Structured simulation-based training with frugal ophthalmic instruments rapidly equips non-ophthalmologists to identify malarial retinopathy

BackgroundMalaria, particularly cerebral malaria, poses a significant health threat, especially for children in sub-Saharan Africa. Identification of malarial retinopathy (MR) has diagnostic value in cerebral malaria but can be impractical due to lack of availability of trained and equipped ophthalmic specialists. Recent developments in low-cost simulation tools and ophthalmoscopes offer the potential to train non-ophthalmologists to offer fundus assessments in low-resource settings. MethodsTwenty non-ophthalmologist healthcare providers in Malawi attended a training program focused on identification of MR using direct and binocular indirect ophthalmoscopy. The curriculum included didactic sessions, hands-on practice with simulation eyes, and assessment of skill acquisition with immediate feedback. Pre- and post-training confidence surveys were conducted. ResultsParticipants demonstrated significant improvement in identification of malarial retinopathy after completing the training, with a mean accuracy of 83%. Clinician confidence levels increased across all domains of retinal examination covered in the course. ConclusionStructured simulation-based training using frugal ophthalmoscopes can equip non-ophthalmologists with skills to identify MR in simulation eyes. Future work should focus on long-term skill retention and validation in a real-world clinical setting.