Teaching by the slit-lamp

Ayesha Karimi, National Rep for the UK

‘Medicine is learned by the bedside and not in the classroom’, by Sir William Osler. As valuable today, as decades previously. It is reported that in real practice history taking can help a physician diagnose up to 56% of patient problems and this figure rises to 73% with a physical examination.

However, there has been a gradual decline in ‘bedside’ teaching and more tutors have turned to lectures, presentations, simulations, discussions, etc. Busier hospitals, increased patient throughput, more reliance on high-quality reliable scans and lab-testing other than physical examination, all means reduced opportunities for slit-lamp based teaching.

Why teach by the slit-lamp?

Teaching by the slit-lamp can improve history-taking, examination and communication skills. It not only reinforces theoretical knowledge, but also develops the rapport and relationships with patients. It makes the educational process as ‘real’ as possible. Rather than listening to a lecture or reading from a book, learners have a more practical and memorable experience. It is much easier understanding the difference between flare and cells in the anterior chamber or the different types of corneal dystrophies when a case with relevant signs is in front of you. Not only do the trainees get a chance to practice and improve their consultation skills, but an interactive discussion regarding differential diagnoses, rationale behind investigations and management options can occur. Additionally, patients and relatives value teaching in this way, as they get an opportunity to spend more time with the healthcare professionals and sometimes understand their conditions and management better as a result.

Why not?

It is time consuming and requires space. Patients can decline, they may feel uneasy or under the spotlight. Additionally, trainees can feel exposed being tested in front of a patient or relatives.

How to improve slit-lamp teaching

Preparation and planning are key, both from the tutor as well as the trainees. Tutors should understandably have ophthalmic knowledge and teaching skills. The smaller the group, the better the participation. It avoids overcrowding and can be less distressful to the patient. The tutor should acquire appropriate consent from the patient, keep the patient informed on what to expect and make sure patient comfort and anxiety is considered. Tutors may want to cover some ground rules with the trainees on what aspects to focus on. It is beneficial to establish the previous knowledge of the trainees and a relevant case with good clinical signs should be selected. The trainees should have background knowledge but should also be familiar with the equipment to examine. Trainees can be prompted to look for specific signs or focus on a particular part of the eye to find signs themselves