Structured simulation-based training with frugal ophthalmic instruments rapidly equips non-ophthalmologists to identify malarial retinopathy in simulation eyes - an audit of a training course

Sep 30, 2026

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Structured simulation-based training was evaluated to enable non-ophthalmologists to identify malarial retinopathy (MR), a finding with diagnostic relevance in cerebral malaria where specialist ophthalmic resources are often unavailable in low-resource settings. Twenty non-ophthalmologist healthcare providers in Malawi completed a course combining didactic teaching, hands-on simulation-eye practice with direct and binocular indirect ophthalmoscopy, and immediate feedback. Pre- and posttraining confidence surveys showed improved accuracy (mean 83%) and increased confidence across retinal examination domains.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages7

Reading Time18 min

AccessFree to download

Background

Malaria and cerebral malaria context

Malaria retinopathy and examination methods

Methods

Training programme design

Assessment and confidence surveys

Results

Accuracy improvements

Confidence across retinal examination domains

Conclusions

Implications for non-ophthalmologists

Future validation and retention work

Wilson et al. BMC Medical Education (2026) 26:35 BMC Medical Education [https://doi.org/10.1186/s12909-025-08213-4](https://doi.org/10.1186/s12909-025-08213-4) RESEARCH Open Access Structured simulation-based training with frugal ophthalmic instruments rapidly equips non-ophthalmologists to identify malarial retinopathy in simulation eyes: an audit of a training course Kyle J. Wilson 1,2*, Obaid Kousha3,4, Harold Nkume5, Alice M. Liomba6, Nicholas A. V. Beare 1,7 and Andrew Blaikie3,8 Abstract Background Malaria, 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. Methods Twenty 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 posttraining confidence surveys were conducted. Results Participants demonstrated significant improvement in identification of malarial retinopathy in simulation eyes after completing the training, with a mean accuracy of 83% . Clinician confidence levels increased across all domains of retinal examination covered in the course. Conclusions Structured 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 areal-world clinical setting. Keywords Ophthalmology, Simulation, Malaria, Resource-limited, Low-cost *Correspondence: Kyle J. Wilson [kyle.wilson@liverpool.ac.uk](kyle.wilson@liverpool.ac.uk) 1Department of Eye and Vision Science, University of Liverpool, Liverpool, UK 2Malawi-Liverpool-Wellcome Clinical Research Programme, Blantyre, Malawi 3Infection and Global Health Division, School of Medicine, University of St. Andrew’s, St Andrew’s, UK 4Department of Ophthalmology, NHS Tayside, Dundee, UK 5Department of Ophthalmology, Queen Elizabeth Central Hospital, Blantyre, Malawi 6Blantyre Malaria Project, Queen Elizabeth Central Hospital, Blantyre, Malawi 7St. Paul’s Eye Unit, Liverpool University Hospitals Foundation Trust, Liverpool, UK 8Department of Ophthalmology, NHS Fife, Fife, UK © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creativecommons.org/licenses/by/4.0/](http://creativecommons.org/licenses/by/4.0/.)[.](http://creativecommons.org/licenses/by/4.0/.) Wilson et al. BMC Medical Education (2026) 26:35 Background Malaria remains a significant public health concern globally, being responsible for more than 600,000 deaths in 2022 [1]. Over 70% of these deaths occur in children in the African region. Within the spectrum of disease caused by malaria infection, c

FAQs

Why is identification of malarial retinopathy important for cerebral malaria?

MR identification supports diagnostic value in cerebral malaria. It can be difficult in practice where trained and equipped ophthalmic specialists are not available.

What training activities did non-ophthalmologists complete?

Participants attended didactic sessions, practiced with simulation eyes using direct and binocular indirect ophthalmoscopy, and received immediate feedback to support skill acquisition.

What were the main outcomes after the training?

Participants showed a significant improvement in identifying malarial retinopathy in simulation eyes, with a mean accuracy of 83%, and increased confidence across covered retinal examination domains.

Sep 30, 2026

Uploaded by Stanford