Abstract

Background: Over 70% of UK medical students report inadequate slit lamp training, citing equipment unfamiliarity and limited hands-on practice as primary barriers. This study evaluated whether a brief Day-1 skills workshop could enhance student learning, confidence and clinical participation during ophthalmology placements through targeted reduction of equipment-related cognitive load.
Methods: This quasi-experimental pilot study compared 30 third-year medical students (15 control, 15 intervention) attending week-long ophthalmology placements. The intervention group received a 90-minute skills workshop on Day 1 using Peyton’s 4-step approach and peer-assisted learning. The control group received standard induction. Primary outcome was number of patients examined independently. Secondary outcomes included slit lamp knowledge, self-efficacy and cognitive load.
Result: Groups demonstrated baseline equivalence across all measures (p>0.05). Students in the intervention group showed a trend toward examining more patients independently (mean 2.6±0.99 vs 2.1±0.8, mean difference 0.53, 95% CI: -0.11 to 1.18, p=0.115, Cohen’s d=0.59). The intervention produced significant improvements in slit lamp knowledge (mean change 11.9±3.9 vs 7.1±3.2, p=0.001, d=1.34) and self-efficacy (mean change 1.84±0.30 vs 1.19±0.61, p=0.001, d=1.35). Intervention students reported lower extraneous cognitive load (2.42±0.44 vs 2.87±0.76, p=0.062, d=0.71) and higher germane load (3.58±0.44 vs 3.13±0.76, p=0.062, d=0.71), supporting the proposed cognitive mechanism.
Conclusion: This pilot study demonstrates that a brief, theory-driven skills workshop produces large, significant improvements in equipment-specific knowledge and confidence. Although underpowered to detect differences in clinical participation, the medium effect size (d=0.59) and strong effects on foundational competencies provide compelling evidence to support a fully-powered randomised controlled trial. The cognitive load findings support the theoretical mechanism linking technical mastery to enhanced learning capacity.

Keywords:Medical education; Ophthalmology; Slit lamp; Cognitive load theory; Self-efficacy; Skills training; Pilot study