Assessing The Impact Of An Ophthalmology Teaching Program On Residents' Confidence In Corneal Foreign Body Management In The Emergency Department

Corneal foreign bodies (FB) are a common presentation in emergency departments (ED). Prompt intervention prevents complications such as infection and scarring. However, early career residents working in ED often lack confidence in managing corneal FB due to limited ophthalmology training in undergraduate education. This study evaluates the efficacy of a simulated corneal FB teaching programme in improving confidence and skill acquisition among residents.

The study was conducted at two UK hospitals: St Thomas’ Hospital, London, and Royal Blackburn Teaching Hospital, Lancashire. Residents participated in a structured simulation-based training programme integrated within clinical teaching sessions.

Between January 2024 and February 2025, residents received small-group teaching on basic eye anatomy and ophthalmic assessment utilsing a slit lamp. A simulation model was created using expired agar plates sourced at no cost from the microbiology lab. The agar plates were suspended in front of the slit lamp, and small cake sprinkles were used as simulated corneal FBs. Students practiced FB removal using a 25-gauge long bevelled orange needle under slit lamp guidance. A 10-point Likert scale questionnaire was administered before and after the training to assess confidence in performing a slit lamp examination, identifying, removing, and managing corneal foreign bodies.

Of the 25 participants included within this study, none received prior slit lamp training. The average effectiveness rating for the agar plate simulation was 8 on the Likert scale. After slit lamp training, students' confidence significantly improved, with a median increase from 1 (IQR: 2) before training to 7 (IQR: 2) after training (p < 0.0001). Confidence in identifying corneal FB improved from a median of 2 (IQR:2) before to 8 (IQR:3) after training (p<0.0001).  Confidence in removal of corneal FB improved from a median 1(IQR:2) to 7 (IQR:1) after training (P<0.0001). Confidence in clinical management of corneal FB improved from a median of 2 (IQR=2) to 7 (IQR:2) after training (p<0.001).

This study demonstrated significant improvements in students’ confidence in slit lamp use and corneal FB management. Given the increasing burden on eye casualty services across Europe, integrating this low-cost, high-fidelity simulation into emergency medicine curricula could enhance ophthalmic skill training in ED settings. Collaboration with local ophthalmology departments can further support skill acquisition and improve patient care outcomes.