Perceptual learning enhances diabetic retinopathy detection skills in novice optometry students

Abstract

Background: This study aimed to evaluate a perceptual learning module (PLM) for improving visual diagnostic skills among novice students and to investigate the underlying cognitive mechanisms using eye-tracking. Methods: In this mixed-design study, 63 novice optometry students (Year 1 and 2) were randomly assigned into one of three groups: perceptual learning (PL), perceptual learning with enhanced-contrast (PLC), or a no-training control. A benchmark group of 21 senior students (Year 5) with formal clinical training was also recruited. The PL and PLC groups completed a four-week, web-based perceptual learning program focused on identifying signs of diabetic retinopathy. Diagnostic accuracy was assessed at pre-training and post-training for all groups, and at a three-month follow-up for the PL group. Fixation patterns, defined as the percentage and duration of fixations on pathological areas, were recorded using an eye-tracker. Results: After the four-week intervention, the diagnostic accuracy of the PL and PLC groups improved significantly (p < 0.001), achieving a level similar to the senior students (p > 0.99) and better than the control group (p < 0.001). This improvement was retained at the three-month follow-up (p > 0.99). The training also increased the PL group’s fixation hits and duration on pathological areas (p < 0.001) to a level comparable to that of the senior students (p = 0.92). Post-training diagnostic accuracy in the PL group was moderately correlated with percentage of fixation hit (r = 0.50, p = 0.03), a relationship not observed at baseline or in the senior students. Conclusions: Perceptual learning is a potent and durable educational intervention that refines the fixation patterns of novice learners to a level comparable to that of more experienced students. These findings support the integration of PLMs into health professions curricula to efficiently improve pattern identification – a foundation of diagnostic skill.