident” to manage eye emergencies in EDs from a high of only 36.1% in 2003 to just 2.3% in 2018. When evaluating their secondary outcomes, they found that 10.7% of FY2s and 29% of STs and consultants in EDs confident to perform fundoscopy, despite the General Medical Council stipulating this as a core competency of newly qualified doctors. Confidence in FY2 / SHOs to use the slit-lamp in EDs fell from a high of 39.1% in 2003 to just 9.8% in 2018. On the question of training, in the 2018 national survey of FY2s, 59% (204/346) had received no formal ophthalmology training in EDs and in a 2014 study, 65% (14/21) of FY2s stated that “undergraduate ophthalmology teaching at medical school had not prepared them well for their ED placement.” The authors were forthcoming with the limitations of this systematic review recognising (1) only seven studies were available, (2) quality of the papers was variable with a mean AXIS score of 12/20, and (3) there was only good data for FY2 / SHOs but not for ED STs / SAS / consultants. The authors conclude that confidence in FY2 / SHOs in EDs to manage ophthalmic emergencies is low and that further training in medical school and in ED rotations is needed. Further studies are required to establish the confidence of EM trainees and consultants. Confidence of emergency nurse practitioners and other allied health professionals in EDs was not established, which may be relevant given their increasing role in emergency eyecare in EDs.

Confidence of emergency department doctors in managing ophthalmic emergencies: a systematic review.
Mendall J, Tolley A, Parisis V, et al.
EYE
2024;38:2751–60.