Learning retinoscopy: A journey through problem space

Purpose- Retinoscopy is a skill that requires the integration of procedural skill and declarative knowledge. Whilst the actual technique is simple, retinoscopy is a complex skill to acquire and is one that students often find challenging. This study compared the strategies that novices, third-year students and experts use when performing retinoscopy, with the aim of identifying the key stages of learning that may enlighten teaching practice. Method- This study employed a protocol-based approach in which the verbal protocols and cognitive strategies of novices, students and experts were recorded and then subjected to ‘problem space’ analysis. Results- Clear differences existed when the retinoscopy of novices, students and experts was directly compared using a standardised simulated task. Experts were more accurate in performance and used defined strategies to reach the goal. The presence of these strategies significantly predicted the accuracy of the retinoscopy result. Conclusion- This study highlights the importance of meta-cognitive strategies and the need for an adequate theoretical foundation in skill acquisition. The underpinning knowledge provides a pedagogic tool that specifies activities which are beneficial to learning a clinical skill.