Do Checklist-Induced Behavioral Changes Improve Self-Confidence in Fundoscopic Examination? A Mixed-Methods Study

Daiki Yokokawa,1 Kiyoshi Shikino,1 Akiko Ikegami,1 Tomoko Tsukamoto,1 Kazutaka Noda,1 Takanori Uehara,1 Yoshiyuki Ohira,1,2 Masatomi Ikusaka1 1Department of General Medicine, Chiba University Hospital, Chiba, Japan; 2Department of General Medicine, International University of Health and Welfare, School of Medicine, Narita, JapanCorrespondence: Daiki YokokawaDepartment of General Medicine, Chiba University Hospital, 1-8-1 Inohana, Chuo-Ku, Chiba City, Chiba 260-8677, JapanTel/Fax +81 43 224 4758Email dyokokawa6@gmail.comPurpose: Fundoscopic exams are conducted during outpatient consultations to assess intracranial disease and complications from chronic diseases. Low level of confidence in these skills which physicians have is one of the causes that implementation frequency is low. Research has not yet identified specific measures through which the healthcare system may increase the implementation of fundoscopic exams nor a qualitative process that enables physicians to gain confidence in their fundoscopic exam skills. We introduced a checklist and conducted a mixed-methods study.Methods: This study is a before-and-after study, within an embedded-experimental mixed-methods design. We sampled 15 physicians in the department of general medicine at a university hospital assigned to initial consultation. We introduced a checklist to verify whether the fundoscopic exam was implemented. Measures are implementation ratio of the fundoscopic exam to the total number of indication cases, and Visual Analog Scale (VAS) values for the confidence in procedure are measured before and after the intervention. We obtained qualitative data from interviews and used the Modified Grounded Theory Approach.Results: We observed significant increases in the implementation ratio (19.2% (29/151 cases) vs 64.8% (105/162 cases), p< 0.001) and in the VAS value for the confidence (1.89 mm vs 4.68 mm (p< 0.001)). Analysis of the interviews revealed the following. To increase the implementation, it is necessary to reduce the and , which is prevented by the checklist. The leads to a . Repeated executions result in .Conclusion: The intervention increased the implementation ratio, thereby increasing successful experiences and confidence among physicians. The growth of confidence boosted motivations to implement fundoscopic exams.Keywords: mixed-methods study, fundoscopic examination, checklist, self-confidence