The influence of a novel simulated learning environment upon student clinical subjective refraction performance: A pilot study

Woodman-Pieterse, Emily C., De Souza, Neilsen J., & Vincent, Stephen J. (2016) The influence of a novel simulated learning environment upon student clinical subjective refraction performance: A pilot study. Clinical and Experimental Optometry, 99(4), pp. 342-349.

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  • Optometry students are taught the process of subjective refraction through lectures and laboratory based practicals before progressing to supervised clinical practice. Simulated learning environments (SLEs) are an emerging technology that are used in a range of health disciplines, however, there is limited evidence regarding the effectiveness of clinical simulators as an educational tool.


  • Forty optometry students (20 fourth year and 20 fifth year) were assessed twice by a qualified optometrist (two examinations separated by 4-8 weeks) while completing a monocular non-cycloplegic subjective refraction on the same patient with an unknown refractive error simulated using contact lenses. Half of the students were granted access to an online SLE, The Brien Holden Vision Institute (BHVI®) Virtual Refractor, and the remaining students formed a control group. The primary outcome measures at each visit were; accuracy of the clinical refraction compared to a qualified optometrist and relative to the Optometry Council of Australia and New Zealand (OCANZ) subjective refraction examination criteria. Secondary measures of interest included descriptors of student SLE engagement, student self-reported confidence levels and correlations between performance in the simulated and real world clinical environment.


  • Eighty percent of students in the intervention group interacted with the SLE (for an average of 100 minutes); however, there was no correlation between measures of student engagement with the BHVI® Virtual Refractor and speed or accuracy of clinical subjective refractions. Fifth year students were typically more confident and refracted more accurately and quickly than fourth year students. A year group by experimental group interaction (p = 0.03) was observed for accuracy of the spherical component of refraction, and post hoc analysis revealed that less experienced students exhibited greater gains in clinical accuracy following exposure to the SLE intervention.


  • Short-term exposure to a SLE can positively influence clinical subjective refraction outcomes for less experienced optometry students and may be of benefit in increasing the skills of novice refractionists to levels appropriate for commencing supervised clinical interactions.

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ID Code: 91466
Item Type: Journal Article
Refereed: Yes
Additional URLs:
Keywords: Simulated learning environments, Optometric education, Subjective refraction, Online learning, E-learning
DOI: 10.1111/cxo.12374
ISSN: 1444-0938
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > OPTOMETRY AND OPHTHALMOLOGY (111300)
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Current > Schools > School of Optometry & Vision Science
Copyright Owner: Copyright 2016 Optometry Australia
Copyright Statement:

This is the peer reviewed version of the following article: Clinical and Experimental Optometry

Volume 99, Issue 4, pages 342–349, July 2016
, which has been published in final form at 10.1111/cxo.12374. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.

Deposited On: 22 Dec 2015 23:52
Last Modified: 23 Aug 2016 22:01

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