Application-Based Education for Corneal Foreign Body Removal in an Emergency Medicine Residency - 07/05/25

Doi : 10.1016/j.annemergmed.2025.03.031

Viran Jayanetti, BMed, MD ^a,^⁎ , James Miers, BMBS, BSc ^b, Angela L. Chiew, MBBS, PhD ^b
^a Liverpool Hospital, Sydney, NSW, Australia
^b Prince of Wales Hospital, Sydney, NSW, Australia

^∗Corresponding Author.

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 07 May 2025

Abstract

Study objective

To assess whether Emergency Procedures App (EPApp) use among emergency physicians improves knowledge and skill in performing corneal foreign body removal compared with usual practice.

Methods

This single-blinded, multicenter, randomized trial involved emergency physicians assessing their knowledge and performance in corneal foreign body removal. Participants were randomized into 2 groups (crossover and EPApp) and completed written and procedural assessments. The crossover group was initially prepared using usual methods, whereas the EPApp group reviewed the EPApp. Both groups used the EPApp for the second attempt. Performance scores from both attempts were compared, with subgroup analyses based on postgraduate years (PGYs) experience less than 4 or more than or equal to 4).

Results

Thirty physicians were recruited, including 14 with PGYs less than 4. The crossover group had 16 participants, with 8 PGYs less than 4. Initial mean test scores were lower in the crossover arm (53%, standard deviation [SD]: 26%) compared with the EPApp arm (72%, SD:15%) (mean difference 18.9%; 95% confidence interval [CI] 2.8, 35). Both groups improved on their second attempt, with larger improvement in the crossover group (25.4%; SD:15.6%; 95% CI 17.14, 33.73) compared with the EPApp arm (13.4%; SD:10.3%; 95% CI 7.45, 19.26). The greatest improvements were seen in participants with PGYs less than 4.

Conclusion

EPApp use improved knowledge and procedural skills in corneal foreign body removal, especially for junior physicians. Further research into its effectiveness for other procedures and with broader participant groups is warranted.

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Keywords : App learning, Procedural skills, Medical education

Plan

Introduction

Importance

Goals of This Investigation

Methods

Study Design and Setting

Selection of Participants

Characteristics of Study Subjects

Main Results

Limitations

Discussion

	Please see page XX for the Editor’s Capsule Summary of this article.
	Supervising editor: Ambrose H. Wong, MD, MSEd. Specific detailed information about possible conflict of interest for individual editors is available at editors.
	Author contributions: VJ, JM, and AC conceived the study and designed the trial. JM obtained research funding. VJ and AC gained ethics approval. VJ and JM undertook recruitment of participating centers and study participants. VJ and JM collected data. VJ and AC undertook statistical analysis. VJ drafted the manuscript, and all authors contributed substantially to its revision. VJ takes responsibility for the paper as a whole.
	Data sharing statement: Deidentified data can be provided by emailing the corresponding author VJ at viranrakshitha.jayanetti@health.nsw.gov.au.
	All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
	Funding and support: By Annals’ policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org/).
	Dr. James Miers is a principal author in development of the Emergency Procedures App. Dr. Viran Jayanetti was involved in authoring the section on corneal foreign body removal. Dr. Viran Jayanetti will also be using this research to fulfill his 4.10 research component of the Australian College of Emergency Medicine training program. This study and the EPApp were supported by a grant from the Prince of Wales Hospital Foundation.